In the past, hospitals were routinely led by doctors. That has changed. In the UK and the US, most hospital chief executive officers (CEOs) are non-physician managers rather than physicians (Falcone and Satiani 2008). Of the 6,500 hospitals in the US, only 235 are led by physicians (Gunderman and Kanter 2009).

On average, healthcare spending in OECD countries – and especially in the US – has outpaced GDP growth by nearly two percentage points a year, and this trend will continue to persist over time (Hall and Jones 2007). As the healthcare sector lags behind others in improving its productivity, it can also create a productivity drag on the economy overall.