Appointing a governing body (fund administrator)
One of the most crucial decisions concerns the appointment of a governing body to oversee the new entity responsible for administering the funds. Important considerations include the selection method for members, the interests that they will represent, and whether parliamentarians will be eligible for membership. Appointments of governing board members may be carried out using a range of methods and formulae. In most cases, appointments are made by ministers, generally ministers of health. However, where ministerial appointments are made without any particular criteria having been established, there is the potential for political influence and bias.
The Thai Board is chaired by the Prime Minister and the Vice-Chair is the Minister for Health. Estonia also has high profile government ministers on the governing body, while the Victorian Health Promotion Foundation (Vic Health) has parliamentarians representing the three major political parties on the board to avoid political bias. The Western Australian Health Promotion Foundation (Healthway), on the other hand, does not include parliamentary representatives on its Board. Indeed the Western Australian legislation goes to great lengths to remove Healthway from any possibility of political interference, or the perception of it, by excluding Members of Parliament from being associated with any payments made by the organization, or their photographs being included in any of the organization’s publications.
Some boards comprise nominees of particular organizations, covering the spectrum of activities in which the organization is involved. In some cases, like Healthway, the relevant organizations are named in the enabling legislation. Research, health promotion, sports, arts, and regional interests may all be included using this model of nomination. Others have criteria which cover the relevant skills and expertise required for the efficient and effective functioning of the organization. These may include business, law, medicine, media, and public relations.
In Estonia, the highest body of the Health Insurance Fund has, in roughly equal numbers, government representation, consumers representing the interests of insured persons, and nominees of employers. The Austrian Health Promotion Foundation, on the other hand, has a board of 13 members, about half of whom are government appointees. The remainder are nominees of organizations such as the Association of Austrian Cities, Association of Austrian Municipalities, Austrian Medical Association, Austrian Pharmacists’ Association and the Association of Austrian Private Insurance Companies.
Health Promotion Switzerland has a board of 17 members, elected by the Swiss Federal Department of Home Affairs, and has federal as well as canton (local government) representation. The board also has the support of a nine-member advisory committee, selected on the basis of individual knowledge and skills.
However the governing body is appointed and structured, it should be able to operate equitably, independently and without fear or favour. Its general selection and operational criteria should be included in the legislation so that there are barriers to change for political or other reasons. Sound governance procedures and protocols will further strengthen the operational environment of the board.