A Systematic Literature Review on Prioritizing Quality of Care over Commercialization

Abstract

Background: Health care is increasingly organised around revenue, market share and capital return. Whether this logic displaces the clinical, relational and equity-oriented purposes of care is a central question for health policy.

Objective: To synthesise evidence on whether, how and under what conditions quality of care can be prioritised over commercial imperatives.

Methods: A review guided by PRISMA 2020 and informed by scoping-review practice was conducted on a defined corpus of 117 bibliographic records. A purposively selected benchmark set of landmark conceptual and comparative studies was added. After screening, 54 corpus records were retained: 48 thematic evidence records and six methodological sources. Findings were organised through thematic synthesis and synthesis without meta-analysis, then benchmarked against published comparative evidence on ownership, outsourcing and private equity.

Results: Seven domains emerged: epidemiological and equity context; patient safety and care environments; leadership and workforce; digital and artificial-intelligence-enabled care; law and regulation; cross-sector quality assurance and marketisation; and integrative or wellness care. Benchmark studies show that commercial orientation is not uniformly harmful. It is, however, repeatedly associated with higher costs, selective service provision and, in several settings, poorer safety or outcomes, especially where regulation, transparency and professional autonomy are weak. Evidence from accreditation, platform labour and market-driven education shows the same structure: measurable proxies displace unmeasured public value.

Conclusions: Quality-first governance depends on institutional design, not on exhortation. The review proposes a Quality-First Governance Model with four pillars: purpose protection, measurement integrity, accountable regulation and equitable financing. It also advances six testable propositions.