Performance-based management (PBM) has become a dominant form of governance in health care and there is a need for careful assessment of its function and effects. This article contains a cross-disciplinary literature synthesis of current studies of PBM. Literature was retrieved by database searches and categorized according to analytical differences and similarities concerning (1) purpose and (2) governance mechanism of PBM. The literature could be grouped into three approaches to the study of PBM, which we termed: the ‘functionalist’, the ‘interpretive’ and the ‘post-modern’ perspective. In the functionalist perspective, PBM is perceived as a management tool aimed at improving health care services by means of market-based mechanisms. In the interpretive perspective, the adoption of PBM is understood as consequence of institutional and individual agents striving for public legitimacy. In the post-modern perspective, PBM is analysed as a form of governance, which has become so ingrained in Western culture that health care professionals internalize and understand their own behaviour and goals according to the values expressed in these governance systems. The recognition of differences in analytical perspectives allows appreciation of otherwise implicit assumptions and potential implications of PBM. Reflections on such differences are important to ensure vigilant appropriation of shifting management tools in health quality governance.

Exchange of material originating in human bodies is essential to many health technologies but potentially conflicts with a prominent moral ideal according to which human bodies and their parts are beyond trade. In this article, I suggest that the inclination to keep bodies apart from ‘commercial exchange’ has significant implications for the way their parts come to be exchanged. The analysis revolves around two versions of the hip: one prosthetic version made of metal and one version made of bone, the femoral head, which is excised in conjunction with hip replacements and later used for transplantation. How are exchange systems for something moving in and out of human beings organized? Who provides what and who receives what? When and where does money change hands? How are the specific amounts determined? By answering these questions, I provide a description of the exchange form that avoids assuming it to be simply a ‘market’ or a ‘gift economy’. I focus on the mechanisms that allow money to be generated despite the moral ideal viewing body parts as beyond trade—or, rather, the how the ideal facilitates mechanisms through which money can be generated without being viewed as profit. In particular, I suggest that ‘compensation’ is an important example of a mechanism in need of further scrutiny.

It is a striking feature of current biomedicine that it increasingly relies on access to various types of human biological material. Social scientists often criticize the exchange systems facilitating this access for causing a process of ‘commodification’. Though it is not always clear what commodification is thought to imply, a morally degrading transformation from something intrinsically human to an object of ownership seems to be at stake in most accounts. Enrolment in capitalist exchange is typically portrayed as (actively) changing the status of the (passive) body part from being part of a dignified human whole to be a mere fungible commodity. In this article I argue that the notion of commodification is inadequate for an analysis of the dynamics at play in the establishment of exchange systems for human biological material. In particular I focus on the development of the patent regime. The point is that rather than focusing merely on what capitalist forms of exchange do to biotechnology and the body, we might begin to appreciate what biotechnology and the socio-cultural significance of the body do to capitalism and its property structures—or, more precisely, how people’s engagement with, and concern about, biotechnology contributes to the shaping of multiple capitalisms.