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Nature Medicine, Published online: 22 July 2026; doi:10.1038/s41591-026-04535-y Health systems rely on unpaid care that is poorly measured and governed. We argue that unpaid care, and the wider social production system behind it, is a productive input whose breakdown drives avoidable admissions, delayed discharge, and labor-force exit. We propose a national accounting framework, a diagnostic lens, and five policy priorities.
Governing the social production of care: the hidden foundation of health systems
Nature Medicine, Published online: 22 July 2026; doi:10.1038/s41591-026-04535-y Health systems rely on unpaid care that is poorly measured and governed. We argue that unpaid care, and the wider social production system behind it, is a productive input whose breakdown drives avoidable admissions, delayed discharge, and labor-force exit. We propose a national accounting framework, a diagnostic lens, and five policy priorities.