If the culture of a politically dominant healthcare system is held to be equivalent to the perspectives of those charged with the medical management of leading healthcare institutions and programs, the definition fails to recognize the potential for division either within such an elite or between a healthcare elite and the wider population.
Hvis kulturen i et dominerende sundhedssystem anses som svarende til opfattelsen hos de ansvarlige for den medicinske ledelse af sundhedsinstitutionerne, så kan definitionen hverken rumme den potentielle splittelse inden for sådan en elite eller mellem en sundhedselite og den bredere befolkning.