Healthcare reforms and restructuring have been a global phenomenon since the early 1980s, driven by a number of factors such as increasing health expenditure and changing health needs, advancement of medical and information technology, and adoption of the new model of public health. More significant changes worldwide are the development of a new public management paradigm in the public sector. These changes were marked by the adoption of private sector management models and practices. It is widely believed that the healthcare reforms, the process of the reforms, and the instability brought about by the reforms may have not only resulted in the change of senior healthcare management practices, but also in the change of skills and competencies required for senior healthcare managers. In fact, a number of international, national, and local studies have examined the roles, skills, competencies and educational needs of health service managers since the 1980s. There are differences in findings from these studies in the 1980s, and 1990s, and early 2000s. This paper explores the above differences and their implications for further research and education development. The findings not only lead to the development of a number of questions for future research, but also indicate a new direction for healthcare managers in assisting them to acquire new skills and competencies in meeting the challenges in the new era.