Relevance of the paper: After a long period of decentralisation efforts, a potential new paradigm of (re)centralisation emerged in the health care sector, and the role of the central government had begun to strengthen in... [ view full abstract ]
Relevance of the paper:
After a long period of decentralisation efforts, a potential new paradigm of (re)centralisation emerged in the health care sector, and the role of the central government had begun to strengthen in several countries (Saltman, 2008). Centralisation of the hospital sector also occurred in Hungary after 2010: ownership of hospitals has been transferred from local governments to the state level, a new central supervising agency has been set up, and there are plans to integrate the social health insurance fund into the ministry responsible for health. The Hungarian health care reform clearly reflects the doctrinal foundations of the Sub-National Governance Reforms carried out by the current government, “inherently different from existing doctrines” of NPM, NWS, and NPG (Hajnal–Rosta, 2016). This political context heavily influences how the accountability for financial results and overall health system performance changed during the transition, and directly leads to the implementation of new control mechanisms in the relation of the central government and hospital managers.
Significance of the research:
A similar reform, carried out in Norway in 2002 (Hagen–Kaarbøe, 2006), has already been documented and evaluated from several aspects, however, the description and analysis of the more recent Hungarian case is still missing from the academic literature. The Hungarian case also creates a good opportunity to study how the unique political context influences the implementation of the reform, which was claimed by the government to be evidence-based and built on theoretically solid bases.
Research questions and method:
Our research questions are formulated as follows:
- What statements did policymakers make about the objectives of the centralisation, and to what extent was the reform able to fulfil these objectives?
- How did the accountability relation between the hospital management and the owner/supervisor change during and after the transition?
- Does the hospital reform fit fully into the general doctrines of the Sub-National Governance Reforms, or are there “deviations” (for example, due to specificities of the health sector)?
A combination of research methods is used: document analysis and interviews with key players of the reform as well as a questionnaire-based survey about the tools of centralisation.
Theoretical/conceptual foundations for the research:
We examine three main factors, increasing the likelihood of a reform being successful (Pollitt–Bouckaert, 2004):
- political factor: a common platform on the main directions of the reform;
- program cohesion factor: the main elements of the reform programs are carefully selected, fully elaborated, and properly scheduled to build on each other;
- implementation factor: a strong reform governance.
The paper also analyses the relation of the tools of re-centralization and the bases of accountability (legality, process, performance, programme or policy) (Nyland–Pettersen, 2015).
Results:
It is expected to better understand how the political context influences the implementation of a health policy reform, claimed to be based on available international evidence. The description of the Hungarian case also contributes to the analysis of the re-centralisation wave, having an impact over health care systems in several European countries.
