2002年-世界发展银行全球_Organizational_Reform_in_the_Hungarian_Hospital_Sector___Institutional_Analysis_of_Hungarian_Hospitals_and_the_Possibilities_of_Corporatization_26页_597kb

Summary of "Organizational Reform in the Hungarian Hospital Sector: Institutional Analysis of Hungarian Hospitals and the Possibilities of Corporatization"

Core Content

This document provides an institutional analysis of the Hungarian hospital sector, focusing on the organizational changes and the potential for corporatization as part of broader health sector reforms. It examines the effectiveness of reforms aimed at improving efficiency, quality, and consumer responsiveness in public hospitals, drawing on organizational theory and the "organizational modality - incentive regime" model.

Main Views and Key Information

1. Overview of Changes in the Hungarian Hospital Sector

• Structural and Regulatory Reforms: Over the past decade, Hungary has undergone significant structural, regulatory, and financial changes in its hospital sector.
• Ownership Transfer: In 1990, most hospitals were transferred from the central government to local governments, becoming autonomized organizations.
• Ownership Structures: A minority of hospitals remain state-owned and are supervised by ministries or government agencies, such as medical universities and specialized institutes.
• Financial Trends:
  • Hospital funding decreased by 16% between 1994 and 2000.
  • The number of beds per 1000 inhabitants fell from 9.84 to 8.41.
  • Hospital staff numbers have remained relatively stable, with an increase in physicians and nurses until 1998, followed by a decline due to labor migration.
• Financing Mechanism: The Health Insurance Fund (HIHF) finances acute care services, with DRG-based funding introduced in 1993. This has led to some efficiency improvements, but also issues like supplier-induced demand and increased debt.
• Management Autonomy: Hospital managers have some autonomy in labor decisions and financial management, but capital investment decisions still require approval from local governments.
• Accountability and Performance: While direct accountability mechanisms exist, they are not consistently applied. Indirect accountability is weak, and the overall incentive regime is not well aligned with market pressures.

2. Organizational Analysis of Hungarian Hospitals

• Organizational Modalities: The model outlines five key organizational modalities: decision rights, residual claimant rights, market exposure, accountability, and social functions.
• Incoherence in Reforms: Hungarian hospitals exhibit a mix of these modalities, often resulting in an incoherent organizational structure.
• Key Findings:
  • Management Decisions: Relative independence exists in labor decisions, but financial and capital decisions remain constrained.
  • Residual Claimant Rights: Hospitals have some residual claimant rights, but the downside (deficit) is largely borne by the owners and public budget.
  • Market Exposure: Despite DRG-based financing, market exposure is low due to passive contracting by the HIHF and exclusion from capital markets.
  • Accountability: Direct accountability is medium, while indirect accountability is weak.
  • Social Functions: Hospitals are expected to fulfill social roles, such as care for minority populations and social patients, but these functions are not clearly defined or adequately funded.

3. Corporatization Efforts in Hungary

• Legal Framework: The Health Institutional Law (Act CVII of 2001) aimed to support corporatization, improve efficiency, and increase market exposure.
• Objectives: The law sought to create a favorable incentive environment for public benefit companies and professional management teams.
• Potential Effects: Anticipated outcomes include improved fundraising, reduced perverse privatization, better management, and clearer social functions.
• Implementation Halt: The law was suspended after the 2002 parliamentary election, which led to a socialist-liberal coalition government. The idea of corporatization remains part of the health reform agenda.
• Future Proposals:
  • Corporatized hospitals may operate in any corporate form, not just non-profit public benefit companies.
  • Investors from pharmaceutical or hospital-related industries may be allowed to become potential owners.

4. Case Study Highlights

• The case study explores the practical implications of these reforms and their impact on hospital performance.
• It emphasizes the importance of a well-designed incentive regime and consistent regulatory changes for successful reform.
• It also highlights the need for ongoing monitoring and evaluation to ensure that reforms lead to improved outcomes.

Conclusion

The document concludes that while organizational reforms in Hungary have stirred up the legal, financial, and operational environment of hospitals, they have not consistently improved performance across the sector. The mixed ownership and management structures, along with the lack of coherent incentive regimes, have contributed to an incoherent and inefficient system. The potential for corporatization is seen as a path to better performance, but its implementation is hindered by political and regulatory uncertainty. Systematic reform, including clear definitions of social functions, better financial management, and professional management training, is necessary for sustainable improvements in the Hungarian hospital sector.

Keywords

• Hospital sector
• Institutional analysis
• Corporatizing reforms
• Marketizing reforms
• Organizational modality
• Incentive regime
• Public health care system
• Management autonomy

References

• Orosz and Holló [1]
• Gaál et al. [4]
• Harding and Preker [6]
• Réthelyi et al. [7]
• Szócska et al. [8]
• Act XX of 1949 on the Constitution of the Republic of Hungary amended by Act XXXI of 1989 [2]
• Act LXV of 1990 on Local Government [3]
• Act CVII of 2001 [10]