Changing the Governance of Public Hospitals

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Abstract

Failure of coordination among public hospitals has resulted because they were governed by different government ministries. The new policy aims to change the governance of those public hospitals, and to make them contribute to health policy goals more effectively. Now the Ministry of Health and Welfare has jurisdiction over those public hospitals and is responsible for organizing the public hospital delivery system.

Purpose of health policy or idea

Role of public hospitals has been very weak in weak in Korea because the number of public hospitals is less than 10% of all hospitals. In addition, public hospitals are governed by different ministries, resulting in the failure of coordination among public hospitals. Ministry of Health and Welfare (MOHW) has jurisdiction over National Medical Center, National Cancer Center, and National Rehabilitation Center, but national university hospitals were under the jurisdiction of the Ministry of Education and Human Resources (MOEHR). Local public hospitals were governed by local governments and the Ministry of Government Administration and Home Affairs (MOGAHA).

The new policy aims to change the governance of those public hospitals and make them contribute to health policy goals more effectively. With the new policy in the change in governance, the Ministry of Health and Welfare has jurisdiction over those public hospitals and is responsible for organizing the public hospital delivery system.

Main points

Main objectives

Streamline the governance and functions of public hospital system, and strengthen the role of public hospitals.

Type of incentives

Non-financial and financial

Groups affected

patients, public hospitals

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral

Political and economic background

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Origins of health policy idea

Public hospitals have been criticized that they have failed to function as a key subsystem of public health care system, and consequently failed to contribute to health policy goals. Failure of coordination among public hospitals under the jurisdictions of different government ministries has often been quoted as a root problem. Ministry of Health and Welfare has taken the lead to streamline the governance structure of public hospitals by putting most of public hospitals under its jurisdiction.

National university hospitals, which used to be under the jurisdiction of the Ministry of Education and Human Resources (MOEHR), are regarded as high-quality tertiary care hospitals in each province. In spite of its good reputation for quality medical staff and state-of-the-art medical technology and facility, the behaviour of national university hospitals is not different from that of private hospitals (e.g., patient mix, fees). MOEHR was more concerned about teaching and research function of national university hospitals than their contribution to health policy. 

There are about 60 local public hospitals as secondary care health institutions, which used to be under the jurisdiction of local governments and the Ministry of Government Administration and Home Affairs (MOGAHA). However, most of them have suffered from under-investment and have failed to build reputation for quality. There has been a vicious circle of under-funding by local governments, reputation of lower quality, lack of patients, and chronic deficits for those hospitals.

Initiators of idea/main actors

• Regierung

Approach of idea

The approach of the idea is described as:
new:

Stakeholder positions

Ministry of Government Administration and Home Affairs were not opposed to the change in governance because many of those local public hospitals have chronic problems of fiscal deficits. (Some local governments had attempted to privatize local hospitals previously.) 

However the Ministry of Education and Human Resources (MOEHR) is not supportive of the policy change. As leading tertiary-care hospitals or centers of medical excellence, national university hospitals have added prestige to the MOEHR. 

Another stakeholder is national university hospitals (medical schools). The Ministry of Health and Welfare (MOHW) emphasizes the close linkage among public hospitals, particularly among national university hospitals and local public hospitals. The initial proposal of the MOHW recommends the rotation of medical staffs of national university hospitals and local public hospitals. National university hospitals were opposed to the initial proposal of the MOHW.

Actors and positions

Regierung
MInistry of Health and Welfare	sehr unterstützend		stark dagegen
Ministry of Education and Human Resources	sehr unterstützend		stark dagegen
Ministry of Government Administration and Home Affairs	sehr unterstützend		stark dagegen

Actors and influence

Regierung
MInistry of Health and Welfare	sehr groß		kein
Ministry of Education and Human Resources	sehr groß		kein
Ministry of Government Administration and Home Affairs	sehr groß		kein

Positions and Influences at a glance

Adoption and implementation

Facing oppositions by the medical staffs of national university hospitals, Ministry of Health and Welfare modified the initial proposal, and the policy will introduce functional coordination rather than staff rotation among national university hospitals and local public hospitals. But the

Expected outcome

Coordination among public hospitals is crucial to make public hospitals contribute to the goal of health policy. Changing the governance structure of public hospitals and strengthening the role of the Ministry of Health and Welfare is an important step toward that goal.

But coordination among public hospitals toward more effective public health care delivery system requires more than the change in governance structure. National university hospitals have very prestigious reputation and they can survive well without government financial support. Medical staffs of those national university hospitals are not enthusiastic about the close coordination between their hospitals and local public hospitals. For local public hospitals, putting more resources, modernizing facilities, recruiting quality staffs will be critical to the strengthening of public hospital systems and the success of the new policy.

Impact of this policy

Qualität	kaum Einfluss		starker Einfluss
Gerechtigkeit	System weniger gerecht		System gerechter
Kosteneffizienz	sehr gering		sehr hoch

References

Author/s and/or contributors to this survey

Soonman Kwon

Empfohlene Zitierweise für diesen Online-Artikel:

Soonman Kwon. "Changing the Governance of Public Hospitals". Health Policy Monitor, April 2006. Available at http://www.hpm.org/survey/rok/a7/1