Public sector reform and hospital management

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

Abstract

In 2001, the Danish Government commissioned a study on alternative models for public sector organization with a particular view to hospital administration. In a report of early 2004, the Commission on Administrative Structure concludes that many counties are too small to ensure efficient hospital planning and recommended a reduction of the number of counties. The models proposed by the Commission are up for political consideration in April 2004.

Purpose of health policy or idea

In 2002, the Danish Government had commissioned a study on alternative models for public sector organization. In a report of early 2004, the Commission on Administrative Structure concludes that many existing counties are too small to ensure optimal planning in the hospital sector and recommended a possible reduction of the number of counties. By contrast, hardly any consideration was made regarding changes of the basic incentive structure. The models proposed by the Commission are up for political consideration in April 2004.

The main objective of the report presented by the Commission on Administrative Structure was "[...] to assess advantages and disadvantages of alternative models for the organisation of the public sector. Against this background, the Commission is to present recommendations for changes that will remain sustainable for many years." (Terms of Reference).

The following criteria were to be used and weighed against each other: efficiency and sustainability, democratic control, citizens' participation and the dialogue between citizens and politicians, quality assurance, closeness to the citizen, citizens' civil rights and options, transparency with respect to the distribution of responsibilities, and correlation in terms of competence and financial responsibility.

The Commission assesses to have identified a number of weaknesses in the current structure and partly relates these to the population size of the municipalities and counties and partly to the distribution of tasks between the State, counties and municipalities. Most of the existing counties are deemed too small to ensure optimal planning in the hospital sector.

The main instrument suggested relates to the number of administrative levels. The focus is on a possible reduction of the number of counties. There is hardly any consideration of changes in the basic incentive structure.

Main points

Main objectives

Purpose: To consider alternative models for the organization of the public sector. A broad range of criteria - e.g. efficiency, sustainability, democratic control, and quality assurance - was to be used.

The Commission concludes that most of the existing counties are too small to ensure optimal planning in the hospital sector.

The main instrument suggested relates to a possible reduction of the number of counties. There is hardly any consideration of changes of the basic incentive structure. The models proposed by the Commission are up for political consideration in April 2004.

Type of incentives

No focus on incentives, whether financial or non-financial.

Groups affected

County hospitals, Patients

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

Political and economic background

The Prime Minister made the following announcement on October 1st 2002: "The existing municipal structure in Denmark is now more than 30 years old and the government feels that it is time for a critical review of the current system. Therefore, the government will appoint a Commission on Administrative Structure this week to investigate whether the existing system lives up to the requirements of a modern welfare state." The question of the performance by the counties and their running of the hospitals had surfaced earlier and that is probably part of the motivation for the government initiative.

For instance the Government had already in 2001 set up an advisory committee on the health care sector, which finalized its work on the organization of the hospital sector in January 2003 (see report 1/2003 "Organization of the health care sector: hospitals, incentives, counties and alternatives"). The findings by the advisory committee's were to be incorporated into the Commission's work.

Complies with

EU regulations

Purpose and process analysis

Current Process Stages

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

Origins of health policy idea

The Commission on Administrative Structure assesses to have identified a number of weaknesses in the current structure and relates those weaknesses partly to the population size of the municipalities and counties and partly to the distribution of tasks between the State, counties and municipalities. Most of the existing counties are deemed too small to ensure optimal planning in the hospital sector.

The main instrument suggested relates to the number of administrative levels. The focus is on a possible reduction of the number of counties. There is hardly any consideration of changes in the basic incentive structure.

The government established the Commission. However, the proposals put forward by the Commission do not necessarily reflect the government's policy or it intentions. It is possible that the government had hoped for proposals along the lines of purchaser/provider split reforms, but that particular expectation was not met by the report.  

The proposals by the Commission will be the topic for further political discussion in the spring of 2004 and possibly even further.

Approach of idea

The approach of the idea is described as:
renewed:

Stakeholder positions

At present (April 12th 2004) the government has yet to announce its position on the proposals presented by the Commission on Administrative Structure. The counties have opposed the proposal to reduce their number while the municipalities have been positive towards a possible transfer of assignments from the counties to the municipalities.

Influences in policy making and legislation

At present (April 12th 2004) the government has yet to announce its position on the proposals presented by the commission. After this there will be further discussion with parties in Parliament and then possibly a proposal presented in Parliament.

Legislative outcome

n/a

Adoption and implementation

The counties have opposed the proposal to reduce their number while the municipalities have been positive towards a possible transfer of assignments from the counties to the municipalities.

Expected outcome

It is not likely that a reduction in the number of counties will change the basic incentives in the system. Consequently it's unlikely that there will be significant change in performance.

As of yet the policy proposal is only at the discussion stage.

References

Sources of Information

The report is available from the ministry's homepage (www.im.dk). In its entirety the report is available in Danish only; however a summary in English is available.

Author/s and/or contributors to this survey

Michael O. Appel

Empfohlene Zitierweise für diesen Online-Artikel:

Michael O. Appel. "Public sector reform and hospital management". Health Policy Monitor, 04/04. Available at http://www.hpm.org/survey/dk/a3/4