The promises and perils of hospital autonomy

London, Jonathan D.

doi:10.1016/j.socscimed.2013.07.009

Cited by 32 publications

(34 citation statements)

References 10 publications

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“…Here, the greater authority of the hospital manager under corporatisation allows them to innovate, but only if this is accompanied by higher capacities. Similar evidence appears in a study of hospital autonomy in Vietnam (London, 2013), which revealed that the increased revenue obtained by autonomised hospitals was not merely due to higher hospital charges but more to innovations introduced by the managers (such as generating patient-requested services and using equipment procured through joint ventures). The lack of improvement in efficiency of the corporatised hospitals in this study implies that the managers in these hospitals may not be exercising their higher decision space to innovate and to manage the hospital efficiently.…”

Section: Discussionsupporting

confidence: 73%

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The double-edged sword of corporatisation in the hospital sector: evidence from Indonesia

Maharani

Tampubolon

2016

HEPL

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Hoping to improve their health system performance, many countries have corporatised their hospitals in the past twenty years. What this means for hospital performance remains as yet largely unknown. This study looks into the association of corporatisation and hospital performance in Indonesia. We apply panel data regression analysis to survey data on 54 public hospitals in East Java province. Our analysis suggests that corporatisation is associated with higher hospital income and expenditure, but fails to improve efficiency. These findings suggest that hospital corporatisation policy in Indonesia should increase emphasis on efficiency rather than on financial performance alone.

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Section: Discussionsupporting

confidence: 73%

“…Vietnam (London, 2013). A monitoring system should also be considered in Indonesia as public hospitals here are the main provider of secondary care under the recently launched social security system promises universal health coverage.…”

Section: Discussionmentioning

confidence: 99%

The double-edged sword of corporatisation in the hospital sector: evidence from Indonesia

Maharani

Tampubolon

2016

HEPL

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“…The decision space approach has been applied to case studies in Pakistan, 6,9 Bolivia, 8 Chile, 8 India, 8,26 the Phillipines, 8 Uganda, 8 Fiji, 11 Ghana, 10,12,27 South Africa, 28 Vietnam, 29 and Tanzania. 30 …”

Section: Resultsmentioning

confidence: 99%

“…Having the support of the organization better enables decision space, which in turn can be used to implement the organizational objectives. 14,21,29 …”

Section: Resultsmentioning

confidence: 99%

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Exploring the Functioning of Decision Space: A Review of the Available Health Systems Literature

Roman

Cleary

McIntyre

2017

Int J Health Policy Manag

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Background: The concept of decision space holds appeal as an approach to disaggregating the elements that may influence decision-making in decentralized systems. This narrative review aims to explore the functioning of decision space and the factors that influence decision space. Methods: A narrative review of the literature was conducted with searches of online databases and academic journals including PubMed Central, Emerald, Wiley, Science Direct, JSTOR, and Sage. The articles were included in the review based on the criteria that they provided insight into the functioning of decision space either through the explicit application of or reference to decision space, or implicitly through discussion of decision-making related to organizational capacity or accountability mechanisms. Results: The articles included in the review encompass literature related to decentralisation, management and decision space. The majority of the studies utilise qualitative methodologies to assess accountability mechanisms, organisational capacities such as finance, human resources and management, and the extent of decision space. Of the 138 articles retrieved, 76 articles were included in the final review. Conclusion: The literature supports Bossert’s conceptualization of decision space as being related to organizational capacities and accountability mechanisms. These functions influence the decision space available within decentralized systems. The exact relationship between decision space and financial and human resource capacities needs to be explored in greater detail to determine the potential influence on system functioning.

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Preparing for the introduction of hospital autonomy in Laos: an assessment of current situation and suggestions for policy‐making

Geng

Chen

2015

Health Planning & Management

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The National Assembly of Lao People's Democratic Republic (Laos) approved the Health Sector Reform Strategy in 2012, which called for an assessment as to whether Laos should introduce hospital autonomy, and if so, in which ways. The purpose of this study is to assess the status quo of hospital governance in Laos and propose policy suggestions for hospital autonomy in the country. We formulated an analytic framework for hospital autonomy based on previous work by other researchers, collected qualitative data through key informant interviews and focus group discussions, and also performed secondary data analysis. Public hospitals in Laos enjoyed some informal autonomy with little accountability and Laos is facing key challenges of hospital governance. As a result, introducing hospital autonomy in Laos could bring risks, benefits and debates. Before Laos decides on granting autonomy to its public hospitals, we strongly suggest that the government do pilot in selected public hospitals with well-regulated governance framework first and conduct rigorous evaluations to examine whether the granted autonomy leads to the intended social goals of equity, quality, efficiency and sustainability. We recommend residual claimants should be monitored by the government and by the society with open and transparent approach, and active measures should be taken to improve performance and ensure social functions. The study findings may also provide some suggestions for low- and middle-income countries, which are contemplating the introduction of hospital autonomy in the public sector. Copyright © 2015 John Wiley & Sons, Ltd.

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The promises and perils of hospital autonomy

Cited by 32 publications

References 10 publications

The double-edged sword of corporatisation in the hospital sector: evidence from Indonesia

The double-edged sword of corporatisation in the hospital sector: evidence from Indonesia

Exploring the Functioning of Decision Space: A Review of the Available Health Systems Literature

Preparing for the introduction of hospital autonomy in Laos: an assessment of current situation and suggestions for policy‐making

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