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2016 | OriginalPaper | Chapter

3. Transformation of Hospital Governance in Post-Semashko Health Systems

Author : Przemyslaw Marcin Sowa

Published in: Governance of Hospitals in Central and Eastern Europe

Publisher: Springer Singapore

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Abstract

This chapter presents the experiences of transforming the hospital sector in 22 countries of Central and Eastern Europe and former Soviet Republics: Albania, Armenia, Azerbaijan, Bulgaria, Belarus, the Czech Republic, Estonia, Georgia, Hungary, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Moldova, Poland, Romania, Russian Federation, Slovakia, Tajikistan, Turkmenistan, Ukraine and Uzbekistan. Using a qualitative approach, the country-level case studies produce detailed and internationally comparable descriptions of changes that took place in the area of hospital governance. Next, the individual reform paths are generalised in order to develop and substantiate a model of transforming hospital governance. Going beyond the public-private delineation, the model identifies five unique stages of prevailing forms of hospital governance: (1) the integrated Semashko model, (2) decentralised hospital management, (3) devolved hospital ownership and (4) corporatised and (5) privatised hospitals. Each stage corresponds to a distinct distribution of decision powers, financial risks and residual claims between the sector participants. These characterisations can be interpreted as efficiency factors associated with decentralisation. Recognising the importance of the above processes leads to an extended typology of post-communist health care systems. Accounting for both the dominant financing arrangements and the governance setup improves our knowledge of transition, compared to common classifications based exclusively on the introduction of social health insurance. The chapter concludes with a reflection on good practices and common mistakes found in this region-wide process.

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previous chapter Selected Socio-economic Aspects of Post-communist Health-Care Transition
next chapter Economic Implications of Transforming Hospital Governance
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Metadata
Title
Transformation of Hospital Governance in Post-Semashko Health Systems
Author
Przemyslaw Marcin Sowa
Copyright Year
2016
Publisher
Springer Singapore
Book
Governance of Hospitals in Central and Eastern Europe

Print ISBN: 978-981-287-765-9

Electronic ISBN: 978-981-287-766-6

Copyright Year: 2016

DOI
https://doi.org/10.1007/978-981-287-766-6_3