The theme os this issue is the decentralization of management responsibility in healt care, in response to a politically derived imperative to control costs. (éditorial).
This article examines a specific management reform at three hospital in a danish county.
Management reform at the hospital level implies a decentralization of responsability and power to the departmental level.
Along with increased responsibility and power, departments get the message : keep your budgets and keep your output level.
This preliminary analysis indicates that departmental budgets can be a way of containing costs in clinical departments.
Non-staff expenditures expenditures especially are subjected to reductions.
The system still seems to favour doctors and nurses, but less than in a system with traditional budgetary institutions.
The behavorial of the top-management teams shows that the output constraint is not seriously meant.
Departments are allowed to reduce capacity, with declining output, with the knowledge of the top-management team.
The declining output makes it easier to departments ceteris paribus to keep within their budgets.
And that makes it easier for the top-management team to keep the overall hospital budget.
The obligation to keep the overall hospital budget is thus an important criterion of success in the eyes of the political masters of hospitals.
Mots-clés Pascal : Hôpital, Gestion hospitalière, Budget, Contrôle coût, Danemark, Centre responsabilité
Mots-clés Pascal anglais : Hospital, Hospital management, Budget, Cost control, Denmark, Centre responsible for its own budget
Notice produite par :
ENSP - Ecole nationale de la santé publique (devenue EHESP)
Cote : 93/10-12 V
Code Inist : 002B30A04B. Création : 09/06/1995.