Table Of ContentPUBLIC SECTOR ORGANIZATIONS
THE COORDINATION OF EUROPEAN
PUBLIC HOSPITAL SYSTEMS
Interests, Cultures and Resistance
Sorin Dan
Public Sector Organizations
Series Editors
B. Guy Peters
Maurice Falk Professor of Government
Pittsburgh University
USA
Geert Bouckaert
Public Governance Institute
KU Leuven
Belgium
Organizations are the building blocks of governments. The role of
organizations, formal and informal, is most readily apparent in public
bureaucracy, but all the institutions of the public sector are comprised of
organizations, or have some organizational characteristics that affect their
performance. Therefore, if scholars want to understand how governments
work, a very good place to start is at the level of organizations involved
in delivering services. Likewise, if practitioners want to understand how
to be effective in the public sector, they would be well-advised to con-
sider examining the role of organizations and how to make organizations
more effective. This series publishes research-based books concerned with
organizations in the public sector and covers such issues as: the autonomy
of public sector organizations; networks and network analysis; bureau-
cratic politics; organizational change and leadership; and methodology for
studying organizations.
More information about this series at
http://www.springer.com/series/14525
Sorin Dan
The Coordination of
European Public
Hospital Systems
Interests, Cultures and Resistance
Sorin Dan, PhD
Lecturer in Management
Emanuel University of Oradea
87 Nuf ărului St., 410597
Oradea, Romania
Public Sector Organizations
ISBN 978-3-319-43427-8 ISBN 978-3-319-43428-5 (eBook)
DOI 10.1007/978-3-319-43428-5
Library of Congress Control Number: 2016957715
© The Editor(s) (if applicable) and The Author(s) 2 017
This work is subject to copyright. All rights are solely and exclusively licensed by the
Publisher, whether the whole or part of the material is concerned, specifi cally the rights of
translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on
microfi lms or in any other physical way, and transmission or information storage and retrieval,
electronic adaptation, computer software, or by similar or dissimilar methodology now
known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specifi c statement, that such names are
exempt from the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information
in this book are believed to be true and accurate at the date of publication. Neither the pub-
lisher nor the authors or the editors give a warranty, express or implied, with respect to the
material contained herein or for any errors or omissions that may have been made.
Cover image © Neuhold
Printed on acid-free paper
This Palgrave Macmillan imprint is published by Springer Nature
The registered company is Springer International Publishing AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
A
CKNOWLEDGMENTS
Throughout the course of working on this book, I greatly benefi ted from
the support of a number of people and institutions. First of all, I would
like to thank Prof. Emeritus Christopher Pollitt who supervised my PhD
dissertation on which this book is based. Prof. Pollitt encouraged me to
think academically—theoretically informed and socially relevant. In his
wisdom, he found the perfect balance between professional guidance
and personal, friendly support. Secondly, I would like to thank Prof. Trui
Steen, who co-supervised my dissertation, for her intelligent and helpful
feedback which contributed to my thinking about some of the ideas that
I was struggling with. She made an important contribution to both the
form and content of the dissertation. The Public Governance Institute at
KU Leuven where I worked on this book was a supportive environment
which provided many opportunities to grow as a young researcher in pub-
lic administration, management and governance. I would like to thank
Prof. Geert Bouckaert for constant encouragement in his own unique
and intelligent way, Prof. Annie Hondeghem, Prof. Marleen Brans and
the many colleagues at the Institute (the Instituters) who contributed
in various ways during the four years I spent in Leuven (2011–2015).
Anneke Heylen, Maaike Vandenhaute, Inge Vermeulen and Anita Van
Gils were very helpful throughout this time in providing much-needed
administrative assistance and guidance. Other colleagues made a signifi -
cant contribution. I would like to especially thank Prof. Steven Van de
Walle who initiated and developed the Coordinating for Cohesion in the
Public Sector of the Future (COCOPS) project along with Prof. Gerhard
Hammerschmid. Without the COCOPS project, this book would have
v
vi ACKNOWLEDGMENTS
probably not existed. I would also like to thank Prof. Per Lægreid for
being a source of support along the way. He organized a seminar on coor-
dination in the public sector in Bergen that I attended and co-chairs the
European Group for Public Administration (EGPA) Permanent Study
Group on Public Sector Organizations where I presented the theoretical
part of this book. I am also grateful to the colleagues, and their institu-
tions, who hosted me during my four stages of fi eld research in Estonia,
Norway and Romania, respectively. They comprise Prof. Tiina Randma-
Liiv, Prof. Lars Erik Kjekshus and Prof. Marius Profi roiu. Riin Savi’s help
during my two stays in Estonia was highly useful. An important compo-
nent of this book is its empirical research. Thus I would like to thank the
many interviewees with whom I spoke in each country. They gave of their
time, input and experience and improved my understanding of hospital
reform and coordination. Last but not least, I would like to thank my fam-
ily, close relatives and friends for bearing with me and doing their best to
understand what this book is all about. Writing a book on hospitals (and
sometimes, in hospitals) while not being a (medical) doctor, I must admit,
can be confusing at times, but they were careful to deal with me with
tact. Special thanks go to my friends with whom I was constantly in touch
while in Belgium and to my friends from Prime Time of the International
Baptist Church of Brussels (IBC). If I were to summarize in a few words,
what I learned while working on this book is that management is impor-
tant, coordination helps, culture matters, and different interests, goals,
norms and values are instrumental to the intriguing and important world
of organizational reform of public hospitals.
I would like to thank Jemima Warren of Palgrave Macmillan and
Vinodh Kumar V of SPi Global for their help and support.
C
ONTENTS
1 Introduction 1
2 Public Management Reform and Coordination 9
3 Theoretical Framework 49
4 Research Design 59
5 Coordination of Public Hospitals in Estonia 75
6 Coordination of Public Hospitals in Romania 131
7 Coordination of Public Hospitals in Norway 179
8 Discussion and Conclusions 219
Appendix 243
Index 2 55
vii
L F
IST OF IGURES
Fig. 3.1 T heoretical framework of coordination of public hospitals 50
Fig. 3.2 P rincipal-agent relations in public hospital systems 5 6
Fig. 4.1 T ype of public hospital systems 6 0
Fig. 5.1 C hange in the number of hospitals in Estonia, 1981–2013 7 9
Fig. 5.2 N umber of acute hospital beds per 100,000 inhabitants
in Estonia, 1992–2013 80
Fig. 6.1 N umber of acute hospital beds per 100,000 inhabitants
in Romania, 1992–2013 141
Fig. 6.2 G ross Domestic Product per capita in Romania in USD,
1995–2014 158
Fig. 6.3 P ublic sector expenditure on health as percent of Gross
Domestic Product in Romania, 1995–2013 159
Fig. 7.1 N umber of acute hospital beds per 100,000 inhabitants
in Norway, 1992–2013 183
Fig. 7.2 T he structure of the public hospital system in Norway, 2 014 1 84
ix
L T
IST OF ABLES
Table 2.1 D efi nitions of coordination 35
Table 2.2 D imensions of coordination 37
Table 3.1 C haracterization of hospital system culture 54
Table 4.1 I nterviews by country and organizational setting 64
Table 5.1 H ealthcare policy initiatives in Estonia, 1991–2013 77
Table 5.2 T ype of hospitals in the HNDP, Estonia 86
Table 6.1 H ealthcare policy initiatives in Romania, 1992–2014 1 34
Table 6.2 N umber of hospitals in Romania, 1990–2014 136
Table 7.1 H ealthcare policy initiatives in Norway, 1984–2014 181
xi
