New Public Management in Health System in Romania

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Transcript of New Public Management in Health System in Romania

New Public Management

Authors: Teodora-Corina Taban, Madalina-Cristina Gogu, 2011


1. 2. 3. 3.1. 3.2. 4. 4. 1 4.2.

Introduction. Overview and aims New Public Management New public management in health care General problems with new public management Physicians professions New Public Management in Health system in Romania Health and statistics Institutions

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4.2.1. Ministry of Public Health 4.2.2. National Health Insurance Fund 4.2.3. Professional associations and trade unions 4.2.4. Federative Chamber of Physicians 4.2.5. The Romanian Medical Association and the Society of General Practitioners 4.2.6. The College of Pharmacists 4.2.7. The Order of Nurses and Midwives 4.2.8. Association of Nurses 4.2.9. Sanitas 4.2.10. Health care providers 5.

Information and communication technology as a part of New Public Management in 21 21 21 23 23 25 26 27 28 29 31 33

the Health system in Romania 5.1. 5.2. 6. 6.1. 6.2. 6.3. 6.4. 6.5. 6.6. 6.7. Information for patients Information systems eHealth strategies Motivation of the eHealth Strategies study Survey methodology ICT use of general practitioners Current strategy eHealth strategy Administrative and organisational structure ePrescription Bibliography


Part made by Corina Taban


1. Introduction. Overview and aims

As noted, the 1980s witnessed a renewal of interest in public sector ethics issues and problems. This decade also witnessed the steady blurring of private/public sector lines, unending bashing of bureaucrats and bureaucracy by the media and American republican presidents (remember it was Ronald Reagan who quipped, Washington is not the solution to our problems; it is the problem), and a steadily growing belief in the application of private sector management tools to public sector management problems (quality circles, total quality management, team building, etc.). Thus, when the former city manager Ted Gaebler and the management consultant David Osborne published Reinventing Government in 1992, the stage was set for even more dramatic change in our thinking about administration and management. The reinvention movement, as it is often called, was galvanized when the Clinton administration assumed office. In October 1992, the administration released the National Performance Review, a document that embodied the spirit and soul of reinventing government per Osborne and Gaebler, by promising to turn the federal government into a government that works better and costs less. The new public management would require men and women who steer organizationsnot row them; empower citizens and coach workers through teamwork and participation; thrive on and promote competition; reject rule-driven organizations in favor of mission-driven organizations; seek results, not outcomes; put customers first; foster enterprising and marketoriented government; and embrace community-owned government. New public managers (NPMs) are also likely to find the privatization of public goods and services an attractive alternative and adopt new management tools such as benchmarking, strategic planning, reengineering, and total quality management as the situation warrants. This new way of thinking about management casts public managers into the forefront of getting the job done for Americans in an economical and cost-effective fashion. The era of the administrator who responds to citizen requests and demands rather than meeting the customers needs, fixes problems when they arise rather than preventing them before they become uncomfortable, and promotes the public interest per the new public administration or some other value set is over. The aim of this paper is to describe and clarify the phenomenon of New Public Management by exploring views of specialists and principles and ideas of the current. Also, one of the main focuses of this essay is to determin the impact of New Public Management on the Romania Public Administration. 4

2. New Public Management

Management and managerialism have stimulated intense argument and large literatures in economics, industrial relations, organization and management studies as well as sociology and political science. It is difficult and dangerous to generalize from such diverse fields, but it is essential to focus on some defined features of managerialism as a set of beliefs and practices, and on management as a distinctive social group. Management as a separate function within the work process emerged with the development of mass production in industrial capitalism (Clegg and Dunkerley 1980). It is inextricably connected with the development of bureaucracy and indeed derives its importance from the need for strategic planning, coordination and control of large and complex decision making processes (Dandeker, 1990). In modern capitalist enterprises, maximizing profits (or output or productivity) for owners and shareholders necessitated an exploitative division of labour in which subordinate workers were expected to comply with subordinates demands and instructions. It also led to the belief that industrial and other work organizations could be more efficient if responsibility for policy and planning and overall control was separated from implementation, routine operations and production tasks. Cadres of specialist managers and systems of surveillance and control were thus established to monitor work flow and quality, and to discipline the workforce, while other functions were also created (finance, marketing, corporate management) to plan investment and to assist companies with strategic intelligence about their products, costumers and competitors. It is this cluster of activities and occupations that are now labeled management. Reed (1989) has noted that management has been situated as a system of authority, as a set of skills, and as a social class of selectional interest group. He suggested a generic and apparently natural working definition in which management is a set of activities and mechanisms for assembling and regulating productive activity (Reed 1989:ix). But like Clegg and Dunkerley, he also reminds that management and managers assert the right to determine resource allocation, to resolve conflict within an organization and to impose ultimate authority by virtue of heir role and delegated mandate from owners/shareholders. New Public Management defines a set of broadly similar administrative doctrines which dominated the public administration reform agenda of most OECD countries from the late 1970s (Hood, 1991; Pollitt, 1993; Ridley, 1996). It captures most of the structural, organizational and managerial changes taking place in the public services of these countries. According to Pollitt, New Public Management has variously been defined as a vision, an ideology or (more prosaically) a bundle of particular management approaches and techniques 5

(many of them borrowed from the private for-profit sector). New Public Management is thus seen as a body of managerial thought (Ferlie et al., 1996) or as an ideological thought system based on ideas generated in the private sector and imported into the public sector (Hood, 1991, 1995). New Public Management shifts the emphasis from traditional public administration to public management (Lane, 1994). As the title of Clarke and Newmans (1997) book, The Managerial State, reflects, New Public Management is pushing the state toward managerialism. The traditional model of organization and delivery of public services, based on the principles of bureaucratic hierarchy, planning, centralization, direct control and self-sufficiency, is apparently being replaced by a market-based public service management (Stewart and Walsh, 1992; Walsh, 1995; Flynn, 1993), or enterprise culture (Mascarenhas, 1993). A review of the literature suggests that New Public Management is not a homogenous whole but rather has several, sometimes overlapping, elements representing trends in public management reforms in OECD countries. Its components and features have been identified by a number of writers, including Hood (1991, 1995), Dunleavy and Hood (1994), Flynn (1993), Pollitt (1993;1994) and Summa (1997) and Borins (1994). A clear view about the conceptions of New Public Management held by some key writers on this subject is presented in the table below. It is apparent that there are several parallels and overlaps, but also important differences in the way New Public Management is perceived. It is worth noting, for example, that Hoods original conception of New Public Management did not explicitly feature the issue of consumers rights. Another idea is the issue of consumers to prominence and has since become a key feature of most New Public Management discussions. Osborne and Gaeblers approach also contains some important differences in emphasis from the general New Public Management approach, and especially from the more ideological politics associated with it. Unlike the ideologically driven New Public Management underpinned by the public bad, private good, ethos in the United Kingdom (Talbot, 1994), Osborne and Gaebler assert their belief in government. They also assert that privatization is not the only, or often the most appropriate, solution and that in some cases, bureaucracies work better (e.g., in social security). Beyond these differences, there is much in common with the different views on New Public Management. Following the authors view, we can identify what may be regarded as the key components of New Public Management. A look at the components suggests that the ideas and themes may be put in two broad strands. On the one hand there are ideas and themes that emphasize managerial improvement and organizational restructuring, i.e., managerialism in the public sector. These clusters of ideas tend to emphasize management devolution or decentralizati