Discussion and Conclusions

Abstract

Discusses the findings across the country cases and draws theoretical and practical conclusions for his research. He concludes that (1) in the face of organizational reform, the state capacity to coordinate the decentralized and autonomous hospitals has been put to the test; (2) hospital autonomy has overall posed serious challenges to the central coordination of autonomous hospitals in Estonia, much more so than in the case of Norway and Romania; (3) however, the autonomy of hospitals is not the only factor that affects the effectiveness of coordination; (4) hospital system culture and principal-agent theory offer complementary insights into the dynamics of public hospital coordination. Conflicting interests and goals and cultural factors are particularly relevant in understanding the effectiveness of central coordination of public hospitals.