Enduring Managerialism in the Internal Governance of Public Hospitals

Abstract

As Paul Pierson suggests, ‘hemmed in by popular sensitivities, powerful interests and economic realities, governments generally find health care to be a cause of political headaches rather than a target for successful retrenchment’ (Pierson, 1994). In a few areas of the welfare state has the reform of welfare administration been so vigorously dominated by the logic of the market and competition as in health care (Le Grand and Robinson, 1984; Ranade, 1998). In the 1990s economic efficiency was the leitmotiv of health care reforms around the world (Saltman and Figueras, 1997; Saltman et al., 1998; Moran, 1998). Productivity and efficiency imperatives originated from the search for ways to meet rising health care demands while limiting public expenditure. The literature on comparative health care systems has grown exponentially in the last 20 years. A spate of comparative reports by international organizations such as the OECD and the World Health Organization (WHO) has provoked commentary and controversy, supplying a wealth of comparative data.