Healthcare managerial roles in a centralized system: does “freedom of managerial choice” exist?

Eva Krenyacz, Eva Revesz

Keywords: centralization, healthcare, autonomy, control, decision-making, hospital

Abstract:

After a long period of decentralisation efforts, a potential new paradigm of (re)centralisation emerged in the healthcare sector, and the role of the central government had begun to strengthen in several countries (Saltman, 2008). Centralisation of the hospital sector started in Hungary in 2010: ownership of hospitals has been transferred from local governments to the state level, a new central supervising agency has been set up, and in 2020 Ministry of Interior took over the role of the maintainer and owner of the Hungarian hospitals and the “quasi-military organization” further centralized the minimal remaining organizational, micro-level autonomies.

The paper examines what management functions are left in the hands of hospital managers and how (not) they can use them by analysing the relationship between the tools of management and control in centralized healthcare hospitals.
RQ: How do the strengthening of centralization and the reduction of autonomy affect organizational decision-making in the case of hospitals?

The document analysis and managerial interviews were made at two selected times (in 2014-2015, after the first powerful centralization process, and in 2022-2023, during the pandemic crisis which was used to push reforms affecting physicians through the system).
As a result of the research, we present how the instructions are transformed into top-down and over-regulated solutions (e.g., in the case of the lack of professionals (doctors, nurses), the authority assigns the human resources to a given territory, instead of using motivation mechanisms or local help.) The local-level solutions are relegated to the background and the politics believes in the administrative, centralized data request, and manual control.