Decentralization and privatization in Portuguese health reforms

ABSTRACT - The Portuguese National Health Service (SNS), a universal, centralized and public owned health care system, exhibits an extraordinary record of equalization in the access to health care and health gains in the late thirty years. However, the most recent history of the Portuguese health reform is pervaded by the influence of decentralization and privatization. Decentralization has been present in the system design since the 1976 Constitution, at least in theory. Private ownership of health care suppliers and out-ofpocket expenditures, on the financing side, both have a long tradition of relevance in the NHS mix of services. The initial aim of this study was to demonstrate expected parallelism between health reforms and public administration reforms, where a common pattern of joint decentralization and privatization was observed in many countries. Observers would be tempted to consider these two movements as common signs of new public management (NPM) developments. They have common objectives, are established around the core concepts of gains in effectiveness, efficiency, equity and quality of public services, through improved accountability. However, in practice, in Portugal, each movement was developed in a totally separated way. Besides those rooted in the NPM theory, there are few visible signs of association between decentralization and privatization. Decentralization, in the Portuguese SNS, was never intended to be followed by a privatization movement; it was seen merely as a public administration tool. Private management of health services, as stated in the most recent SNS legislation, was never intended to have decentralization as a condition or as a consequence. Paradoxically, in the Portuguese context, it has led invariably to centralized control. While presented as separate instruments for a common purpose, the association between decentralization and privatization still lacks a convincing demonstration. Many common health care management stereotypes remain to be checked out if we want to look for eventual associations between these two organizational tools.

Asking why

The growth of a solid, knowledge-intensive firm, OutSystems—an IT company recognized in 2003 by Fortune magazine as one of the most promising start-ups in the world—is accompanied by efforts to create a strong culture that preserves the traits that have driven OutSystems’ success and that drives innovation, adaptability, high performance, and accountability. The lessons OutSystems learned from previous international experiences are presented along with its latest growth model of branded local partners. The case study is intended to introduce concepts related to organizational culture, traits of cultures that drive innovation, national versus organizational culture, and the challenges of globalization. It is designed to be used in Organizational Behavior classes and is appropriate for MBA- and Master’s-level courses in the area of management. It is suggested as a guideline for 60- to 90-minute classes. Participants are invited to discuss the importance of organizational cultures and their fit with the company strategy. Participants are also encouraged to brainstorm about the best approach to face OutSystems’ new stage of growth, specifically the advantages and consequences of growing as a metanational company. Finally, in the conclusion, the most relevant findings taken from the discussions proposed are revisited: The importance of an organizational culture adapted to the market needs and the potential of innovation behind metanational companies. Other considerations are made about: how the case illustrates the importance of leadership, group age, and group size in the process of building a culture; and how OutSystems’ culture solves the apparent contradiction behind adaptable culture.

A prestação de contas e o regime especial da invalidade das deliberações

The obligation of accountability, or the need to make known the economic and financial state of the companies, ceased to be a purely internal activity, becoming a necessity of a general nature. The knowledge of the financial state of the companies, wich is provided by accountability documents, reveals more and more elementary for all interested in the results obtained, whether in terms of profitability, either with a view to assessing the economic and financial health of the companies. This essay aims to a deeper analysis to matters of accountability, in particular, to the special invalidity scheme of corporate resolutions, wich is enshrined in art. 69º of Portuguese Companies Code. We chose to reference the accrual basis accounts approval, through the analysis of financial statements, laying down a set of principles and criteria applicable to different entities. After consideration of the special scheme versed in art. 69º, we conclude there is a certain ambiguity in the adoption of the criteria do delimit each of the hypotheses of the precept, since the legislator uses indeterminate concepts. Nevertheless, if there is a rule, this will be the annulment, and only exceptionally will apply the nullity scheme, where there is injury to the public interest and the interests of the creditors.