A puha költségvetési korlát szindrómája a kórházi szektorban = The soft budget constraint syndrome in the hospital sector

A kutatások eddig főképpen azt vizsgálták, hogyan jelenik meg a puha költségvetési korlát szindrómája a vállalati szférában és a hitelrendszerben. A jelen cikk a kórházi szektorra összpontosítja a figyelmet. Leírja az események öt főszereplőjének, a betegnek, az orvosnak, a kórházigazgatónak, a politikusnak és a kórház tulajdonosának motivációit és magatartásuk ellentmondásos jellegét. A motivációk magyarázzák, miért olyan erőteljes a túlköltési hajlam és a költségvetési korlát felpuhulásának tendenciája. A döntési és finanszírozási folyamatok minden szintjén felfelé hárítják a túlköltés és eladósodás terheit. A cikk kitér a különböző tulajdonformák (állami, nonprofit és forprofit nem állami tulajdonformák) és a puha költségvetési korlát szindrómájának kapcsolatára. Végül normatív szempontból vizsgálja a jelenséget: melyek a költségvetési korlát megkeményítésének kedvező és kedvezőtlen következményei, és hogyan tükröződnek a normatív dilemmák az események résztvevőinek tudatában. ___________ Researches so far have examined mainly how the soft budget constraint syndrome appears in the corporate sphere and the credit system. This article concentrates on the hospital sector. It describes the motivations and the contradictory behaviour of the five main types of participant in the events: patients, doctors, hospital managers, politicians, and hospital owners. The motivations explain why the propensity to overspend and the tendency to soften the budget constraint are so strong. The burdens of overspending and indebtedness are pushed upwards at every level of the decision-making and funding processes. The article considers the connection between the soft budget constraint syn-drome and the various forms of ownership (state ownership and the non-profit and for-profit forms of non-state ownership). Finally, the phenomenon is examined from the normative point of view: what are the favourable and unfavourable consequences of hardening the budget constraint and how these are reflected in the consciousness of the participants in the normative dilemmas and events.

The Soft Budget Constraint. An introductory study to volume IV of the Life’s Work series

The author’s ideas on the soft budget constraint (SBC) were first expressed in 1976. Much progress has been made in understanding the problem over the ensuing four decades. The study takes issue with those who confine the concept to the process of bailing out loss-making socialist firms. It shows how the syndrome can appear in various organizations and forms in many spheres of the economy and points to the various means available for financial rescue. Single bailouts do not as such generate the SBC syndrome. It develops where the SBC becomes built into expectations. Special heed is paid to features generated by the syndrome in rescuer and rescuee organizations. The study reports on the spread of the syndrome in various periods of the socialist and the capitalist system, in various sectors. The author expresses his views on normative questions and on therapies against the harmful effects. He deals first with actual practice, then places the theory of the SBC in the sphere of ideas and models, showing how it relates to other theoretical trends, including institutional and behavioural economics and theories of moral hazard and inconsistency in time. He shows how far the intellectual apparatus of the SBC has spread in theoretical literature and where it has reached in the process of “canonization” by the economics profession. Finally, he reviews the main research tasks ahead.

Introduction of soft budget constraint as an analyzing tool into public management. The case of the Hungarian public administration reform

Public management reforms are usually underpinned by arguments that they will make the public administration system more effective and efficient. In practice, however, it is very hard to determine whether a given reform will improve the efficiency and effectiveness of the public administration system in the long run. Here, I shall examine how the concept of the soft budget constraint (SBC) introduced by János Kornai (Kornai 1979, 1986; Kornai, Maskin & Roland 2003) can be applied to this problem. In the following, I shall describe the Hungarian public administration reforms implemented by the Orbán government from 2010 onward and analyze its reforms, focusing on which measures harden and which ones soften the budget constraint of the actors of the Hungarian public administration system. In the literature of economics, there is some evidence-based knowledge on how to harden/soften the budget constraint, which improves/reduces the effectiveness and hence the efficiency of the given system. By using the concept of SBC, I also hope to shed some light on the rationale behind the Hungarian government’s introduction of such a contradictory reform package. Previously, the concept of SBC was utilized narrowly in public management studies, mostly in the field of fiscal federalism. My goal is to apply the concept to a broader area of public management studies. My conclusion is that the concept of SBC can significantly contribute to public management studies by deepening our knowledge on the reasons behind the success and failure of public administration reforms.