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.

A avaliação institucional como instrumento de racionalização e o retorno à escola como organização formal

O papel central da avaliação, da avaliação institucional e dos processos de garantia da qualidade de escolas e universidades nas políticas educacionais é objeto de discussão, também considerando a reforma do Estado. As teorias da nova gestão pública e as perspectivas gestionárias são consideradas como algumas das principais fontes de inspiração e de legitimação no contexto dominante de uma educação contábil. Dados empíricos preliminares resultantes do processo de avaliação externa de escolas básicas e secundárias portuguesas são apresentados e interpretados de acordo com os principais conceitos e representações organizacionais de escola presentes nos relatórios externos. Examinando algumas das imagens e dos significados de escola, cultura de escola, autonomia, objetivos, liderança e eficácia presentes nos relatórios de avaliação, o autor releva a importância das imagens formais, racionais e burocráticas de escolas. Várias questões de investigação são apresentadas tendo por base aquilo a que o autor chama o processo da hiperburocratização das organizações educativas. Algumas dimensões do conceito de burocracia de Max Weber são revisitadas, em articulação com perspectivas neocientíficas de garantia da qualidade e com as tecnologias da informação e comunicação. O autor sugere que maior relevância deve ser atribuída aos modelos formais e racionais de interpretação das organizações educativas, pois os processos de avaliação e de garantia da qualidade estão a contribuir para a formalização de escolas e universidades e para a intensificação do seu processo de racionalização, isto é, para a emergência de uma imagem analítica das escolas como hiperburocracias.

E-government e participação política em Portugal

Dissertação de Mestrado em MPA - Administração Pública

Les émotions des professionnels dans les réseaux

Ce texte présente une réflexion sur les émotions et résonances émotionnelles dans les réseaux qui réunissent des praticiens de différentes institutions autour des patients qui fréquentent les Hôpitaux de Jour. La question des émotions autour des patients dans le cadre des synthèses internes à une institution est relativement bien connue sous l'angle des transferts et contre-transferts et des questions sur la dynamique de groupe (Anzieu: Le groupe et l'inconscient). Nous tentons ici d'élargir la réflexion aux pratiques en réseaux de plus en plus fréquentes mais encore peu pensées et codifiées.

Reestruturação do serviço nacional de saúde em Portugal: balanço da empresarialização dos hospitais públicos portugueses

Em resultado de pressões diversas associadas ao movimento de New Public Management (NPM), iniciado na década de 1980 no Reino Unido, Portugal começou nos primeiros anos do século XXI uma importante reestruturação de seu Serviço Nacional de Saúde (SNS). Nesse âmbito uma grande parcela dos hospitais públicos portugueses foram corporatizados e transformados em sociedades anónimas (S.A.) e, logo depois, em entidades públicas empresariais (EPE). Neste artigo, pretende-se descrever no que consistiu a empresarialização dos hospitais públicos portugueses entre 2002 e 2005, bem como efetuar uma análise do impacto da introdução do managerialismo no sector. Na análise realizada, mostra-se que existem sinais de melhoria da eficiência dos hospitais públicos portugueses após sua conversão em EPEs, mas que são necessários mais estudos no futuro para consolidar essa perspetiva.

Evaluación y rediseño de la red pública educativa. Un análisis centralizado.

El análisis de eficiencia de los centros escolares constituye un tema de interés actual.El número de publicaciones en este campo de investigación se ha incrementado en lo últimos años, al intentar explicar que ciertas características del centro y del entorno influyen en los resultados de los alumnos. A la luz de la Teoría de la Producción y la Post-New Public Management, el objetivo del trabajo es la evaluación y rediseño, a través de técnicas frontera, de una muestra de centros de la red educativa pública de Catalunya. Los resultados obtenidos determinarán las acciones necesarias que permitan optimizar la red y redistribuir de forma óptima los recursos educativos. Por otro lado, aportarán información útil que ayude a la toma de decisiones por parte de las Administraciones Públicas y a la puesta en marcha de programas de mejora en los centros docentes.

Pouvoir discrétionnaire et redevabilité de la bureaucratie de guichet : les taxateurs d'une caisse de chômage comme acteurs de mise en oeuvre

Résumé en français La thèse de doctorat porte, de manière générale, sur le rôle des acteurs administratifs dans la mise en oeuvre de l'action publique. En particulier, dans le contexte de l'implémentation de la politique suisse d'assurance-chômage, la recherche se focalise sur l'étude de la bureaucratie de guichet, à savoir un type spécifique d'administrations et d'agents publics situés aux premières lignes de l'action étatique et qui sont en contact direct et quotidien avec les usagers. La thèse a pour objectif principal d'obtenir une compréhension détaillée des impacts concrets dont sont porteurs deux types de réformes majeures du secteur public : les réformes de Nouvelle Gestion Publique (NGP) et les nouvelles technologies informatiques. Le questionnement central de la recherche consiste en une étude approfondie des effets de ces réformes sur les bureaucraties de guichet, et en particulier sur deux aspects centraux les concernant : d'une part, le niveau de pouvoir discrétionnaire que les agents publics de base disposent dans l'application de la loi fédérale sur l'assurance-chômage, autrement dit leur marge de manoeuvre ; d'autre part, les manières au travers desquelles ces mêmes agents sont appelés à rendre des comptes quant à leurs actions et leurs décisions, à savoir l'enjeu plus large de la redevabilité publique des acteurs administratifs. Ces enjeux ont été analysés au niveau empirique dans le contexte organisationnel d'une caisse publique cantonale de chômage ayant expérimenté les réformes évoquées ci-dessus. L'organisation choisie a été investiguée au travers d'une étude de cas ethnographique approfondie (observation directe du travail quotidien des agents, entretiens semi-directifs, analyse de documents) pendant une période de six mois environ entre 2008 et 2009. L'analyse empirique fournit quatre résultats : a) de manière générale, les taxateurs de la caisse de chômage disposent d'un faible niveau de pouvoir discrétionnaire ; b) le degré de pouvoir discrétionnaire varie selon le type de tâche ; c) les agents sur le terrain rendent des comptes auprès d'une multiplicité d'acteurs, sur une variété d'aspects de leur travail et au travers de différents mécanismes de contrôle ; d) les outils de NGP et les nouvelles technologies informatiques ont peu d'impact sur l'étendue du pouvoir discrétionnaire des agents mais contribuent à influencer le type de redevabilité publique pratiquée à ce niveau. Summary in English This PhD dissertation deals with the role of public administration in policy implementation. In the Swiss context of unemployment insurance policy, it focuses on street-level bureaucracy, a specific type of public organisations and agents located at the frontline of public action, that is to say low-level civil servants who are in direct, daily and face-to-face contact with citizens. The dissertation aims at a deep understanding of what are the concrete impacts of two main important changes touching public sector organizations : New Public Management reforms (NPM) and Information and Communication technologies (ICT). The main research question consists in assessing the impacts of those reforms on two central issues regarding street-level bureaucrats : on the one hand, the effective degree of discretion frontline agents do have in implementing the federal law on unemployment insurance ; on the other hand, the ways through which these bureaucrats are held accountable about their action and decisions, i.e. accountability regimes at the street-level. These issues have been empirically addressed in the organisational context of a cantonal Unemployment Insurance Funds having experienced the above mentioned reforms. The organisation has been investigated through an in-depth ethnographic case-study (direct observation of daily work, semi-structured interwiews, documentary analysis) in 2008 and 2009 for approximately six months. The empirical analysis indicates that a) in general, street-level agents do exert low degree of policy discretion; b) the level of discretion is variable from one specific task to another ; c) frontline workers are held accountable to many actors, on various aspects of their work and through different mechanisms of control ; d) NPM and ICT instruments have few impact on the issue of policy discretion but more on the type of street-level accountability which is concretely practised at this level.

Motivação e desempenho dos funcionários da administração pública cabo-verdiana actual

The process of changes that have been taking place in contemporary world reaches undoubtedly to the public sector. The quest for a new public management, that seeks to provide quality and effective services to the citizens, has been the target of contemporary State. Within this framework, the study of people inside publics organizations becomes strategic. Knowledge is generated, processed, and communicated at great speed, taking society to adopt new approaches. In order to meet the challenges of the new millennium, organizations must thing more of people and, above all, they must be more concerned with creating incentives that can motivate their collaborators to achieve not only the objectives of the organization but also personal objectives of each individual, since there is no point in gaining profit and having productivity if the organization do not develop policies and practices that focus on the human being. Motivation implies accomplishment feelings and professional recognition, expressed by means of executing tasks and activities that are sufficiently challenging and meaningful to the job. The truth is that the adoption of a public management focused on quality requires changes in organization culture, requiring mainly motivation, which leads to efforts, dedication, persistence, and commitment. This work is intended to research motivation as a tool to achieve productivity and excellence in the performance of activities in Cape Verdean Public Administration. To achieve the aim of this work, a bibliographical research on Human Resources Administration as well as different theories related to work motivation in organizations was conducted. The inquisitive method was used based upon a written questionnaire aimed at obtaining data referring to motivation of Public Administration workers.

Motivação e desempenho dos funcionários da administração pública cabo-verdiana actual

O processo de mudanças que vem acontecendo no mundo contemporâneo alcança, inevitavelmente, o sector público. A busca de uma nova gestão pública, que procure prestar serviços ao cidadão com qualidade e eficiência tem sido o alvo a ser alcançado pelo Estado contemporâneo. Dentro desse prisma o estudo das pessoas dentro das organizações públicas apresenta-se como estratégico. O conhecimento é gerado, processado e comunicado a grande velocidade, o que leva a sociedade a assumir novas posturas. Para enfrentar os desafios do novo milénio, as organizações terão que pensar mais nas pessoas e sobretudo, preocupar-se mais em criar estímulos que motivem os colaboradores para alcançarem tanto os objectivos da organização quanto os objectivos pessoais de cada um porque não adianta obter lucro e produtividade se a organização não desenvolver políticas e práticas que privilegiam o ser humano. Motivação envolve sentimentos de realização e de reconhecimento profissional, manifestado por meio de exercícios das tarefas e actividades que oferecem suficiente desafio e significado para o trabalho. A verdade é que a adopção de uma gestão pública focada na qualidade requer mudanças na cultura organizacional, exigindo principalmente motivação, que conduz ao esforço, dedicação, persistência e comprometimento. Com o presente trabalho pretende-se investigar a motivação como uma ferramenta para alcançar a produtividade e a excelência no desempenho das actividades na Administração Pública Cabo-verdiana. Para alcançar o objectivo deste trabalho, fez-se uma pesquisa bibliográfica sobre a Administração dos Recursos Humanos e sobre as diversas teorias relacionadas com a motivação para o trabalho nas organizações. Utilizou-se o método inquisitivo baseado num interrogatório escrito para se obter dados referentes a motivação dos funcionários da Administração Pública.

Motivação e desempenho dos funcionários da administração pública cabo-verdiana actual

The process of changes that have been taking place in contemporary world reaches undoubtedly to the public sector. The quest for a new public management, that seeks to provide quality and effective services to the citizens, has been the target of contemporary State. Within this framework, the study of people inside publics organizations becomes strategic. Knowledge is generated, processed, and communicated at great speed, taking society to adopt new approaches. In order to meet the challenges of the new millennium, organizations must thing more of people and, above all, they must be more concerned with creating incentives that can motivate their collaborators to achieve not only the objectives of the organization but also personal objectives of each individual, since there is no point in gaining profit and having productivity if the organization do not develop policies and practices that focus on the human being. Motivation implies accomplishment feelings and professional recognition, expressed by means of executing tasks and activities that are sufficiently challenging and meaningful to the job. The truth is that the adoption of a public management focused on quality requires changes in organization culture, requiring mainly motivation, which leads to efforts, dedication, persistence, and commitment. This work is intended to research motivation as a tool to achieve productivity and excellence in the performance of activities in Cape Verdean Public Administration. To achieve the aim of this work, a bibliographical research on Human Resources Administration as well as different theories related to work motivation in organizations was conducted. The inquisitive method was used based upon a written questionnaire aimed at obtaining data referring to motivation of Public Administration workers.

Gemeindereformen in der Schweiz : Gemeinsamkeiten und Auslöser

In den 1990er Jahren ist die Schweizer Gemeindelandschaft in Bewegung geraten. Seither werden zentrale Elemente der kommunalen politischen Systeme den veränderten Voraussetzungen angepasst. New Public Management, verstärkte interkommunale Zusammenarbeit und Gemeindefusionen erscheinen immer häufiger auf der politischen Agenda. Neben einem Überblick zur Verbreitung der verschiedenen Reformbestrebungen sucht dieser Aufsatz nach deren Strategien, Gemeinsamkeiten und Auslösern. Die meisten Reformprojekte können nur indirekt mit der Verschlechterung der wirtschaftlichen Lage in Zusammenhang gebrachg werden. Im Mittelpunkt steht die Neuordnung der Zuständigkeiten für die verschiedenen öffentlichen Aufgaben. Eine zentrale Rolle kommt dabei der politischen Steureung zu. Hier weist die Reformdiskussion allerdings Defizite auf.

Die Schweizer Gemeinden im Wandel : Konvergenz oder Divergenz?

Switzerland is currently going through a phase of political restructuring. The numerous reform activities at the beginning of the twenty-first century leave almost no area of political life untouched. The reforms are particularly abundant in the 2′867 municipalities, spanning from amalgamations, intermunicipal co-operation, New Public Management, to reforms of the political systems. Accounting for the fact that there are big socio-economic differences between the municipalities as well as their political systems, we investigate whether the municipalities are headed for divergence or convergence as a result of these reforms. The empirical results are derived from three surveys of the local authorities conducted in 1988, 1994, and 1998. The results indicate that the communes do convergence in regard to their administrative and political structure. However, the convergence appears to be limited to the single cantons and observable only among certain types of municipalities.

The slow transformation of Swiss federal administrative elites

This article sets out to study the profile of Swiss administrative elites at federal level by showing how their profile has evolved in the light of what has come to be known as the wave of New Public Management (NPM), which has benefited from a very fertile ground in Switzerland. These elites correspond to a specific institutional order, in relation to specific organizational structures and workings, and have specific characteristics in terms of career paths and academic background. However, the administrative reforms that have been rolled out since the 1980s have transformed the institutional order within which executives of the federal administration evolve. This article analyses the extent to which these transformations have had an impact on the characteristics of these elites, through indicators such as academic capital, social capital, and career path within and outside the administration. The results show a slow but significant transformation in the profiles of these elites towards an increasing managerialization, reflecting that of the context in which they evolve.Points for practitioners The relationship between politics and the administration is naturally shaped by individuals but is closely dependent on the profiles of the players. They are currently undergoing a transformation in the wake of administrative reforms, and also of the changing profiles of both the political and administrative players. Gaining an insight into the slow transformation of the profiles of administrative elites therefore sheds light on the political-administrative nexus. The gradual managerialization of the administrative elite highlighted in this article also allows for a better understanding of which professional experiences, qualifications and skills are valued today within the senior civil service in Switzerland.