NPM and healthcare perf - November 2018
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NPM and healthcare perf - November 2018
CardiffUNIVERSITYOnline Research @ CardiffPRIFYSGOL CAERCWThis is an Open Access document downloaded from ORCA. Cardiff University's institutional rep NPM and healthcare perf - November 2018pository: http://orca.cf.ac.Uk/l 17040/This is the author's version of a work that was submitted to / accepted for publication.Citation for final published version:Andrews. Rhys. Beynon. Malcolm J. and McDermott. Aoife 2019. Configurations of new public management reforms and the efficiency, effecti NPM and healthcare perf - November 2018veness and equity of public healthcare systems: a fuzzy-set qualitative comparative analysis. Public Management Review 21 (8). pp. 1236-1260.10.1080/1NPM and healthcare perf - November 2018
4719037.2018.1561927 fi lePublishers page: https://doi.org/l0.1080/l4719037.2018.1561927NPM and healthcare perf - November 2018
New Public Management reforms and the efficiency, effectiveness and equity' of public healthcare systems: a fuzzy-set Qualitative Comparative AnalysiCardiffUNIVERSITYOnline Research @ CardiffPRIFYSGOL CAERCWThis is an Open Access document downloaded from ORCA. Cardiff University's institutional rep NPM and healthcare perf - November 2018s identifies configurations of New Public Management (NPM) reforms (privatization, consumerism, performance management, and corporatization) associated with perceptions of improvements in healthcare efficiency, effectiveness and equity in fourteen European countries. Although these outcomes are purs NPM and healthcare perf - November 2018ued concurrently, no combination of the considered reforms appears to support success or failure across the board and the inter-relations between refoNPM and healthcare perf - November 2018
rms shape their effects. Three NPM reform profiles are evident in Europe; (1) strong reformers, adopting a comprehensive package of reforms that are pCardiffUNIVERSITYOnline Research @ CardiffPRIFYSGOL CAERCWThis is an Open Access document downloaded from ORCA. Cardiff University's institutional rep NPM and healthcare perf - November 2018gement ReviewContact author: Professor Rhys Andrews. AndrewsR-Kd cardiff.ac.uk1IntroductionThe scale of NPM reform in many European public sectors has led to wide-ranging discussion about whether and under what conditions ‘NPM can work' (e.g. Dan and Pollitt 2015; Drechsler and Randma-Liiv 2016). as NPM and healthcare perf - November 2018 well as its' intended and unintended effects (see Simonet 2011). However, integrative international comparative analysis of the positive and negativeNPM and healthcare perf - November 2018
effects of NPM tools has proved challenging (see Drechsler and Randma-Liiv 2016). Due to their varying administrative traditions, countries have tendCardiffUNIVERSITYOnline Research @ CardiffPRIFYSGOL CAERCWThis is an Open Access document downloaded from ORCA. Cardiff University's institutional rep NPM and healthcare perf - November 2018hoices predetermine further development (Kuhlmann. 2006). As field level logics shift, this can result ill the simultaneous appearance of institutional logics in organizational contexts’ (Polzer at al.. 2016. 69).Institutional logics are organising principles that guide 'how to interpret organizatio NPM and healthcare perf - November 2018nal reality, what constitutes appropriate behaviour and how to succeed’ (Thornton. 2004. 70). by focusing attention on the issues and solutions aligneNPM and healthcare perf - November 2018
d with the dominant logic (Thornton, 2004). Logics manifest in practices and structures that help to gain guide action in the world (Greenwood et al. CardiffUNIVERSITYOnline Research @ CardiffPRIFYSGOL CAERCWThis is an Open Access document downloaded from ORCA. Cardiff University's institutional rep NPM and healthcare perf - November 2018y and synergistic benefits or to tension from the combination of inconsistent practices (Christensen & Laegrid, 201 la). In extremis, overt contest and incompatibility may result (Fischer and Ferlie. 2013). Importantly, this aligns with the configurational perspective on public governance, which sug NPM and healthcare perf - November 2018gests that the impact of any given reform is likely to depend on the presence or absence of other reforms (Lynn. Heinrich and Hill 2000) because theirNPM and healthcare perf - November 2018
overall impact cannot be understood as the ‘mere summing of independent elements’ (Lynn, Heinrich and Hill 2000, 236). Yet most extant work on NPM reCardiffUNIVERSITYOnline Research @ CardiffPRIFYSGOL CAERCWThis is an Open Access document downloaded from ORCA. Cardiff University's institutional rep NPM and healthcare perf - November 2018s and Green 2004). or more latterly across countries (e.g. agencification. see Overman and van Thiel 2016), or focuses on a single dimension of performance, especially efficiency (e.g. Alonso. Clifton and Diaz-Fuentes 2015). In fact, surprisingly little research has systematically compared the effec NPM and healthcare perf - November 2018ts of alternative configurations of NPM reforms on public services across different European countries, let alone on outcomes pursued concurrently (thNPM and healthcare perf - November 2018
ough see Plumper and Neumayer 2013).As a result, we ask ‘what configurations of NPM reforms are associated with improvements in the efficiency, effectCardiffUNIVERSITYOnline Research @ CardiffPRIFYSGOL CAERCWThis is an Open Access document downloaded from ORCA. Cardiff University's institutional rep NPM and healthcare perf - November 2018a key issue for governments across the globe (World Health Organization 2007). Within healthcare, as in the public sector more broadly, 'debate on the role of the state on how and where it should intervene' (OECD 2013, 3) requires balancing multiple objectives (Plumper and Neumayer 2013). and especi NPM and healthcare perf - November 2018ally the desire to achieve improvements in the efficiency, effectiveness and equity of senice provision. In particular, we note that in response to ecNPM and healthcare perf - November 2018
onomic arguments regarding public sen ice improvement many countries have introduced New Public Management (NPM) style reforms associated with a markeCardiffUNIVERSITYOnline Research @ CardiffPRIFYSGOL CAERCWThis is an Open Access document downloaded from ORCA. Cardiff University's institutional rep NPM and healthcare perf - November 2018e been adopted with the aim of improving public healthcare by making it more business-like (Byrkjeflot 2011). To address the important gap in our understanding of the configurational effects OÍ' public management reform, we draw on the perceptions of high-ranking civil senants in the health ministri NPM and healthcare perf - November 2018es of fourteen European countries, to study the relationship between privatization, consumerism, performance management and corporatization, and perceNPM and healthcare perf - November 2018
ived improvements in the efficiency, effectiveness and equity of public healthcare.3In doing so. our approach advances extant research in three main wCardiffUNIVERSITYOnline Research @ CardiffPRIFYSGOL CAERCWThis is an Open Access document downloaded from ORCA. Cardiff University's institutional rep NPM and healthcare perf - November 2018, we examine the connection between a commitment lo NPM reforms and the improvement of public healthcare services across multiple countries, rather than within a single country. Ihữd. we utilize fuzzy-set Qualitative Comparative Analysis (fsQCA) to cany out our study (see Ragin. Strand and Rubinson NPM and healthcare perf - November 20182008). which enables us to identify alternative pathways to the same outcome (cquifinalily). and to evaluate configurations of reforms associated withNPM and healthcare perf - November 2018
strong and weak performance improvement (causal asymmetry). This technique is especially valuable for configurational analysis and is also well-suiteCardiffUNIVERSITYOnline Research @ CardiffPRIFYSGOL CAERCWThis is an Open Access document downloaded from ORCA. Cardiff University's institutional rep NPM and healthcare perf - November 20182014).Next we theorise the concept of hybrid reforms. We then develop some theoretical expectations about the likely relationship between privatization, consumerism, performance management, and corporatization, and the efficiency, effectiveness and equity of public healthcare provision. Thereafter, NPM and healthcare perf - November 2018we describe the data and methods used in our analyses, present our findings, and discuss their implications.NP.M reforms and public healthcare performNPM and healthcare perf - November 2018
anceAlthough the high-tide of the NPM phenomenon has arguably passed. NPM-style reforms have re-shaped the public sector in many Luropean countries (lCardiffUNIVERSITYOnline Research @ CardiffPRIFYSGOL CAERCWThis is an Open Access document downloaded from ORCA. Cardiff University's institutional rep NPM and healthcare perf - November 2018ore cost-effective by opening it up to private sector influence (Christensen and Lacgrid 2011b). This has involved the introduction of a market orientation hl the field level institutional logic, with a related (albeit incomplete) shift away from the previously dominant ‘traditional public administr NPM and healthcare perf - November 2018ation' logic (Anessi-Pessina and Cantu,Gọi ngay
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