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Public Accountability and Health Care Governance pp 37–64Cite as

Palgrave Macmillan

Hospital Planning in a Competitive Arena: Sustaining or Suspending Market Forces?

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Abstract

This chapter examines the growing tensions between hospital funding and governance systems in Germany and attempts to understand why individual states promote or curb market competition within the health care sector in response. After briefly reviewing governance reform trends across the country, the author explores the advent of New Public Management (NPM)- and post-NPM-inspired models in the states of Hessen, Sachsen-Anhalt, and Brandenburg using Qualitative Comparative Analysis (QCA) in order to determine which forces push governments away or toward market competition in hospital planning. The findings reveal that economic concerns at both the state and individual hospital levels largely drive desires for reform, but that the diffusion of oft-unchallenged ideas and internationally imported norms regarding efficient and cost-effective management practices in health care are critical to the elevation of market-friendly instruments to fill governance voids. As a result, while state influence persists across cases, governments’ focus is moving away from direct intervention and toward the definition of goals and standards that hospitals must meet by means of heightened market and quasi-market competition.

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Notes

  1. 1.

    In North-Rhine Westphalia, for example, the most populated state in Germany and at the same time the state with the highest hospital density, the first hospital plan was implemented in 1971, which was substantially revised in 1979. In the following 20 years, however, no new plan was released. It was not before 2001, when Birgit Fischer, the then state health minister, developed a substantial new hospital plan. But even then, the reforms of hospital planning were mainly a reaction to the paradigm shift of federal hospital policy. It was the introduction of the new DRG-remuneration system, which put hospital planning at the state level on the political agenda. In this paper, the most recent hospital plan from 2013 is at the centre of the discussion (Ministerium für Gesundheit, Emanzipation, Alter und Pflege des Landes Nordrhein-Westfalen, 2015).

  2. 2.

    The population of a defined area is multiplied by its hospitalization rate per 1,000 inhabitants (inpatient cases divided by its population), its average length of stay (ALOS) and 100. This multiplication is then divided by the multiplication of 1,000 × 365 × bed utilization rate.

  3. 3.

    In terms of the number of units; the share of public provision is still higher with regard to the number of beds.

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Authors and Affiliations

  1. Department of Social Work and Social Welfare, University of Kassel, Kassel, Germany

    Tanja Klenk

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  1. Tanja Klenk
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Correspondence to Tanja Klenk .

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Editors and Affiliations

  1. University of Oxford, Oxford, United Kingdom

    Paola Mattei

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Klenk, T. (2016). Hospital Planning in a Competitive Arena: Sustaining or Suspending Market Forces?. In: Mattei, P. (eds) Public Accountability and Health Care Governance. Palgrave Macmillan, London. https://doi.org/10.1057/978-1-137-47299-1_3

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