From marketization to recentralization: the health-care system reforms in Poland and the post-New Public Management concept1
| Author | Urszula Kaczmarek,Łukasz Mikuła |
| Published date | 01 March 2019 |
| DOI | 10.1177/0020852318773429 |
| Date | 01 March 2019 |
| Subject Matter | Special Issue Articles |
Article
International
Review of
Administrative
Sciences
From marketization
to recentralization:
the health-care system
reforms in Poland and
the post-New Public
Management concept
1
Łukasz Mikuła
Adam Mickiewicz University in Poznan, Poland
Urszula Kaczmarek
Adam Mickiewicz University in Poznan, Poland
Abstract
The aim of the article is to evaluate the outcomes of the post-1990 health-care system
reforms in Poland in the context of New Public Management and post-New Public
Management ideas. The most important arguments put forward in the public debate,
both in favour and against the agencification, marketization and privatization of health
services, are presented and discussed. They are confronted with quantitative data on
the health situation in Poland. In the final sections, the programme of the recentraliza-
tion and de-marketization of the hospital sector, proposed by the new government
formed by the Law and Justice Party (in office since 2015), is analysed against the
theoretical background of the post-New Public Management concept.
Points for practitioners
The transformation of the health-care system in Poland took place in 1999, almost
10 years after the democratic breakthrough of 1989, as a part of the second wave of
territorial-administrative reforms. Commercialization and partial privatization of public
hospitals following the New Public Management model of public sector reform has
Corresponding author:
Łukasz Mikuła, Adam Mickiewicz University in Poznan, Institute of Socio-Economic Geography and Spatial
Management, Krygowskiego 10, Poznan, PL 61-680, Poland.
Email: mikula@amu.edu.pl
International Review of
Administrative Sciences
2019, Vol. 85(1) 28–44
!The Author(s) 2018
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DOI: 10.1177/0020852318773429
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been much discussed in Poland for the last decade. Yet, this process, which is politically
and socially very controversial, has proceeded at a moderate pace. The recent govern-
ment’s proposals for the de-agencification and de-marketization of health care may be
interpreted as a post-New Public Management reform aimed at achieving higher stand-
ards of coordination within the system but also as another step towards the consol-
idation of political power for the ruling party.
Keywords
Central and Eastern Europe, de-marketization, National Health Fund, New Public
Management, post-socialist transformation, privatization, public hospitals
Introduction
During 25 years of political and socio-economical transition after 1990, Poland was
the largest European country representing the post-socialist adaptation path to New
Public Management (NPM) as a model for the organization and steering of public
administration. The neoliberal agenda was perceived as a departure from long-lasting
socialism and served as the ideological basis for transformations of public services in
Poland, including partial commercialization and privatization. The general elections
of 2015 brought about a significant political change as the new government formed
by the right-wing Law and Justice Party announced its programme of de-
agencification and de-marketization in health care, thus reversing some of the
most important elements of NPM-inspired health-care reform of the late 1990s.
The aim of this article is to study the transformation of the Polish health-care
system since the 1990s through the analytical lens of the NPM/post-NPM debate.
As the article is part of a special issue that studies post-NPM in social service
provision in different national contexts (Sweden, France, Germany, the UK, Italy
and Poland), it is important to underline that these countries belong to different
welfare state regimes and hence differ with respect to the institutional settings and
actor constellations that characterize social service provision. The use of the NPM
and post-NPM concepts in the context of health-care system reforms in Poland is a
particularly interesting case as the evolution of public service provision in Poland
has followed a development course different from that taken in most West
European countries but typical of the Central and Eastern Europe (CEE) region.
Context: NPM impact on post-socialist health-care systems
The NPM-driven reforms in health-care organizations have sought to stimulate
entrepreneurial hospital management by relying on quasi-market forces and com-
petition rather than planning, by introducing strong performance measurement
and monitoring mechanisms, and by improving information sharing and
Mikuła and Kaczmarek 29
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