From marketization to recentralization: the health-care system reforms in Poland and the post-New Public Management concept 1

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 recentralization 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 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 government’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 standards of coordination within the system but also as another step towards the consolidation of political power for the ruling party.