Krenyácz, Éva ORCID: https://orcid.org/0000-0003-0647-4736 and Révész, Éva Erika
ORCID: https://orcid.org/0000-0001-5973-1009
(2025)
Consequences of centralized healthcare systems : changing role and autonomy of hospital managers – insights from a Hungarian case.
Journal of Health Organization and Management, 39
(9).
pp. 177-191.
DOI 10.1108/JHOM-08-2024-0358
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Official URL: https://doi.org/10.1108/JHOM-08-2024-0358
Abstract
Purpose The objective of this paper is to investigate how top managers in public healthcare interpret and perceive their autonomy within a highly centralized system and how their roles and attitudes have evolved in response to centralization. Design/methodology/approach The research examines how increased centralization and reduced organizational autonomy affect decision-making in hospitals, employing qualitative analysis through indepth interviews with top managers. The study collected and analyzed data from 15 hospital managers in year 2015 and 2022 (eight interviews each year, one person interviewed twice), to capture changes following significant centralization efforts and the effects of the pandemic and health sector reforms. Findings Centralization has reduced financial and operational managerial autonomy for many institutions, leading to delays in decision-making, especially in financial matters and has also brought significant administrative and reporting burdens. Despite this, hospital managers reported retaining some professional autonomyindevelopingandmanagingtheirserviceportfolios, butthis autonomyisprimarilyoperationalrather than strategic and is limited by financial constraints. Research limitations/implications This study examines the Hungarian healthcare system, influenced by unique political context, which also presents a methodological limitation concerning the transferability of findings. Practical implications Hospital top managers’ professional autonomy is often obscured by heavy administrative and financial pressures; thus, enhancing their strategic mindset is essential. Social implications Policymakers should adopt a comprehensive perspective in hospital maintaining, with a particular focus on balancing financial and medical perspectives. Originality/value The paper focuses on an under-explored area: the organizational autonomy of hospital top management in the context of centralization efforts, delivering a message to both hospital managers and policymakers by emphasizing organizational aspects.
Item Type: | Article |
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Uncontrolled Keywords: | Centralization, Recentralization, Hospital, Manager, Autonomy, Decision making |
Divisions: | Institute of Strategy and Management |
Subjects: | Social welfare, insurance, health care |
DOI: | 10.1108/JHOM-08-2024-0358 |
ID Code: | 11005 |
Deposited By: | MTMT SWORD |
Deposited On: | 13 Mar 2025 13:42 |
Last Modified: | 13 Mar 2025 13:42 |
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