Overview

European public hospitals have undergone a process of change by which they remain publicly-owned but use incentives and follow practices similar to those in the private sector. Governance theory explains the crowded policy process and complex mosaic of decision-making relationships among different actors within the hospital sector, often with blurred boundaries. A central element in those reforms has been establishing some autonomy, which is necessary to confront challenges and to restrain the interference of local and regional political actors in decision-making. Institutional, financial and accountability arrangements as well as decision-making capacity versus responsibility are core variables that capture semi- autonomous governance.