Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #110308

Richard J. Bogue, PhD, Center for Health Futures, Senior Research Fellow, 200 North Lakemont Avenue, Winter Park, FL 32792, 407-376-3740, rjb@richbogue.com, Claude H. Hall, MA, MHA, Sinai Health System, California Avenue at 15th Street, Chicago, IL 60608-1797, and Gerard M. La Forgia, PhD, Department of Human Development, Latin America and the Caribbean Region, World Bank, Edf. Corporate Financial Center, Conjuntos 303/304 e 603, Brasilia, 70712-900, Brazil.

This study is part of an eleven-study research project begun in 2002 by the Brazilian Health Ministry, World Bank and DFID/Brazil. The project aimed to: (a) support development of a medium-term hospital reform plan to improve quality of care, efficiency of services, and effective referrals; (b) develop options for improving performance of hospitals serving low-income populations; and (c) build consensus among policy makers and major stakeholders on the best options for hospital reforms. Our multi-national study adopts a functional perspective on governance by conducting an initial exploration of how governance-level authorities are allocated between public versus private, and between extra institutional versus local, individuals or bodies, and how the allocation of authority affects hospital performance. A twelve-page survey, based on the American Hospital Association's governance survey instrument, was administered in Spanish and Portuguese, and completed by 397 hospitals in Argentina, Brazil, Colombia and Mexico. Questions addressed hospital characteristics, such as size, staffing and services; financial and utilization information; identified institutions that have ultimate authority over general and specific areas of hospital decision making; self-ratings across a variety of performance areas; and governance and/or board characteristics. It also asked opened-ended questions about areas for improvement in national health systems and in governance practices in the hospital. We will discuss survey methodology, procedures and the sample. We will also discuss background information on the four countries, their hospitals, and their roles in the national health systems. Data from this study were used to explore the possible benefits of adapting the New Public Sector Management (NPSM) paradigm to hospital/health system reform. The NPSM paradigm for public sector reform, drawing on OECD reform experience, seeks to redefine and improve managerial and institutional responsibility, accountability and performance. To achieve these improvements, five mutually reinforcing strategies are contemplated: corporatizing public agencies; establishing autonomous agencies; implementing performance-related budgeting; managing competition and contracting; and improving accountability in personnel performance management. We will explore the meaning of the survey results and the value of NPSM both as a framework for health reform policy and for more rigorous examination of public policy, governance, and health system performance.

Learning Objectives:

• 1. Understand the design and methods employed to assess the associations between hospital governance and performance using a survey in four Latin American nations.
• 2. Understand the implications of study findings on health reform models like the NPSM for and the benefits/risks of encouraging their adoption in the countries studied.
• 3. Discuss how hospital systems and their governance affect and are affected by health system reform efforts.

Keywords: Latin American, Health Care Reform

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.