Dissatisfied with Decentralisation: Explaining Citizens' Evaluations of Poland's 1999 Health Care Reforms
2011; Taylor & Francis; Volume: 12; Issue: 3 Linguagem: Inglês
10.1080/15705854.2011.596310
ISSN1570-5854
Autores Tópico(s)Global Health Care Issues
ResumoAbstract Decentralisation of public policy from national to sub-national governments occurs in 80% of developing and transitioning economies worldwide (Manor, Citation1999), and is advocated by the International Monetary Fund, World Bank, and European Union. Proponents argue that decentralisation disperses political power, involves citizens in the political process, and allows sub-national officials to craft efficient policies. After suffering under centralised state policymaking (1945–1989), citizens of Central and Eastern Europe should be avid supporters of decentralisation. Yet 80% of the Polish populace was dissatisfied with decentralisation of health care services by 2000. This article uses public opinion, interview, and elite survey data to examine the critical case of Poland's 1999 health decentralisation, answering two questions about public opinion on decentralisation. First, why were Polish citizens displeased with decentralisation? Second, what factors make or break public evaluations of decentralisation? The article demonstrates that Poles were more dissatisfied with their health care during health decentralisation (1999–2001) than when it was centralised (1994–1998, and 2002–2007). Aggregate public opinion data suggests support for decentralisation dwindles when it becomes synonymous with offloading state responsibilities to private citizens. However, surveys of health care consumers, providers, and administrators in four Polish provinces show the important role political parties play in managing expectations and support for decentralisation. Key Words: Decentralisationhealth carePolandpolitical parties Acknowledgements The authors would like to thank John Carey, Andrew Roberts, Saul Lerner, and panelists at Midwest Political Science Association for their comments on earlier drafts of this manuscript. Any errors are our own. Notes M. Rincker, July 2002. Interview with Deputy Head Nurse in Kraków, Poland. ‘Kas Chorych’ is also known as a Sick Fund but for clarity here is translated as a Patient Fund. Responding to the 1993 elections, in which electoral thresholds were introduced, a number of Solidarity successor parties and parties on the political right of the spectrum received no representation in the Sejm. By 2006, Freedom Union's neoliberal position was replaced by Donald Tusk's Civic Platform PO and the further right Truth and Justice Party, led by the twin brothers: former President Lech Kaczynski (deceased) and former Prime Minister Jarosław Kaczyński. In the centre lie the agrarian Polish People's Party, and Poland Comes First, led by Joanna Kluzik-Rostkowska. On the left, the Democratic Party and Social Democracy of Poland have formed and hold seats in the Sejm, in addition to Labour Union and Democratic Left Alliance. Thus, in 2011, there are eight political parties active in the Polish national Sejm. M. Rincker, June 2002. Interview with former Vice Minister of Health in Kraków, Poland. M. Rincker, May 2002. Interview with Patient Fund employee, Poland. M. Rincker, June 2002. Interview with Patient Fund Director, Poland. The role of the respondent in the health care system (health care provider, consumer or administrator) was not a statistically significant predictor of respondent's evaluation of decentralised health care in Poland.
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