Responsabilidad paradójica en el suministro de servicios públicos: El caso de la atención hospitalaria en Alemania y un experimento mental sobre México / Paradoxical Accountability in Public Service Provision.

Ingo Bode

Resumen


Resumen. Este artículo explora las relaciones entre las organizaciones públicas que suministran servicios y su entorno más amplio, con énfasis en la transformación de la responsabilidad pública. El supuesto clave es que esta última se vuelve más fuerte y menos inmediata al mismo tiempo. Se elucidará esta paradoja, por un lado, con base en conceptos como la lógica institucional, la gobernanza pública orientada hacia el mercado y la rendición de cuentas híbrida y, por el otro, mediante una ilustración empírica del sector hospitalario alemán que se complementa con una pequeña incursión en el desarrollo reciente del sistema de salud mexicano. Se argumenta que, bajo la influencia de movimientos de reforma recientes, el suministro contemporáneo de dicho servicio público entraña la paradoja mencionada, sin importar los legados (nacionales) institucionales en la administración pública. Sin embargo, parece que la paradoja es más pronunciada en Estados de bienestar maduros, mientras que en países como México, la fuerte heterogeneidad dentro de los campos organizacionales afectados podría impedir un choque en todo el terreno de las lógicas institucionales, aunque otros problemas funcionales más básicos sigan siendo cruciales.

Abstract. This article explores relations between public service-providing organizations and their wider environment, with an emphasis on the transformation of public accountability. The key assumption is that the latter becomes stronger and less immediate at the same time. This paradox will be elucidated by drawing on concepts such as institutional logics, market-oriented public governance, and hybrid accountability on the one hand, and by an empirical illustration from the German inpatient care sector which is complemented by a short foray into recent developments in the Mexican health care system, on the other. It is argued that, under the influence of recent reform movements, contemporary public service provision is fraught with the aforementioned paradox, regardless of (national) institutional legacies in public management. However, it seems that the paradox is more pronounced in mature welfare states, whereas in countries such as Mexico strong heterogeneity within the affected organizational fields may impede a fieldwide clash of institutional logics even as more basic functional problems remain crucial.


Palabras clave


gobernanza; responsabilida; sistemas de salud; lógica institucional; Alemania; governance; accountability; health care systems; institutional logics; Germany

Texto completo:

PDF

Referencias


Augurzky, B., C. Hentschker, S. Krolop, A. Pily y C.M. Schmidt (2015), Krankenhaus Rating Report 2015, Essen, RWI.

Bär, S. (2011), Das Krankenhaus zwischen ökonomischer und medizinischer Vernunft: Krankenhausmanager und ihre Konzepte, Wiesbaden, Verlag für Sozialwissenschaften.

Birkinshaw, P., I. Harden y N. Lewis (1990), Government By Moonlight: The Hybrid Parts of the State, Londres, Unwin Hyman.

Blomgren, M. y C. Waks (2015), “Coping with Contradictions: Hybrid Professionals Managing Institutional Complexity”, Journal of Professions and Organization, 2(1), pp. 78-102.

Bode, I. (2008), The Culture of Welfare Markets: The International Recasting of Care and Pension Systems, Nueva York y Londres, Routledge.

Bode, I. (2010), “Towards Disorganised Governance in Public Service Provision? The Case of German Sickness Funds”, International Journal of Public Administration, (33)2, pp. 172-181.

Bode, I. y M. Märker (2014), “Medicine in Management or Medics in Management? The Changing Role of Doctors in German Hospitals”, International Journal of Public Sector Management, 27(5), pp. 395-405.

Bode, I. y W. Vogd (eds.) (2016), Mutationen des Krankenhauses: Soziologische Diagnosen in organisations- und gesellschaftstheoretischer Perspektive, Wiesbaden, Springer vs.

Bogue, R.J., C.H. Hall y G.M. La Forgua (2007), Hospital Governance in Latin America: Results from a Four Nation Survey, Washington, D.C., World Bank/Health, Nutrition, and Population.

Borowiak, C.T. (2011), Accountability and Democracy: The Pitfalls and Promise of Popular Control, Oxford, Oxford University Press.

Bovens, M. (2007), “Analysing and Assessing Accountability: A Conceptual Framework”, European Law Journal, 13(4), pp. 447-468.

Braun, B., P. Buhr, S. Klinke y R. Rosenbrock (2010), Pauschalpatienten, Kurzlieger und Draufzahler: Auswirkungen der drgs auf Versorgungsqualität und Arbeitsbedingungen im Krankenhaus, Berna, Huber.

Clarke, J. y J. Newman (2009), Publics, Politics and Power: Remaking the Public in Public Services, Londres, Sage.

Cookson, R. y D. Dawson (2012), “Hospital Competition and Patient Choice in Publicly Funded Healthcare”, en A.M. Jones (ed.), The Elgar Companion of Health Economics, Cheltenham, Edward Elgar, pp. 219-230.

Culebro Moreno, J.E. (2014), “Modernización administrativa y post-nueva gestión pública: De los dilemas y tensiones hacia las nuevas formas de coordinación y regulación”, Revista Mexicana de Análisis Político y Administración Pública, 3(1), pp. 53-74.

Currie, G. y D. Spyridonidis (2016), “Interpretation of Multiple Institutional Logics on the Ground: Actors’ Position, their Agency and Situational Constraints in Professionalized Contexts”, Organisation Studies, 37(1), pp. 77-97.

Dacin, M.T. (1997), “Isomorphism in Context: The Power and Prescription of Institutional Norms”, Academy of Management Journal, 40(1), pp. 46-81.

Dent, M., H. Howorth, F. Mueller y C. Preuschoft (2004), “Archetype Transition in the German Health Service? The Attempted Modernisation of Hospitals in a North German State”, Public Administration, 82(3), pp. 727-742.

De Vries, M. y J. Nemec (2013), “Public Sector Reform: An Overview of Recent Literature and Research on npm and Alternative Paths”, International Journal of Public Sector Management, 26(1), pp. 4-16.

DiMaggio, P.J. y W.W. Powell (1983), “The Iron Cage Revisited: Institutional Isomorphism and Collective Rationality in Organizational Fields”, American Sociological Review, 48(1), pp. 147-160.

Dubnick, M.J. y H.G. Frederickson (eds.) (2011), Accountable Governance: Problems and Promises, Nueva York, M.E. Sharp.

Edmonds-Poli, E. y D.A. Shirk (2012), Contemporary Mexican Politics, Lanham, Rowman & Littlefield.

Flood, C. (2003), International Healthcare Reform: A Legal, Economic and Political Analysis, Londres, Routledge.

Friedland, R. y R.R. Alford (1991), Bringing Society Back In: Symbols, Practices, and Institutional Change, en W.W. Powell y P.J. DiMaggio (eds.), The New Institutionalism in Organizational Analysis, Chicago, University of Chicago Press, pp. 232-263.

García-Junco Machado, David (2012), “La transformación del sistema de salud y el Seguro Popular”, Gaceta Médica de México, 148, pp. 518-524.

Goodrick, E. y G.R. Salancik (1996), “Organizational Discretion in Responding to Institutional Practices: Hospitals and Cesarean Births”, Administrative Science Quarterly, 41(1), pp. 1-28.

Gooijer, W.D. (2007), Trends in EU Healthcare Systems, Berlín y Nueva York, Springer.

Greenwood, R., C. Oliver, K. Sahlin y R. Suddaby (2008), “Introduction”, en R. Greenwood, C. Oliver, K. Sahlin y R. Suddaby (eds.), The Sage Handbook of Organizational Institutionalism, Londres, Sage, pp. 1-46.

Hentschker, C., R. Mennicken y T. Schmid (2014), “Defining Hospital Markets: An Application to the German Hospital Sector”, Health Economics Review, 4(28), disponible en: https://link.springer.com/article/10.1186/s13561-014-0028-0 [fecha de consulta: 5 de septimbre de 2017].

Herrera Huerta, E.V., L.A. Pacheco Ramón, R. Escutia Gutiérrez, E.A. García Montalvo, M. Bulás Mendoza y J.G. López López (2015), “Certificación de hospitales en México: Estándares internacionales”, Revista Médica de la Universidad de Costa Rica, 9(1), pp. 12-19.

Heydebrandt, W. (1973), “Hospital Bureaucracy: A Comparative Study of Organizations”, Nueva York, Dunellen.

Hill, M. y P.L. Hupe (2009), Implementing Public Policy: An Introduction to the Study of Operational Governance, Londres, Sage.

Hodge, G.A. y K. Cockhill (2007), “Accountability in the Privatized State”, Governance, 20(4), pp. 675-702.

Ibarra I., G. Martínez, N. Aguilera, E. Orozco, G.E. Fajardo-Dolci y D. Gonzáles-Block (2013), “Capacidad del marco jurídico de las instituciones públicas de salud en México para apoyar la integración funcional”, Salud Pública de México, 55(3), pp. 310-317.

Inek (Institut für das Entgeltsystem im Krankenhaus) (2011), Endbericht zum 2, Zyklus der g-drg-Begleitforschung (2006-2008), junio, Berlín.

Isfort, M. y F. Weidner (coords.) (2010), Pflege-Thermometer 2009. Eine bundesweite Befragung von Pflegekräften zur Situation der Pflege und Patientenversorgung im Krankenhaus, Colonia, Deutsches Institut für Angewandte Pflegeforschung.

Jepperson, R.L. (1991), “Institutions, Institutional Effects, and Institutionalism”, en W.W. Powell y P. J. DiMaggio (eds.), The New Institutionalism in Organizational Analysis, Chicago, Chicago University Press, pp. 143-163.

Jos, P. y M.E. Tomkins (2004), “The Accountability Paradox in an Age of Reinvention. The Perennial Problem of Preserving Character and Judgement”, Administration & Society, 36(3), pp. 255-281.

Klenk, T. (2011), “Ownership Change and the Rise of a For-profit Hospital Industry in Germany”, Policy Studies, 32(3), pp. 263-275.

Kurunmaki, L., I. Lapsley y K. Melia (2003), “Accountingization vs. Legitimation: A Comparative Study of the Use of Accounting Information in Intensive Care”, Management Accounting Research, 14(1), pp. 112-139.

Lægreid, P. (2014), “Accountability and New Public Management”, en M. Bovens, R.E. Goodin y M. Schillemanns (eds.), The Oxford Handbook of Public Accountability, Oxford, Oxford University Press, pp. 325-338.

Laurell, A.S. (2015), “The Mexican Popular Health Insurance: Myths and Realities”, International Journal of Health Services, 45(1), pp. 105-125.

Lawrence, T. y R. Suddaby (2006), “Institutions and Institutional Work”, en C. Clegg, C. Hardy y T. Lawrence (eds.), Sage Handbook of Organization Studies, Londres, Sage, pp. 215-254.

Le Grand, J. y W. Bartlett (1993), “The Theory of Quasi-Markets”, en J. Le Grand y W. Bartlett (eds.), Quasi-Markets and Social Policy, Londres, Macmillan, pp. 13-34.

López, M.J., A. Martínez Valle y N. Aguilera (2015), “Reforming the Mexican Healthcare System to Achieve Effective Healthcare Coverage”, Health Systems & Reforms, 1(3), pp. 181-188.

López Arellano, O. y E.C. Jarillo-Soto (2016), “Is There a Way Forward for the Mexican Healthcare System? A Human Rights Perspective”, Social Medicine, 10(1), pp. 1-11.

Lounsbury, M. y E. Boxenbaum (2013), “Institutional Logics in Action”, Research in the Sociology of Organisations, 39A, pp. 3-22.

Martínez-Molina, R., R. Rodríguez, I. Borges-Carrete, R. Hernández-Centeno, H. Robledo- Galván y D. Olvera-López (2012), “El sistema de gestión de calidad, una ventaja competitiva para el hospital Durango”, Revista Conamed, 17(4), pp. 165-171.

Meyer, J.W. y B. Rowan (1977), “Institutionalized Organizations: Formal Structures as Myth and Ceremony”, American Journal of Sociology, 83(2), pp. 340-363.

Nigendo, G, V.J. Wirtz, L.M. González-Robledo y M.M. Reich (2015), “Evaluating the Implementation of Mexico’s Health Reform: The Case of Seguro Popular”, Health Systems & Reforms, 1(3), pp. 217-218.

Olvera, A. (2015), “La crisis política, los movimientos sociales y el futuro de la democracia en México”, Revista Mexicana de Ciencias Políticas y Sociales, 225, pp. 213-220.

Pache, A.C. y F. Santos (2010), “Inside the Hybrid Organization: An Organizational Level View of Responses to Conflicting Institutional Demands”, documento de trabajo 1101, Research Center essec.

Page, S. (2006), “The Web of Managerial Accountability”, Administration & Society, 38(2), pp. 166-197.

Parsons, T. (1956), “Suggestions for a Sociological Approach of Organizations”, Administrative Science Quarterly, 1(1-2), pp. 63-85, 225-248.

Pfaff, H., T.D. Gloede y A. Hammer (2015), “Germany”, en J. Braithwaite, Y. Matsuyama, R. Mannion y H. Johnson (eds.), Healthcare Reform, Quality and Safety: Perspectives, Participants and Prospects in 30 Countries, Surrey, Ashgate, pp. 239-247.

Pollitt, C. y G. Bouckaert (eds.) (2011), Public Management Reform: A Comparative Analysis: New Public Management, Governance, and the Neo-Weberian State, Nueva York, Oxford University Press.

Reay, T. y C.R.B. Hinings (2009), “Managing the Rivalry of Competing Instutional Logics”, Organization Studies, 30(6), pp. 629-652.

Reich, A.R. (2014), Selling our Souls: The Commodification of Hospital Care in the United States, Princeton, Princeton University Press.

Rhodes, R.A.W. (1997), Understanding Governance: Policy Networks, Governance and Accountability, Buckingham, Open University Press.

Romzek, B.S. (2011), “The Tangled Web of Accountability in Contracting Networks: The Case of Welfare Reform”, en M.J. Dubnick y H.G. Frederickson (eds.), Accountable Governance: Problems and Promises, Nueva York, M.E. Sharp, pp. 22-41.

Romzek, B.S. y M.J. Dubnick (1987), “Accountability in the Public Sector: Lessons from the Challenger Tragedy”, Public Administration Review, 47(3), pp. 227-238.

Rowlinson, M. (1997), Organizations and Institutions: Perspectives in Economics and Sociology, Londres, Macmillan.

Sauerland, D. (2009), “The Legal Framework for Healthcare Quality Assurance in Germany”, Health Economics, Policy and Law, 4(1), pp. 79-98.

Selznick, P. (1948), “Foundations of the Theory of Organizations”, American Sociological Review, 13(2), pp. 25-35.

Simon, M. (2016), “Die ökonomischen und strukturellen Veränderungen des Krankenhausbereichs seit den 1970er Jahren”, en I. Bode y W. Vogd (eds.), Mutationen des Krankenhauses: Soziologische Diagnosen in organisations- und gesellschaftstheoretischer Perspektive, Wiesbaden, Springer vs, pp. 29-46.

Simonet, D. (2011), “The New Public Management Theory and the Reform of European Healthcare Systems: An International Comparative Perspective”, International Journal of Public Administration, 34(12), pp. 815-826.

Schillemanns, T. (2011), “Does Horizontal Accountability Work? Evaluating Potential Remedies for the Accountability Deficit of Agencies”, Public Organization Review, 47(3), pp. 227-238.

Scott, W.R. y J.W. Meyer (1991), “The Organization of Societal Sectors: Propositions and Early Evidence”, en W.W. Powell y P.J. DiMaggio (eds.), The New Institutionalism in Organizational Analysis, Chicago, University of Chicago Press, pp. 108-140.

Scott, W.R., M. Ruef, P.J. Mendel y C.R. Caronna (2000), Institutional Change and Health care Organizations: From Professional Dominance to Managed Care, Chicago, University of Chicago Press.

Solano, C.E. (2015), “Universalist Reform of the Healthcare Systems in Mexico and Chile: A Change of Time or Historical Inertia?”, Journal of Public Governance and Policy, 1(2), pp. 32-59.

Thornton, P.H., W. Ocasio y M. Lounsbury (2012), The Institutional Logics Perspective: A New Approach to Culture, Structure and Process, Oxford, Oxford University Press.

Weber, K. y M.A. Glynn (2006), “Making Sense with Institutions: Context, Thought and Action in Karl Weick’s Theory”, Organization Studies, 27(11), pp. 1639-1660.

Witman, Y., G.A.C. Smid, P.L. Meurs y D.L. Willems (2011), “Doctors in the Lead: Balancing between Two Worlds”, Organization, 18(4), pp. 477-495.

Wolf, J.F. (2005), “Public Administration’s Multiple Institutionalized Frameworks”, Public Organization Review, 5(1), pp. 183-200.

Wooten, M. y A.J. Hoffman (2008), “Organizational Fields: Past, Present and Future”, en R. Greenwood, C. Oliver, K. Sahlin y R. Suddaby (eds.), The Sage Handbook of Organizational Institutionalism, Londres, Sage, pp. 120-147.




DOI: http://dx.doi.org/10.29265/gypp.v26i3.357

Enlaces refback

  • No hay ningún enlace refback.


 

       Gestión y Política Pública

www.gestionypoliticapublica.cide.edu