The New Public Management theory and European health-care reforms

This article analyses the dynamics of health-care reforms in Germany, the U.K., Switzerland, France and Italy. In light of the "New Public Management" (NPM) theory, the author discusses governments' attempts at providing better health-care services for less. Health-care reforms inspired by NPM meant opening up to competition and revamping service provision to improve organizational performance. These reforms also put the emphasis on outcomes measurements to improve insurers and providers' accountability, demanded greater decentralization of the decision-making process (e.g., planning, investment and financing of health-care services), and encouraged contracting-out of public services and partnerships between the public and the private sector. While most features of the NPM theory were applicable to EU health-care reforms, NPM was not a panacea: it advanced at different paces across nations, with some aspects of NPM being more appropriate in some countries but less so in others. It led to greater inequity and more bureaucracy in some, but not all, countries. Competition, a major characteristic of the NPM, did not necessarily lead to better health outcomes, and, unlike in other sectors, the application of NPM in health care meant larger providers (e.g., insurers, hospitals) and regulations have remained strong.