Power and cost containment in a Danish public hospital.
The assumption that hospital decision-making is hierarchical in character underpins the policy formulation process in public as well as pluralist national health care systems. This article's analysis of decision-making in a Danish public hospital reinforces the contrary assertion: that effective authority in acute-care hospitals rests in an amorphous power relationship among the hospital's several occupational groups, in which physicians clearly have the upper hand. After a brief introduction to this Danish hospital, the article develops a detailed portrait of its informal power structure and of the different occupational groups' permanent power-maximizing strategies. Subsequently, the article assesses the impact of these strategies upon two recent efforts to contain the hospital's costs: a decision to close an expensive specialty clinic, and an attempt to shrink the hospital's size by transferring less sick elderly patients to a newly created rehabilitation facility. The study's findings suggest that efforts to impose hospital cost containment by exclusively political means are unlikely to succeed.
D003363:Cost Control; D003657:Decision Making; D003718:Denmark; D005376:Financial Management; D005377:Financial Management, Hospital; D006740:Hospital Administrators; D006746:Hospital Bed Capacity, 500 and over; D006779:Hospitals, Public / Q000458:organization & administration*; D006801:Humans; D007400:Interprofessional Relations; D007750:Labor Unions; D008505:Medical Staff, Hospital; D009741:Nursing Staff, Hospital; D011057:Politics; D012047:Rehabilitation Centers / Q000458:organization & administration