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Performance Budgeting in Practice: the Case of Danish Hospital Management

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Abstract

Performance budgeting systems have been introduced in the OECD countries with the proclaimed aim to increase public sector efficiency. However, the aim has often been hampered by a lack of relevant information, symbolic politics and conflicting political preferences. In this study, we investigate Danish public hospitals to see how performance budgeting works in the regions where the fundamental problems of performance information are negligible and the regions statutorily obligated to increase public sector efficiency by performance budgeting. The analysis shows that the regions in general have designed the performance budgeting system to increase efficiency and mitigate the dilemma of performance budgeting between increasing activity and controlling cost at the same time. Still, there are signs of moderation of the instrumental efficiency use of performance budgeting due to political concerns for equity.

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References

  • Andreasen, M., Søgaard, J., Kjellberg, J., & Jensen, C. B. (2009). Privat/offentligt samspil i sundhedsvæsenet. Dansk Sundhedsinstitut.

  • Ankjær-Jensen, A., Rosling, P., & Bilde, L. (2006). Variable prospective financing in the Danish Hospital sector and the development of a Danish case-mix system. Health Care Management Science, 9(3), 259–268.

    Article  Google Scholar 

  • Bevan, G., & Hood, C. (2006). What’s measured is what matters: targets and gaming in the English public health care system. Public Administration, 84(3), 517–538.

    Article  Google Scholar 

  • Bevan, G., & Robinson, R. (2005). The interplay between economic and political logics: path dependency in health care in England. Journal of Health Politics, Policy and Law, 30(1–2), 53–58.

    Article  Google Scholar 

  • Brancheforeningen for Danske Privathospitaler og Klinikker (2011). Baggrundsnotat – Privathospitalerne er ikke overbetalte. http://privatehospitaler.dk/wp-content/uploads/Baggrundsnotat-Privathospitalerne-er-ikke-overbetalte-final.pdf.

  • Burgess, S., & Ratto, M. (2003). The role of incentives in the public sector: issues and evidence. Oxford Review of Economic Policy, 19(2), 285–300.

    Article  Google Scholar 

  • Carlin, T., & Guthrie, J. (2003). Accrual output based budgeting systems in Australia: the rhetoric-reality gap. Public Management Review, 5(2), 145–162.

    Article  Google Scholar 

  • Cots, F., Chiarello, P., Salvador, X., Castells, X., & Quentin, W. (2011). DRG-based hospital payment: Intended and unintended consequences. In R. Busse, A. Geissler, W. Quentin, & M. Wiley (Eds.), Diagnosis-related groups in Europe. Maidenhead: McGraw-Hill International.

    Google Scholar 

  • Curristine, T. (2007). Performance budgeting—linking funding and results. In Performance budgeting : Linking funding and results. Washington: International Monetary Fund.

  • Cutler, D. M. (2002). Equality, efficiency, and market fundamentals: the dynamics of international medical-care reform. Journal of Economic Literature, 40(2), 881–906.

    Article  Google Scholar 

  • Danske Regioner. (2009a). Aftale mellem Danske Regioner og BPK om vilkårene for private sygehuse og klinikker vedr. udvidet frit valg, Notat. http://www.regioner.dk/DanskeRegionerInternet/Aktuelt/Nyheder/2009/December/Nye%20delaftaler%20mellem%20Danske%20Regioner%20og%20privathospitalerne.asp.

  • Danske Regioner. (2009b). Fakta om takstniveau for private sygehuse i forhold til DRG-takster, Notat. http://www.regioner.dk/Sundhed/~/media/Filer/Sundhed/Fakta_om_takstniveauet_for_private_sygehuse.ashx.

  • Danske Regioner. (2010). Styr på regionerne 2010. København: Danske Regioner.

    Google Scholar 

  • Danske Regioner, & Regeringen. (2006). Aftale mellem regeringen og Danske Regioner om regionernes økonomi for 2007. København: Danske Regioner & Regeringen.

    Google Scholar 

  • Dixit, A. (2002). Incentives and organizations in the public sector: an interpretative review. The Journal of Human Resources, 37(4), 696–727.

    Article  Google Scholar 

  • Dørken, Rasmus, Simon Feilberg, Torben Buse, Mads Leth Felsager Jakobsen, Thomas Pallesen, Xenia Brun Hansen, Søren Rud Kristensen og Mickael Bech (2012). Takststyring i faste rammer. En analyse af takst- og økonomistyringen på sygehusområder. Aarhus: Krevi.

  • Entwistle, T. (2011). For appropriateness or consequences? Explaining organizational change in English local government. Public Administration, 89(2), 661–680.

    Article  Google Scholar 

  • Gilmour, J. B., & Lewis, D. E. (2006a). Assessing performance budgeting at OMB: the influence of politics, performance, and program size. Journal of Public Administration Research and Theory, 16(2), 169–186.

    Article  Google Scholar 

  • Gilmour, J. B., & Lewis, D. E. (2006b). Does performance budgeting work? An examination of the office of management and budget’s PART scores. Public Administration Review, 66(5), 742–752.

    Article  Google Scholar 

  • Hannan, M. T., & Freeman, J. (1984). Structural inertia and organizational change. American Sociological Review, 49(2), 149–164.

    Article  Google Scholar 

  • Hansen, X B. (2012). Appendiks til rapporten ”Takster i faste rammer”. Datado kumentation. Aarhus: Krevi. http://krevi.dk/files/Appendiks_-_Hansen._Datadokumentation.pdf

  • Helmuth, U. (2010). Better performance with performance budgeting? International public management journal, 13(4), 408–428.

    Article  Google Scholar 

  • Ho, A. T.-K. (2011). PBB in American local governments: it’s more than a management tool. Public Administration Review, 71(3), 391–401.

    Article  Google Scholar 

  • Hood, C. (2002). Control, bargains, and cheating: the politics of public-service reform. Journal of Public Administration Research and Theory, 12(3), 309–332.

    Article  Google Scholar 

  • Jakobsen, M. L. F. (2010). The effects of new public management: activity-based reimbursement and efficiency in the Scandinavian hospital sectors. Scandinavian Political Studies, 33(2), 113–134.

    Article  Google Scholar 

  • Jegers, M., Kesteloot, K., De Graeve, D., & Gilles, W. (2002). A typology for provider payment systems in health care. Health Policy, 60(3), 255–273.

    Article  Google Scholar 

  • Labelle, R., Stoddart, G., & Rice, T. (1994). A re-examination of the meaning and importance of supplier-induced demand. Journal of Health Economics, 13(3), 347–368.

    Article  Google Scholar 

  • Lavertu, S., & Moynihan, D. P. (2013). Agency political ideology and reform implementation: performance management in the Bush administration. Journal of Public Administration Research and Theory, 23(3), 521–549.

    Article  Google Scholar 

  • March, J. G., & Olsen, J. P. (1989). Rediscovering institutions : The organizational basis of politics. New York: Free Press.

    Google Scholar 

  • Mayne, J. (2007). Challenges and lessons in implementing results-based management. Evaluation, 13(1), 87–109.

    Article  Google Scholar 

  • Mikesell, J. L., & Mullins, D. R. (2011). Reforms for improved efficiency in public budgeting and finance: improvements, disappointments, and work-in-progress. Public Budgeting & Finance, 31(4), 1–30.

    Article  Google Scholar 

  • Miles, M. B., & Huberman, A. M. (1994). Qualitative data analysis : An expanded sourcebook (2nd ed.). Thousand Oaks: Sage.

    Google Scholar 

  • Miller, G. (2000). Above politics: credible commitment and efficiency in the design of public agencies. Journal of Public Administration Research and Theory, 10(2), 289–327.

    Article  Google Scholar 

  • Moynihan, D. P. (2005). Why and how do state governments adopt and implement “managing for results” reforms? Journal of Public Administration Research and Theory, 15(2), 219–243.

    Article  Google Scholar 

  • Moynihan, D. P. (2006). Managing for results in State government: evaluating a decade of reform. Public Administration Review, 66(1), 77–89.

    Article  Google Scholar 

  • Moynihan, D. P. (2008). The dynamics of performance management : Constructing information and reform. Washington, D.C.: Georgetown University Press.

    Google Scholar 

  • Nielsen, P. A. (2013) Performance management, managerial authority, and public service performance. Journal of Public Administration Research and Theory, forthcoming.

  • OECD. (2007). Performance budgeting in OECD countries. Paris: OECD.

    Google Scholar 

  • Pallesen, T. (1997). Health care reforms in Britain and Denmark : The politics of economic success and failure. Aarhus: Politica.

    Google Scholar 

  • Pedersen, L. D. (1997). The politics of cost containment in public services : Hospital budgeting in Denmark, Germany and the Netherlands, 1978–92. Aarhus: Politica.

    Google Scholar 

  • Pollitt, C. (1999). Integrating financial management and performance management (OECD).

  • Robinson, M. (2007). Performance budgeting models and mechanisms. In Performance budgeting : Linking funding and results (pp. 1–18). Washington: International Monetary Fund.

  • Robinson, M., & Paul, E. (2007). Performance budgeting, motivation, and incentives. In: Performance budgeting : Linking funding and results (pp. 330–378). Washington: International Monetary Fund.

  • Roy, C., & Seguin, F. (2000). The institutionalization of efficiency-oriented approaches for public service improvement. Public Productivity and Management Review, 23(4), 449–468.

    Article  Google Scholar 

  • Serritzlew, S. (2006). Linking budgets to activity: a test of the effect of output-purchase budgeting. Public Budgeting & Finance, 26(2), 101–120.

    Article  Google Scholar 

  • Street, A., Vitikainen, K., Bjorvatn, A., & Hvenegaard, A. (2007). Introducing activity-based financing: A review of experience in Australia, Denmark, Norway and Sweden, CHE Research Paper 30.

  • Swiss, J. E. (2005). A framework for assessing incentives in results-based management. Public Administration Review, 65(5), 592–602.

    Article  Google Scholar 

  • Wennberg, J. (2011). Time to tackle unwarranted variations in practice. British Medical Journal, 342(7799), 687–690.

    Google Scholar 

  • Wildavsky, A. (1961). Political implications of budgetary reform. Public Administration Review, 21(4), 183–190.

    Article  Google Scholar 

  • Wilson, J. Q. (2000). Bureaucracy: What government agencies do and why they do it (New ed.). New York: Basic Books.

    Google Scholar 

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Authors and Affiliations

  1. Aarhus University, Aarhus, Denmark

    Mads Leth Felsager Jakobsen & Thomas Pallesen

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  1. Mads Leth Felsager Jakobsen
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  2. Thomas Pallesen
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Correspondence to Mads Leth Felsager Jakobsen.

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Jakobsen, M.L.F., Pallesen, T. Performance Budgeting in Practice: the Case of Danish Hospital Management. Public Organiz Rev 17, 255–273 (2017). https://doi.org/10.1007/s11115-015-0337-8

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