Paper/Speech Details of Conference Program for the 27th NISPAcee Annual Conference Program Overview PhD Pre-conference Seminar Author(s) Olga Angelovska Charles University Praha 2 Czech Republic Title A Multiple Stream Approach and Understanding Resistance and Change: the Case of Czech Hospitals File Paper files are available only for conference participants, please login first. Presenter Olga Angelovska Abstract Recent decades the roles played by the state and the market in the public sectors have seen a major transformation. Health systems have had to cope with many socio-economic and political environment changes, such as pressures to contain costs, changes in the welfare state (Pierson 2001, Bonoli 2004), and globalization processes (Edwards, Wyatt, McKee 2004, Vetter 1995). A key feature of Czech health care reform after 1989 was the principle of de-monopolization and decentralization. At the same time, the health care reforms focused on the privatization of health care facilities and health care providers (Angelovská, Háva 2010). Long-term evaluation of the differences between private and public health have not been able to identify any significant positive evidence supporting the promised benefits of this privatization process (Maarse 2006). However, there is an inverse relationship between the level of solidarity in access to health care and competition (Saltman, Figueras 1998). In my paper as well as in my Ph.D. thesis I focus on efforts to change the organizational-legal status of hospitals after 2000 when a reform of the state administration occurred. The main goal is to understand why some affords have been successful (the law passed in 2005) and some unsuccessful (the laws proposed in 2008 and 2017) in giving a legislative anchor to the new organizational-legal form of hospitals. In order to do this, I used the multiple stream framework which was developed by John Kingdon (1984) to explains how different streams (policy, politics and problem streams) couple and open a policy window that allows a policy change. While being a theory of agenda setting in US, Kingdon´s theory has been also applied to implementation processes and other public policy fields and countries (Kane 2016, Zohlnhofer et al. 2015, Herweg 2016, Ackrill at al. 2013, Mukherjee, Howlett 2015). I use a broadened concept combining the multiple streams framework and the policy process theory (Howlett, Connell, Perl 2016), which clarify why and up to what stage some of the initiatives succeeded or failed. The research adopted a case study design. Data were obtained through document analysis (law proposals, resolutions of Constitutional Court, stenographic records, strategic documents etc.) and semi-structured interviews with experts in the health care policy.
