The world is changing, and with it our ideas about the states role in economic and social development. This quotation shows that governments throughout the world are reconsidering their role in the health care sector, mainly because of growing pressures. The common needs within all healthcare systems of cost control and a response to the power of healthcare professionals have encouraged the use of the rhetoric of New Public Management (Radcliffe and Dent, 2005), but its exact definition and implementation is unclear. It is obvious that managers have been able to expand their domain into areas previously regarded as the responsibility of clinicians (Radcliffe and Dent, 2005). Hence because governments back out of the system, and managers and incentives get in, a new characterization of the relationship between the different actors in the health care system is needed.
New Public Management (NPM) is the dominant intellectual force in public management since the 1980s but more and more questioned since the early 2000s. Beside the difficulties of its implementation and its negative side effects it is furthermore questioned whether it really achieves the wanted efficiency in the health care sector. In order to evaluate the implementation and the impacts of NPM in the health care sector a comparison of experiences from the countries Norway and Germany is undertaken. The countries Norway and Germany provide a superior basis for a comparison, especially because of their different welfare systems and different regional conditions. Both countries implemented several reforms in order to adjust to the new circumstances that the health care sector is facing. A range of questions this review asks are: how far both countries implemented the ideas of NPM into the health care system, how the different welfare systems are influencing the implementation of NPM and whether both countries went into the same direction or into different ones regarding NPM.
Already Paul Cairney stated in his paper that the evaluation of the implementation of NPM within health care is difficult because of the absence of geographical uniformity, as well as a lack of empirical data on the subject of healthcare reform and its effects. Nevertheless, on the basis of the present literature, I will try to point out the main developments and characteristics of NPM in the organization of both countries health care systems.
1 World Bank, World Development Report 1997: The State in a Changing World2 New public management and the Thatcher healthcare legacy: enough of the theory, what about the implementation? 2002