Abstract
The Czech Republic experienced a significant transformation of health care due to society-wide changes that started thirty years ago. The paper aims to identify factors of successful and unsuccessful processes in giving a legislative anchor to the new form of Czech hospitals.
There were several efforts to change the organisational-legal structure of hospitals. However, it is paradoxical that despite many attempts, only two of them succeeded in entering the decision-making phase in parliament, and only one led to the successful approval of the act.
Even this act was repealed in 2011 without any real impact because it transformed no hospital. Existing literature does not address sufficiently the rarity of the policy change in this domain.
Therefore, better inquiry of the related policy process helps us better understand resistance to the policy change and this policy domain and nature of its policymaking process. A closer examination from the policy process perspective, particularly from the Multiple Streams Framework (MSF) one, fills the gap in the healthcare field and test current conceptualisations in post-communist settings of the Czech Republic and enlarge applications to the health care domain.
For this purpose, MSF represents a salient perspective, because assuming ambiguity fits well to the post-Communist country with transforming health care and competing framings of hospitals transformation. We use MSF to explain how different streams (policy, politics and problem stream) couple and open a policy window that allows a policy change.
We follow the recent MSF literature and address agenda-setting and decision-making processes that accompanied Czech hospitals' change in the new millennium. More particularly, we aim to identify the contextual factors of success or failure to open and exploit the agenda and decision windows of opportunity to change the organisational-legal form of hospitals within the reporting period.
To emphasise this rare successful adoption, we contrast it with one more attempt of change the organisational and legal arrangement of hospitals when politicians tried to replace the legislation the form of contributory organisation with a new legal form. We follow two periods (2002-2006, and 2014-2017).
Our methodology reflects the qualitative nature of the research, similar to the majority of MSF studies because it seems to be more appropriate to capture peculiarities of our cases.