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The soft budget constraint syndrome in the hospital sector

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  • János Kornai

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Abstract

Research to date has focused mainly on the soft budget constraint syndrome in the corporate sector and in the credit system. This article concentrates on the hospital sector. It describes the motivations and the contradictory nature of the behaviour of the patient, the physician, the hospital director, the politician and the hospital owner. The motivations explain the reasons behind the strong inclination to overspend and the tendency of softening budgetary limits. The burden of overspending and debt is pushed upward at each level of the decision-making and financing processes. This article covers the relationship between the various ownership types (state, non-profit and for-profit non-state ownership types) and the soft budget constraint syndrome. Finally, it looks at the phenomenon from normative aspects: the favourable and unfavourable consequences of the hardening of the budgetary limit and how normative dilemmas are reflected in the minds of the participants of the events.

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Bibliographic Info

Article provided by Springer in its journal International Journal of Health Care Finance and Economics.

Volume (Year): 9 (2009)
Issue (Month): 2 (June)
Pages: 117-135

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Handle: RePEc:kap:ijhcfe:v:9:y:2009:i:2:p:117-135

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Web page: http://www.springerlink.com/link.asp?id=106603

Related research

Keywords: Soft budget constraint; Bail-outs; Hospitals; Central–local government; Healthcare financing; I1; P3; H7;

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References

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  1. Massimo Bordignon, 2000. "Problems of Soft Budget Constraints in Intergovernmental Relationships: The Case of Italy," Research Department Publications 3099, Inter-American Development Bank, Research Department.
  2. Eggleston, Karen & Shen, Yu-Chu, 2011. "Soft budget constraints and ownership: Empirical evidence from US hospitals," Economics Letters, Elsevier, vol. 110(1), pages 7-11, January.
  3. Yingyi Qian & Gerard Roland, . "Federalism and the Soft Budget Constraint," Working Papers 97045, Stanford University, Department of Economics.
  4. Magnussen, Jon & Hagen, Terje P. & Kaarbøe, Oddvar M., 2006. "Centralized or decentralized? A case study of Norwegian hospital reform," Working Papers in Economics 02/06, University of Bergen, Department of Economics.
  5. Lindrooth, Richard C. & Lo Sasso, Anthony T. & Bazzoli, Gloria J., 2003. "The effect of urban hospital closure on markets," Journal of Health Economics, Elsevier, vol. 22(5), pages 691-712, September.
  6. Massimo Bordignon & Gilberto Turati, 2003. "Bailing Out Expectations and Health Expenditure in Italy," CESifo Working Paper Series 1026, CESifo Group Munich.
  7. Jonathan A. Rodden & Gunnar S. Eskeland (ed.), 2003. "Fiscal Decentralization and the Challenge of Hard Budget Constraints," MIT Press Books, The MIT Press, edition 1, volume 1, number 0262182297, December.
  8. Sujoy Chakravarty & Martin Gaynor & Steven Klepper & William B. Vogt, 2005. "Does the Profit Motive Make Jack Nimble? Ownership Form and the Evolution of the U.S. Hospital Industry," GSIA Working Papers 2005-E55, Carnegie Mellon University, Tepper School of Business.
  9. Dewatripont, Mathias & Tirole, Jean, 1996. "Biased principals as a discipline device," Japan and the World Economy, Elsevier, vol. 8(2), pages 195-206, June.
  10. Yu-Chu Shen & Karen Eggleston, 2008. "The Effect of Soft Budget Constraints on Access and Quality in Hospital Care," NBER Working Papers 14256, National Bureau of Economic Research, Inc.
  11. Capps, Cory & Dranove, David & Lindrooth, Richard C., 2010. "Hospital closure and economic efficiency," Journal of Health Economics, Elsevier, vol. 29(1), pages 87-109, January.
  12. Mathias Dewatripont & Eric Maskin, 2004. "Credit and efficiency in centralized and decentralized economies," ULB Institutional Repository 2013/9605, ULB -- Universite Libre de Bruxelles.
  13. Eggleston, Karen, 2008. "Soft budget constraints and the property rights theory of ownership," Economics Letters, Elsevier, vol. 100(3), pages 425-427, September.
  14. David Rae, 2005. "Getting Better Value for Money from Sweden's Healthcare System," OECD Economics Department Working Papers 443, OECD Publishing.
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Cited by:
  1. Brekke, Kurt R. & Siciliani, Luigi & Straume, Odd Rune, 2012. "Hospital competition with soft budgets," Discussion Paper Series in Economics 6/2012, Department of Economics, Norwegian School of Economics.
  2. Martine Audibert & Xiao Xian Huang & Jacky Mathonnat & Aurore Pelissier & Anning Ma, 2012. "Health Insurance Reform and Efficiency of Township Hospitals in Rural China: An Analysis from Survey Data," Working Papers halshs-00587799, HAL.
  3. Massimiliano Piacenza & Gilberto Turati, 2010. "Does fiscal discipline towards sub-national governments affect citizens’ well-being? evidence on health," Working Papers 2010/56, Institut d'Economia de Barcelona (IEB).
  4. Karen Eggleston & Yu-Chu Shen & Mingshan Lu & Congdong Li & Jian Wang & Zhe Yang & Jing Zhang, 2009. "Soft budget constraints in China: Evidence from the Guangdong hospital industry," International Journal of Health Care Finance and Economics, Springer, vol. 9(2), pages 233-242, June.
  5. Yu-Chu Shen & Karen Eggleston, 2009. "The effect of soft budget constraints on access and quality in hospital care," International Journal of Health Care Finance and Economics, Springer, vol. 9(2), pages 211-232, June.

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