Acting on the Edge of Public Sector: Hospital Corporatization and Collective Bargaining in Hungary and Slovakia

Effective public sector management became central to economic and political debates across Europe in the last decade. One of the most affected domains is public healthcare that is often subject to ambiguous reforms combining private and public sector “best practices”. This paper attempts to extend our theoretical and empirical knowledge on healthcare reforms and their effect on employment relations in Hungary and Slovakia. A particularly salient feature of healthcare reforms in both countries is hospital corporatization, defined as a process in which public hospitals become subject to regulations applicable to private sector companies, formally entailing the possibility of bankruptcy. We argue that effects of corporatization on employment relations are more complex than the available literature in organizational change and public sector management suggests. Corporatization contributed to stability in bargaining patterns, while produced diversity in bargaining outcomes in Hungary and Slovakia. Particular effects of corporatization have been channelled through the interests and responses of involved actors. Despite market-oriented reforms of the institutional environment, we found remarkable similarities in how actors responded to hospital reorganization; and in the stability of bargaining institutions due to actors’ commitment or inability to bring forth institutional change in bargaining patterns.