Does the new public management contribute to improving the performance of obstetric care in Mexico public hospitals?

Belkis Aracena Genao,René Leyva,María Del Rocío Soto Flores

doi:10.22201/fca.24488410e.2019.2109

Abstract

In pursuit of higher performance in the Public Administration, the Mexican government implemented the New Public Management (NPM) model in 2008, with the aim of correcting deficiencies in its public services - including those of the Ministry of Health (MoH) -. In ten years of work under the new model, no information has been provided on the effects of NPM on the performance indicators, such as effectiveness and efficiency, of government institutions. The present study had the objective to analyze the impact of the NPM on the effectiveness and efficiency of MoH care facilities. Effectiveness was evaluated as the proportion of hospital discharges (HD) indicating a recovery diagnosis, and efficiency as the average length of hospital stays, modeled with survival analysis and local kernel regression methods. Data analyzed pertained to a time series of 16.5 million obstetric HD (64% of total discharges) produced from 2000 to 2015. The results revealed high levels of effectiveness (98% of HD with recovery diagnosis) and efficiency (an average hospital stay of 1.74 days), before and after NPM. The consistently high performance throughout the period analyzed, indicate that MoH hospitals had attained optimal effectiveness and efficiency levels prior to the NPM implementation. The indistinctive impact of the public management reform may suggest that NPM was applied as a blanket solution without considering institutional specificities.

Highlights

Ineffectiveness and inefficiency in public services have caused substantial concern worldwide, with government institutions often viewed as incapable of responding to the constantly changing needs of society (World Bank, 2016)
From 2009 to 2015, that is, following New Public Management (NPM) implementation, obstetric complications rose to 50.4% of obstetric hospital discharges (HD), followed by vaginal (45.2%) and cesarean (4.4%) deliveries (Figure 1)
The results presented here indicate that the administration of public health services related to obstetric care was already highly effective - even exceeding the national target of 93.3% (Ministry of Health (MoH), 2017) - prior to NPM implementation, and remained stable (98%) throughout the period analyzed

Summary

Introduction

Ineffectiveness and inefficiency in public services have caused substantial concern worldwide, with government institutions often viewed as incapable of responding to the constantly changing needs of society (World Bank, 2016). A number of proposals have been formulated with the aim of transforming the administrative model of governments into one grounded in the principles of private management (Marvel, 2016). NPM requires governments to participate in the economy as facilitators, rather than competitors, of private activity (World Bank, 2016). It proposes that governments transform their institutions into outcome-driven organizations that abandon bureaucratic schemes in order to focus on effectiveness and efficiency as the cornerstones in the production of social services for those unable to afford them privately (World Bank, 2016)

Methods

Results

Discussion

Conclusion