Budgetary Control in Public Health Care - A Study about Perceptions of Budgetary Control among Clinical Directors

Health care expenditures have increased rapidly in most OECD-countries, and several reforms have been considered for the improvement of cost-containment in the health care sector. Physicians in particular have been recognized to have considerable impact on health care expenditures and as a result they have become increasingly involved in budgetary control with the hope of a more efficient use of resources. Until 1997 only physicians were allowed to take clinical directional positions in Sweden. Then a new regulation made it possible for non-physicians to become clinical directors of a hospital department or primary care centre. Most often it has been nurses who entered such positions in the Swedish health care. The overall aim of this thesis was to analyse perceptions of tight budgetary control among clinical directors with different professional backgrounds in public health care organizations. Three questionnaire surveys of clinical directors in both hospitals and primary health care have been conducted. The results suggest that the perception of budgetary control differs between groups of clinical directors. The nurses often perceived the budgetary control as tighter than the physicians. The findings adhere to previous theories that nurses in directorial positions adopt administrative principles more easily; they accept and feel more bound by budgetary control than physicians in the same position. An alternative interpretation is that nurses in these positions actually are more controlled by the hospital management than the physicians. The nursing profession has a lower status and nurses in directorial positions may have less autonomy for managing their department.