Public management reforms and their impact on democratic processes

Over recent decades, a religious-like reform fervour has dominated the hospital sector in many European countries. Among them, Germany has systematically enacted cost containment measures, as well as other governance reforms designed to increase the efficiency of the hospital care system. Many of these reforms aimed at promoting managerialism and increasing managerial autonomy of hospitals in the hope of relieving central governments from direct intervention in the operational strategies of public hospitals. ‘Autonomy’ has become a golden value associated with managerial reforms, an uncontested solution to the vicissitudes facing public hospitals in Europe, under enormous pressures from demographic changes, the recent financial crisis, rising patients’ demands and increasing technological costs.