Responsabilidad paradójica en el suministro de servicios públicos: El caso de la atención hospitalaria en Alemania y un experimento mental sobre México / Paradoxical Accountability in Public Service Provision.
DOI:
https://doi.org/10.29265/gypp.v26i3.357Keywords:
gobernanza, responsabilida, sistemas de salud, lógica institucional, Alemania, governance, accountability, health care systems, institutional logics, GermanyAbstract
Resumen. Este artículo explora las relaciones entre las organizaciones públicas que suministran servicios y su entorno más amplio, con énfasis en la transformación de la responsabilidad pública. El supuesto clave es que esta última se vuelve más fuerte y menos inmediata al mismo tiempo. Se elucidará esta paradoja, por un lado, con base en conceptos como la lógica institucional, la gobernanza pública orientada hacia el mercado y la rendición de cuentas híbrida y, por el otro, mediante una ilustración empírica del sector hospitalario alemán que se complementa con una pequeña incursión en el desarrollo reciente del sistema de salud mexicano. Se argumenta que, bajo la influencia de movimientos de reforma recientes, el suministro contemporáneo de dicho servicio público entraña la paradoja mencionada, sin importar los legados (nacionales) institucionales en la administración pública. Sin embargo, parece que la paradoja es más pronunciada en Estados de bienestar maduros, mientras que en países como México, la fuerte heterogeneidad dentro de los campos organizacionales afectados podría impedir un choque en todo el terreno de las lógicas institucionales, aunque otros problemas funcionales más básicos sigan siendo cruciales.
Abstract. This article explores relations between public service-providing organizations and their wider environment, with an emphasis on the transformation of public accountability. The key assumption is that the latter becomes stronger and less immediate at the same time. This paradox will be elucidated by drawing on concepts such as institutional logics, market-oriented public governance, and hybrid accountability on the one hand, and by an empirical illustration from the German inpatient care sector which is complemented by a short foray into recent developments in the Mexican health care system, on the other. It is argued that, under the influence of recent reform movements, contemporary public service provision is fraught with the aforementioned paradox, regardless of (national) institutional legacies in public management. However, it seems that the paradox is more pronounced in mature welfare states, whereas in countries such as Mexico strong heterogeneity within the affected organizational fields may impede a fieldwide clash of institutional logics even as more basic functional problems remain crucial.
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