Suchergebnisse

The international community, led by the United Nations, created Kosovo's new post-war institutions and continues to influence them, even after Kosovo declared independence in 2008. One of the very first priorities of the United Nations Interim Administration Mission in Kosovo (UNMIK) was to establish the rule of law and to develop institutions and legal frameworks for a normally functioning economy. However, after almost two decades of internationally led institution-building, Kosovo is still, measured by European standards, a poor country with weak institutions. This paper shows that the creation of institutions does not follow a rational decision-making model, even when, like in Kosovo, institutions are created under direct international involvement and with the intention to develop the rule of law and facilitate economic development. The garbage can model approach to governance and decision-making provides a better explanation of the formation of governance institutions and why institutions, despite perhaps the best intentions, do not produce the desired results; failing to solve the underlying policy problems. The case studies on the privatisation of socially owned property and the development of contract law show that, in the case of Kosovo, adopting the best international and European standards almost always meant adopting a decontextualised solution promoted by an international actor. It did not really matter if that solution indeed solved the problem. In fact, in most cases the problem remained, with new problems being created because of the inadequacy of the imported ready-made solution. The conclusion is that sometimes less international assistance is more. In the absence of so much international financial and technical assistance, Kosovar leadership would have been required to assume more ownership of the policy-making for solving their problems. Less international assistance would also have meant less competition between international actors and less pressure to adopt ready-made decontextualised solutions.

The paper outlines the current healthcare sector reform process in Kosovo and the challenges to its implementation. The reform attempts to introduce modern public management principles into Kosovo's healthcare sector, including a purchaser–provider split, performance incentives, and performance-based contracting, as well as a reorganisation of healthcare service delivery with a view to improving effectiveness and efficiency. This is the first major reform of the healthcare sector since Kosovo declared independence in 2008, and it intends to replace the healthcare system established by the United Nations between 1999 and 2008. Kosovo's earlier healthcare system had been characterised by decentralised decision-making, but was re-established by the UN in the form of an emergency healthcare system after the UN was deployed to administer Kosovo in 1999. The reform envisages separating healthcare regulators from healthcare providers and healthcare purchasers. Kosovo Hospital and University Clinical Services is established as a new entity providing healthcare services, and a new Health Insurance Fund will become the healthcare purchaser. The Ministry of Health will be restricted to the functions of a regulator, divested of all administrative functions in favour of healthcare providers and purchasers. A major challenge lies in the limited capacities of the Kosovo Government to implement such an ambitious reform. This is also an attempt to introduce modern public management principles into a public administration which is dominated by traditional public administration principles. Lack of implementation capacities and contradictory public administration principles are the most important factors that may endanger the successful implementation of the reform. ; U radu se opisuje reforma zdravstvenog sektora Kosova te izazovi s kojima se ona susreće. U sklopu reforme u kosovski se zdravstveni sektor nastoje uvesti načela modernog javnog menadžmenta, uključujući podjelu na pružatelja i kupca javnih usluga te ugovaranje temeljeno na rezultatima. Također, nastoji se provesti reorganizacija pružanja zdravstvenih usluga s ciljem povećanja djelotvornosti i učinkovitosti. Radi se o prvoj opsežnoj reformi kosovskoga zdravstvenog sektora od proglašenja nezavisnosti 2008. te se njome nastoji zamijeniti sustav koji su Ujedinjeni narodi postavili u izvanrednim okolnostima 1999., a kojim je zamijenjen dotadašnji zdravstveni sustav koji se temeljio na decentraliziranom odlučivanju. Reformom se namjerava razdvojiti regulatore zdravstvenog sustava od pružatelja i kupaca zdravstvenih usluga. Uvodi se unitarna ustanova nazvana Kosovske kliničke usluge kao novi pružatelj zdravstvenih usluga, dok novi Fond za zdravstveno osiguranje preuzima ulogu kupca zdravstvenih usluga. Funkcija Ministarstva zdravstva bit će isključivo regulacijska te će ono izgubiti sve upravljačke funkcije u korist pružatelja i kupaca zdravstvenih usluga. S obzirom na velike ambicije koje se ovom reformom žele ostvariti, velik izazov predstavljaju ograničeni provedbeni kapaciteti kosovske vlade. Reforma također predstavlja pokušaj uvođenja modernih načela javnog menadžmenta u javnu upravu kojom dominiraju tradicionalna načela. Upravo manjak provedbenih kapaciteta i proturječna načela predstavljaju glavne faktore koji bi mogli ugroziti uspješnu provedbu reforme.