Autonomy of health care facilities: it is more an ideal than an institutional reality

Abstract

The issue of hospital autonomy has aroused considerable international interest since the mid-1990’s, especially with regard to its linkage to governmental decentralization processes and reform of the health field. Non-profit hospitals have increasingly been obliged to become more autonomous as they compete for funding with private institutions. Objective: to understand how autonomy expresses itself through key management processes in non-profit and for-profit hospitals both in Medellín, the second largest city of Colombia, and its metropolitan area. Different institutional factors—political, administrative and economic—influencing autonomy are examined. Methods: a grounded theory method was used, consisting of semitructured interviews with managers in six hospitals. Results: findings suggest that autonomy is perceived more as an ideal to aspire to, which would enable the hospital management to make free decisions, providing services in a manner that ensures financial sustainability. In practical terms, however, the degree of administrative and financial autonomy is circumscribed by both internal organizational factors associated with hospitals characteristics and external factors associated with institutional environment