SAĞLIK HİZMETLERİNİN ÖRGÜTLENMESİNDE KAMU-ÖZEL ORTAKLIĞI

Year 2011, Volume: 66 Issue: 03, 217 - 262, 01.03.2011

Koray Karasu

https://doi.org/10.1501/SBFder_0000002221

Cited By: 20

Abstract

Keywords

-

SAĞLIK HİZMETLERİNİN ÖRGÜTLENMESİNDE KAMU-ÖZEL ORTAKLIĞI

Abstract

Kamu-özel ortaklığı, yönetim ilişkisini kuşatan ve dönüştüren sözleşme temelinde bir örgütlenme modelidir. Sağlık alanında hızla yaygınlaşan bu model, hizmetlerin işletmecilik esasları temelinde örgütlendirilmesine dayanmakta olup, hizmetlerin finansmanı ve örgütlenme ilke ve değerleri açısından piyasa dostu bir modeldir. Devletin sadece tıbbi hizmet (çekirdek hizmet) üretiminde yer aldığı bu modelde, sağlık tesislerinin yapımı, tıbbi destek ve tıbbi olmayan hizmetlerin sunumu ve ticari alanların işletilmesi özel sektöre (tek bir ortak girişime) blok halinde devredilmektedir. Bu şekilde ölçeğin de büyütüldüğü modelin kilit özelliği, finansman biçimidir. Devlet, uzun süreli sözleşmelerle ortak girişimden temin ettiği mal, hizmet ve yapım işinin karşılığını bütçe dışı yollarla, yıllık kira şeklinde ödemektedir. Yazı, sağlık hizmetleri alanında Türkiye’de kamu-özel ortaklığı modeliyle yapılacak hastanelerin örgütlenme biçimini, modeli uygulayan farklı ülkelerin deneyimlerinden de yararlanarak analiz etmeyi amaçlamaktadır. Çalışmada model, dayandığı neo liberal örgüt kuramlarının varsayımları açısından da test edilerek eleştirel bakışla değerlendirilmektedir.

Keywords

Kamu-özel ortaklığı, kamu örgütlenmesi, sözleşme ilişkisi, sözleşme yönetimi, sağlık yönetimi

References

• Akdağ, Recep (Ed.) (2010), Türk Sağlık Sistemi’nde Kurum Dışından Hizmet Alım Uygulamaları: Araştırma Raporu (Ankara: Refik Saydam Hıfzısıhha Merkezi Başkanlığı).
• Argyriades, Demetrios (2010), “From Bureaucracy to Debureaucratization?” Public Organization Review, 10/3: 275–297.
• Ataay, Faruk (2008), “Sağlık Reformu ve Yurttaşlık Hakları,” Amme İdaresi Dergisi, 41/3: 169-184.
• Büber, Bülent (2010), Yeni Bir Çatışma Alanı: Kamu Alımları (Ankara: AÜ SBE Yayımlanmamış Doktora Tezi).
• Council of Europe (2003), Guide to Successful Public-Private Partnerships, DG Regio March 2003, ec.europa.eu/regional_policy/sources/docgener/guides/ppp_en.pdf, (20.06.2011).
• Council of Europe (2004), Green Paper on Public-Private Partnerships and Community Law on Public Contracts and Concessions, COM (2004) 327 final. Brussels 30.04.2004, http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=COM:2004:0327:FIN:EN:PDF, (20.06.2011).
• Edwards, Pam - Shaoul, Jean - Stafford, Anne - Arblaster, Lorna (2004), Evaluating The Operation of PFI in Roads and Hospitals (London: Certified Accountants Educational Trust).
• Eisenstadt, S. N. (1959), “Bureaucracy, Bureaucratization, and Debureaucratization,” Administrative Science Quarterly, 4/3: 302-320.
• Flinders, Matthew (2005), “The Politics of Public–Private Partnerships,” The British Journal of Politics and International Relations, 7/2: 215-239.
• Gerrard, Michael B. (2001), “What Are Public-Private Partnerships, and How Do They Differ from Privatization,” Finance & Development, A Quarterly Magazine of the IMF, 38/3: 1-4.
• Grimsey, Darrin - Lewis, Mervyn K. (2005), “Are Public Private Partnerships Value For Money? Evaluating Alternative Approaches and Comparing Academic and Practitioner Views,” Accounting Forum, 29: 345–378.
• Grimshaw, Damian - Vincent, Steven - Willmott, Hugh (2001), “New Control Modes and Emergent Organizational Forms: Private-Public Contracting in Public Administration,” Administration Theory & Praxis, 23/3: 407-430.
• Grimshaw, Damian - Vincent, Steven - Willmott, Hugh (2002), “Going Privately: Partnership and Outsourcing in UK Public Services,” Public Administration, 80/3: 475-502.
• Hall, David (2004), PPPs: a Critique of the Green Paper (London: Public Services International Research Unit (PSIRU).
• Hoggett, Paul (1996), “New Modes of Control in the Public Services,” Public Administration, 74: 9- 32.
• House of Commons (Treasury Committee) (2011), Private Finance Initiative: Written Evidence, 17.5.2011,
• http://www.publications.parliament.uk/pa/cm201012/cmselect/cmtreasy/ writev/pfi/pfi.pdf, (01.07.2011). Jorna, Frans - Wagenaar, Pieter - Das, Enny - Jezewski, Jan (2010), “Public–Private Partnership in Poland: A Cosmological Journey,” Administration & Society, 42/6: 668-693.
• Karasu, Koray (2009a), “Yeni ‘Kamusal’ Örgütler: Kamu Yararı Şirketleri,” AÜ SBF Dergisi, 64/3: 117-147.
• Karasu, Koray (2009b), “Kamu-Özel Ortaklığı: Sözleşme Sisteminin Genelleşmesi,” Övgün, B. (ed.), Kamu Yönetimi: Yapı-İşleyiş-Reform (Ankara: KAYAUM): 79-91.
• Linder, S. H. (1999), “Coming to Terms With the Public-Private Partnership: A Grammar of Multiple Meanings,” The American Behavioral Scientist, 43/1: 35-51.
• Lister, John (2003), The PFI Experience: Voices from the Frontline (London: Unison).
• McKee, Martin - Edwards, Nigel - Atunc , Rifat (2006), “Public–Private Partnerships for Hospitals,” Bulletin of the World Health Organization, 84/11: 890-896.
• Miraftab, Faranak (2004), “Public-Private Partnerships: The Trojan Horse of Neoliberal Development,” Journal of Planning Education and Research, 24: 89-101.
• Mols, Frank (2010), “Harnessing Market Competition in PPP Procurement: The Importance of Periodically Taking a Strategic View,” The Australian Journal of Public Administration, 69/2: 229-244.
• Monbiot, George, “Public Fraud Initiative,” http://www.guardian.co.uk/politics/2002/jun/18/ publicservices.politicalcolumnists, (4.5.2011).
• National Audit Office (NAO) (2002), The PFI Contract for the Redevelopment of West Middlesex University Hospital (London: HC 49 Session 2002-2003: 21).
• National Audit Office (NAO) (2010), The Performance and Management of Hospital PFI Contracts (London: HC 68 Session 2010–2011).
• National Audit Office (NAO) (2011), Lessons From PFI and Other Projects (London: HC 920 Session 2010–2012).
• OECD (2008a), Public-Private Partnerships: In Pursuit of Risk Sharing and Value for Money (OECD Publishing, Paris).
• OECD (2008b), OECD Sağlık Sistemi İncelemeleri Türkiye (OECD-World Bank).
• OECD (2010), Dedicated Public-Private Partnership Units: A Survey of Institutional and Governance Structure (OECD Publishing, Paris).
• Parker, David - Hartley, Keith (2003), “Transaction Costs, Relational Contracting and Public-Private Partnerships: A Case Study of UK Defence,” Journal of Purchasing & Supply Management, 9: 97-108.
• Pollock, Allyson M. - Price, David - Moritz, Liebe (2011), “Private Finance Initiatives During NHS Austerity,” BMJ, 342: 417-419.
• PricewaterhouseCoopers (PwC) (2010), Build and Beyond: The (R)evolution of Healthcare PPPs, http://www.pwccn.com/home/eng/healthcare_ppp_dec2010.html, (20.05.2011).
• Sağlık Bakanlığı (2003), Sağlıkta Dönüşüm (Ankara). Shaoul, Jean (2005), “The Private Iniative or The Public Funding of Private Profit,” Hodge, Graeme A. - Greve, Carsten (Eds.), The Challenge of Public-Private Partnerships: Learning from International Experince (UK: Edward Elgar Publishing): 190-206.
• Sönmez, Mustafa (2010), Paran Kadar Sağlık; Türkiye’de Sağlığın Ticarileşmesi (İstanbul: Yordam Kitap
• Standard & Poor’s (2005), Infrastructure & Public Finance Ratings, Public Private Partnerships, Global Credit Survey 2005, http://www2.standardandpoors.com/spf/pdf/fixedincome/ PPP_Credit_Survey_2005.pdf, (13.05.2011).
• Tan, Turgut (1995), “İdari Sözleşme Kuramına İlişkin Gözlemler,” AÜ SBF Dergisi, 50/3-4: 291- 309.
• TÜSİAD (2005), Charting The Way Forward: Health Care Reform in Turkey (İstanbul: TÜSİAD Publication).
• Vincent-Jones, Peter (2000), “Contractual Governance: Institutional and Organizational Analysis,” Oxford Journal of Legal Studies, 20/3: 317-351.
• Vincent-Jones, Peter (2007), “The New Public Contracting: Public Versus Private Ordering,” Indiana Journal of Global Legal Studies, 14/2: 259-278