The extent of New Public Management thinking in Public Administration Reform in Central and Eastern Europe: A comparative study of Primary Health Care reforms in Estonia and Romania

The proposed paper will seek to analyse comparatively reform in health care in Estonia and Romania since the early 1990s to 2012. The focus of the paper is on understanding the underlying theory and temporal development of new public management (NPM) type reforms that have been promoted and implemented in primary health care (PHC) in the two health care systems. In both countries reforms in healthcare were impelled after the fall of communism (1991 and 1989 respectively) concurrently with numerous fundamental reforms in the public sector aimed at the establishment of democratic state structures and moving from centralized state planned economies towards market oriented free economies. Hence the health sector reforms in Estonia and Romania are typical examples of large scale public sector reforms (and policymaking) in transitional societies. Using an extensive list of official and academic documents from both countries, the paper will trace the progression of NPM thinking in PHC to identify and compare the rationale, patterns and implementation success or failure. Theoretically and methodologically, the research will combine ‘new institutionalism’, particularly historical institutionalism and process tracing to explore and explain the changes in the reform process. On the basis of this detailed analysis the paper will seek to anchor its findings into the larger public management literature in healthcare and draw theoretical and practical implications for future research and for practice