Successful Multiple Couplings in the Czech Health Care Policy Settings

The development of the Czech health care policy after 1989 corresponded to the development in the region of Central and Eastern Europe that experienced a major transformation of health care as a consequence of society-wide changes. A key feature of Czech health care reform was the principle of de-monopolization and decentralization. The aim of the paper is to use the multiple streams’ lens to identify factors of successful and unsuccessful processes in giving a legislative anchor to the new organizational-legal form of Czech hospitals after 2000. There were several attempts to change the organizational-legal structure of hospitals – in 2004, 2008 and 2017, but only one of them led to the successful approval of the Act. The multiple stream framework (MSF) was originally developed by John Kingdon (1984) to explain how different streams (policy, politics and problem streams) couple and open a policy window that allows a policy change. It is considered as one of the significant contributions to public policy research, particularly in the field of agenda setting. The research paper is based on modified MSF which broadens the concept by including agenda setting as well as decision-making process as proposed by Zohlnhöfer, Herweg, and Huß (2016). The modified framework offers two coupling processes. Following authors have often applied MSF to other levels of public policy in different countries and across a range of fields. Thus, the research paper develops the MSF and particular public policy in health care field and specifically in the Central Europe.