Reforms of Czech Hospitals in Multiple Streams Perspective: The Cases of Success and Failure

Abstract The Czech Republic experienced a significant transformation of health care as a consequence of society-wide changes which started 30 years ago. The article aims to identify factors of successful and unsuccessful processes in giving a legislative anchor to the new organisational–legal form of Czech hospitals after 2000. There were several attempts to change the organisational–legal structure of hospitals. Just two of them succeeded to enter the decision-making phase in the Parliament, and only one led to successful approval of the Act. In the article, we use the Multiple Stream Framework (MSF) to explain how different streams (policy, politics and problem stream) couple and open a policy window that allows a policy change. We chose modified MSF, which broadens the concept by including the agenda-setting as well as decision-making processes and offers two coupling processes. In a comparison of two cases of the policy process, we identified the factors that cause closing the window before the agenda is set.