Management in Health, Vol 15, No 1 (2011)

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SOCIAL NETWORK ANALYSIS AS A TOOL TO EVALUATE THE BALANCE OF POWER ACCORDING TO THE SERBIAN HEALTH INSURANCE ACT

Helmut WENZEL, Vesna BJEGOVIC, Ulrich LAASER

Abstract


The Serbian Health Insurance Act of 2005 was supposed to be a corner stone for a more decentralised health care system, which offers to the insured, an opportunity for greater self-management.  The questions now are whether the new organisational structure would foster a transition from a socialistic health care system to a more contribution driven system (which also is based on a rather decentralised decision making and funding), and how the balance of power is institutionalised. We have studied the structure of the Serbian health care system and describe how the various players are positioned in the network applying Social Network Analysis (SNA). Power arises from occupying advantageous positions. The distribution and balance of power may be depicted by three ”measures of advantage” (indices): degree centrality, closeness centrality and betweenness centrality. The SNA was set up applying a position approach for two reasons:  firstly, to analyse the formal structure as it is laid down in the law and, secondly, it is less time-consuming. Other options like reputation approach and decision approach would have to refer to surveys and questionnaires. The matrix of connectivity representing the directed links was exported to Visone 2.6.2 for further analysis and visualisation. The SNA depicted here and the corresponding distribution of power is a snapshot of players, their links and the associated possibilities to exercise power. The structure found is therefore the framework for concrete policy-making, enabling or impeding political problem solving. Our findings could be seen as a basis for further analyses of specific decisions/non-decisions where capacity is converted into concrete action.

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