In the last thirty years, in the context of post-communist transition and Europeanisation, hospital services in Central and Eastern Europe (CEE) have been undergoing a profound transformation. It has involved liberalization and different forms of privatization, as well as the adoption of, and the adjustment to, the acquis communautaire. The latter has included the implementation of the EU Working Time Directive (WTD). These processes have resulted in an emergence of public-private constellations of financing, provision and governance, and has significantly influenced sectoral labour relations and employment conditions (Kaminska and Kahancova 2017).
This contribution analyzes the modes of behavioural (non-)compliance with WTD in the hospital sector in CEE, and impact thereof on sectoral employment and working conditions.
With reference to the importance of the availability of resources in effective policy implementation whereby ‘struggles over the […] enforcement of institutional rules are inextricably intertwined with the resource allocations they entail’ (Mahoney and Thelen 2010:11), this paper analyzes how, given the scarcity of financial and human resources, especially doctors and nurses, the state in CEE countries has often reacted to the regulatory challenge of WTD implementation by decoupling formal and behavioural compliance (Zhelyazkova et al. 2016; Börzel et al. 2017). While WTD has been de-jure implemented into the national legal frameworks across the region, a number of countries display de-facto practices of intentional non-application on the ground, pointing to the existence of a ‘world of dead letters’ (Falkner et al. 2008). Rather than adjusting the level of financial and human resources in the hospital sector to the EU social policy requirements, the state in CEE has opted for policy drift (see Hacker 2010; Streeck and Thelen 2010), which has led to a deterioration of employment and working conditions, visible in the increasing substitution of formal employment forms with atypical forms of employment and/or self-employment, and ultimately in a demise of sectoral labour relations.
The paper relies on qualitative methods and comparatively analyzes case studies of four CEE countries (Czech Republic, Hungary, Latvia and Poland).