ISSN 2591-2240 Volume 23 Number 2 November 2025 Central European Public Administration Review Volume 23, Number 2, November 2025 ISSN 2591-2240 (printed ed.) ISSN 2591-2259 (on-line ed.) Central European Public Administration Review Volume 23, Issue 2, 2025 Slovenian title: Srednjeevropska revija za javno upravo Editor-in-chief: Prof. Maja Klun (University of Ljubljana, Faculty of Public Administration, Slovenia) Technical and managing editor: Nataša Svržnjak Layout designer: Dean Zagorac Cover designer: Branka Smodiš Translation and language proofreading of selected parts: Dean Zagorac Field/Section editors: – Prof. Aleksander Aristovnik (University of Ljubljana, Faculty of Public Administration, Slovenia) – Assist. Prof. Nejc Brezovar (University of Ljubljana, Faculty of Public Administration, Slovenia) – Prof. Gerhard Hammerschmid (Hertie School of Governance, Germany) – Assoc. prof. 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We would like to thank the following organisations for their support: Contents Lucie Sedmihradská, Eduard Bakoš 7 Budget Punctuations in Czech Local Government 1.01 Original scientific article Špela Mar, Nina Kristl, Eva Murko, Jernej Buzeti, Polonca Kovač 31 Advancing the Legal Competences of Public Officials through the Administrative Consultation Platform: A Conceptual and Empirical Approach 1.01 Original scientific article Armenia Androniceanu, Sofia Elena Colesca 63 Triple Helix Model and Artificial Intelligence in Public Administration 1.01 Original scientific article Tomislav Geršić, Nenad Vretenar, Jelena Jardas Antonić 93 Country Attractiveness for Conducting Clinical Trials – A Literature Review 1.01 Original scientific article Eva Ivanová, Katarína Štefčíková, Martina Jakubčinová 119 Implementation of the SMART Concept within the Framework of the 2030 Agenda in the NUTS 3 Regions of the Slovak Republic 1.01 Original scientific article Tatyana Tomova, Elena Kalfova, Simeon Petrov, Kaloyan Haralampiev 155 Environmental Policy Implementation: Can We Reduce Failures Without Changing Objectives? 1.01 Original scientific article Romario Marijanović, Mihaela Bronić, Simona Prijaković 191 Analysis of the Cost Efficiency of Public General Hospitals in Croatia 1.01 Original scientific article Michal Radvan, Klára Doležalová 221 Fair Taxation of Inheritance? 1.01 Original scientific article Mari-Isabella Stan, Tănase Tasențe 239 From Co-Creation to Circular Cities: Exploring Living Labs in EU Governance Frameworks – A Literature Review 1.01 Original scientific article Natalija Shikova 271 The Ombudsman as a Guardian of Good Governance: Insights from North Macedonia 1.01 Original scientific article Dalibor Stanimirović, Tatjana Stanimirović 301 Beyond the Speculation: Mapping the Real Impacts of Digitalization on the Slovenian Healthcare Business Model 1.01 Original scientific article DOI: 10.17573/cepar.2025.2.01 1.01 Original scientific article Budget Punctuations in Czech Local Government Lucie Sedmihradská Prague University of Economics and Business, Czech Republic sedmih@vse.cz https://orcid.org/0000-0001-5474-2673 Eduard Bakoš Masaryk University, Faculty of Economics and Administration, Czech Republic eduard.bakos@econ.muni.cz https://orcid.org/0000-0001-7186-3418 Received: 3. 2. 2025 Revised: 6. 5. 2025 Accepted: 26. 6. 2025 Published: 11. 11. 2025 ABSTRACT Purpose: This paper aims to identify which phases of the budgetary pro- cess are, according to the predictions of punctuated equilibrium theory, more prone to punctuations; to determine the factors influencing the oc- currence of punctuations in these phases; and to test these assumptions using Czech regional data from 2005 to 2023. Design/methodology/approach: The study utilises data on Czech re- gional current expenditure from 2005 to 2023, disaggregated into 113 functional budget lines. A two-sample Z-test is employed to determine whether the number of large annual changes in a functional budget line differs across the approved, amended, and executed budgets. A binary logit model is applied to assess whether external shocks, electoral chang- es, or budget complexity increase the likelihood of punctuations in the different budget phases. Findings: The analysis reveals that punctuations occur more frequently in budget allocation than in actual spending, and that greater complexity in the budgeting process leads to an increased number of punctuations. The number of punctuations rose during the rebudgeting phase in response to the COVID-19 outbreak in 2020 and the influx of Ukrainian refugees in 2022. Elections and changes in government leadership were found to have no significant impact. Academic contribution to the field: This paper offers a novel application of punctuated equilibrium theory by linking it to the distinct phases of lo- cal government budgeting. It traces the evolution of punctuations across the stages of approved, amended, and executed budgets, and evaluates the influence of external shocks. The study demonstrates the theory’s Sedmihradská, L., Bakoš, E. (2025). Budget Punctuations in Czech Local Government. 7 Central European Public Administration Review, 23(2), pp. 7–29 2591-2259 / This is an open access article under the CC-BY-SA license https://creativecommons.org/licenses/by-sa/4.0/ Lucie Sedmihradská, Eduard Bakoš adaptability in analysing the effects of unprecedented events on public policy and budgeting. Originality/significance/value: The research recognises the differentia- tion between local government budgeting phases in terms of institution- al costs and exogenous shocks affecting decision-making and implemen- tation. This segmentation of the budgetary process makes a significant contribution to both the theoretical understanding and practical applica- tion of the punctuated equilibrium theory. Keywords: budgetary process, Czech Republic, local government, punctuated equilibrium theory, rebudgeting Proračunske diskontinuitete v češki lokalni samoupravi POVZETEK Namen: avtorja si prizadevata ugotoviti, katere faze proračunskega pro- cesa so po napovedih teorije prekinjenega ravnotežja bolj podvržene dis- kontinuitetam; določiti dejavnike, ki vplivajo na pojav diskontinuitet v teh fazah; ter te predpostavke preveriti na podatkih čeških regij za obdobje 2005–2023. Načrt/metodologija/pristop: študija uporablja podatke o tekočih izdat- kih čeških regij za obdobje 2005–2023, razčlenjene na 113 funkcionalnih proračunskih postavk. Za ugotavljanje, ali se število velikih letnih spre- memb v posamezni funkcionalni postavki razlikuje med sprejetim, spre- menjenim (rebalansiranim) in realiziranim proračunom, je uporabljen Z-test za dva vzorca. Za oceno, ali zunanji pretresi, volilne spremembe ali kompleksnost proračuna povečajo verjetnost diskontinuitet v različnih proračunskih fazah, je uporabljen binarni logitni model. Ugotovitve: analiza razkrije, da se diskontinuitete pogosteje pojavljajo pri proračunskih alokacijah kot pri dejanski porabi ter da večja kompleksnost proračunskega procesa vodi v večje število diskontinuitet. Število diskon- tinuitet se je v fazi rebalansa povečalo kot odziv na izbruh covida-19 leta 2020 in prihod ukrajinskih beguncev leta 2022. Volitve in spremembe v vodstvu vlade niso imele pomembnega (statistično značilnega) vpliva. Akademski prispevek k področju: članek ponuja novo aplikacijo teorije prekinjenega ravnotežja, saj jo povezuje z različnimi fazami proračun- skega procesa v lokalni samoupravi. Sledi razvoju diskontinuitet sko- zi faze sprejetih, spremenjenih in realiziranih proračunov ter ocenjuje vpliv zunanjih pretresov. Študija pokaže prilagodljivost teorije pri analizi učinkov dogodkov brez primere na javne politike in proračun. Izvirnost/pomen/vrednost: raziskava prepoznava razlikovanje med fa- zami lokalnega proračunskega procesa glede institucionalnih stroškov in eksogenih pretresov, ki vplivajo na odločanje in izvedbo. Ta segmentacija proračunskega procesa je pomemben prispevek tako k teoretičnemu ra- zumevanju kot tudi k praktični uporabi teorije prekinjenega ravnotežja. Ključne besede: proračunski proces, Češka republika, lokalna samouprava, teorija prekinjenega ravnotežja, rebalans proračuna JEL: H70, H72 8 Central European Public Administration Review, Vol. 23, No. 2/2025 Budget Punctuations in Czech Local Government 1 Introduction The theory of punctuated equilibrium explains long-term empirical observa- tions of budgetary behavior, showing that periods of relative stability or mi- nor changes (so-called increments) are interrupted by more sizable changes (so-called punctuations) (True et al., 1999). Although the pattern, predicted by the punctuated equilibrium theory, was confirmed in every study exam- ining public budgets (True et al., 2007), little attention was paid so far to the different phases of the budget cycle, when the budget is first approved by the legislative body, then goes under numerous budget amendments (rebud- geting) and faces impossibility or unwillingness to spend fully the budget al- location, ultimately leading to substantial differences between the approved, amended, and executed budgets (Dougherty et al., 2003). The purpose of the paper is to determine what phases of the budgetary pro- cess are according to the predictions of the punctuated equilibrium theory more prone to punctuations, which factors determine the occurrence of punctuations in the different budget phases, and to test these assumptions using Czech regional data from 2005 to 2023. We take advantage of the availability of detailed budget data in all three bud- get phases for the 13 Czech regions and use data on the Czech regional cur- rent expenditure from 2005 to 2023 disaggregated into 113 functional bud- get lines. The two-sample Z-Test is used to determine if the number of large annual changes in a functional budget line differs in the approved, amended, and executed budgets. A binary logit model is used to test whether external shocks, electoral change or budget complexity make policymakers more likely to adopt punctuations in the different budget phases. The use of the punctuated equilibrium theory framework allowed us to ex- pand the analysis of resource allocation in the public sector from merely an- alyzing final budget data to including the decision-making process that pre- cedes these final outcomes as well. The decision-making process involves many participants and responds to a variety of rules, characteristics of the internal and external environment, and various impulses. The punctuated equilibrium theory provides predictions about how all these variables can affect the final allocation, and its verification in different contexts generally brings a better understanding of the decision-making processes in the allo- cation of public funds. We see the contribution of our paper as twofold: in identifying the impact of additional budgetary changes during the fiscal year and in using unique data on the second tier of local government from a country in Central and Eastern Europe with fragmented public administration. To our knowledge, our study is one of the few studies (e.g., Sebők and Berki, 2017, Sebők and Berki, 2018, Wordlizcek, 2021 or Pernica and Zdražil, 2022) testing the hypotheses of the punctuated equilibrium theory in the Central and Eastern Europe. Central European Public Administration Review, Vol. 23, No. 2/2025 9 Lucie Sedmihradská, Eduard Bakoš The paper begins with an introduction to punctuated equilibrium theory and its predictions regarding punctuations in various phases of the budget pro- cess. Five hypotheses are proposed to be tested. This is followed by an over- view of the characteristics of Czech regions and the local government budget process. Subsequently, the data, variables, and methods used to test the hy- potheses are described. Finally, the results are presented and discussed. 2 Punctuated Equilibrium Theory of Budgeting Punctuated equilibrium theory offers an agenda-based model of budgeting when the boundedly rational process of human decision-making and disag- gregated political institutions cause budgets to change only incrementally until a radical change occurs (True et al., 2007). Baumgarten and Jones pro- posed the theory for the very first time in 1993 and in the next two decades, they thoroughly developed, explained, and tested it with several coauthors. When decision makers incrementally adjust this year’s budget from a start- ing point of last year’s budget, the annual changes within a given spending category have a normal distribution. This is, however, not the situation we observe in the real world, where decision-makers prioritize information and their subsequent actions and which leads to non-Gaussian dynamics (Jones et al., 2009). The distribution of annual budget changes is leptokurtic, with a high central tendency and fat-tails (Jordan, 2003). Policymaking institutions are generally sticky and do not allow continuous adjustment to the environment. Jones et al. (2003) mark this as institutional friction. Friction results from either elevated decision costs or disproportion- ate information processing. The more friction an institution imposes on its ability to adapt to changes in the environment, the more punctuated is the institution’s process of change (Park and Sapotichne, 2020). Institutional friction is influenced by institutional costs, which include decision and transaction costs (Jones et al., 2003, and Jones and Baumgartner, 2005). Decision costs are incurred by actors that try to get to an agreement, such as bargaining costs or institutionally imposed costs, e.g., voting rule which requires that majority of all regional council representatives approve the bud- get, not just majority of representatives present at the meeting. Transaction costs are incurred after the actors reach an agreement, e.g., costs to complete the transaction or costs of compliance with the agreement. Deci- sion costs severely outweigh the transaction costs (Jones et al., 2003). What are the institutional costs during the different phases of the budget cycle and how do they impact the occurrence of budget punctuations? True et al. (2007) claim that punctuations occur at all levels of policymaking, all levels of the budget, and during all time periods. They expect that hier- archy will produce inequality in the transmission of punctuations from one level to another and by comparing the outputs of diverse institutional ar- 10 Central European Public Administration Review, Vol. 23, No. 2/2025 Budget Punctuations in Czech Local Government rangements. Jones et al. (2003) confirm that the kurtosis is higher for budget authority than budget outlays, meaning that the institutional costs hence the institutional friction are higher earlier in the budget process, leading to more punctuations in the budget debate and approval phase. Decisions about how scarce resources are allocated to various social and eco- nomic needs take place throughout the entire process. The budget is primar- ily a political tool that reflects the preferences of individual participants in the process, and the resulting budget depends on whose preferences prevail (Wildavsky, 1992). Before the beginning of the given budget year, the draft budget is prepared, debated, and approved by the legislative body. This phase lasts several months, many participants are involved, and getting an agreement may be quite costly, leading to more punctuations. During the budget year, the executive body manages the affairs according to the approved budget. The approved budget is continuously adjusted through budget amendments (rebudgeting). The amended budget is the initially ap- proved budget plus all budget amendments and fully reflects political will re- garding the budget allocation. The key player in this budget execution phase is the executive body, com- pared to the legislative body decisive in the first phase. The decision-making should be more flexible due to the composition of the executive body (there are only representatives from the leading party or bound by a coalition agree- ment) and likely higher professionalism of the representatives (especially in local governments members of the assemblies are involved in the administra- tion only part-time). Therefore, theoretical expectations are: H1: Approved budget has more punctuations than the amended budget. Budget execution may or may not equal the amended budget and reflects impossibility, unwillingness, or intention not to spend the entire budget ap- propriation. Budget execution also brings some flexibility to the budgetary process (Raudla and Douglas, 2021). In the execution phase, professional management plays an important role. This makes this phase quite flexible and thus less punctuated as suggested by Park and Sapotichne (2020) who confirmed a decreasing effect of bureau- cracy on punctuated policy processes in Michigan cities. After the end of the budget year, the final account is compiled, audited, and approved by the leg- islative body. Therefore, it is expected that: H2: Actual spending has fewer punctuations than the approved budget. Budgets react to both endogenous and exogenous forces, which may include changing levels of public attention, striking, or compelling new information (True et al., 2007). Cavalieri (2025) expects that crisis moments produce bud- get punctuations as the urgency of the situation significantly reduces the time available for bargaining processes. The derived hypothesis is the following: Central European Public Administration Review, Vol. 23, No. 2/2025 11 Lucie Sedmihradská, Eduard Bakoš H3 Exogenous shocks lead to more punctuations. Major policy changes are often associated with turnover in the composition of the decision-making body (True et al., 2007) or with electoral replacement. Kwak (2017) confirmed that the change in party control of the governorship in US states increased the number of budget punctuations. Consequently, the following hypothesis predicts that: H4 The electoral change leads to more punctuations. In the case of complex issues policymakers must consider more information and deal with less agreement about the priorities, which leads to the dynam- ic of policy change characterized by punctuated equilibrium theory (Epp and Baumgartner, 2017). Therefore, the more complex a policy area is, the great- er the likelihood of extreme spending changes. In the case of the budget and budgetary process, complexity is related to comprehensiveness, i.e., all operations of the given government unit are in- cluded and treated the same way (Premchand, 1983), which means that all operations are part of a single budget or that there is a single decision-making process for all operations. This allows for the following hypothesis: H5 Complexity in the budgetary process leads to more punctuations. We test these hypotheses using the Czech regional budget data to explore the difference between local government budgeting phases and the impact of exogenous shocks, electoral change or budget complexity when reaching and implementing a decision. 3 Czech Regions and Local Government Budgeting and Rebudgeting After 1989, the Czech Republic transitioned from a centralized system to- wards a decentralized system of self-governing subnational governments. It has a two-tier subnational system with 6,254 municipalities, 13 regions, and the capital city of Prague, which has unique dual status as both a re- gion and a municipality. The establishment of regions was legislated in 2000 and came into force in 2001. The first elections for regional assemblies took place in 2000 and since then have taken place every four years in the first half of October. In 2003, the competencies of the regions were significantly expanded in connection with the public administration reform and the abo- lition of district offices. The regional assembly is an elected body. The regional committee represents the region’s executive body and is composed of the president, vice presi- dents, and other members elected by and from within the regional assembly. The regional office is led by a director and presents a highly professional pub- lic office with four to seven hundred employees. 12 Central European Public Administration Review, Vol. 23, No. 2/2025 Budget Punctuations in Czech Local Government Regions exercise simultaneously the so-called own responsibility, which is exercised by the region and its bodies on its behalf, and delegated respon- sibility, which is performed on behalf of the state and the state is legally responsible for the performance of the delegated power. The Czech regions are responsible for the delivery of many key services. Their main spending categories include education, transportation, social services, healthcare, culture, and administration (Janský and Kolář, 2024). They are also responsi- ble for the management of their property (Bečica, 2015), the development of their territory, regional economic development, and environmental pro- tection (OECD, 2020). Two thirds of regional revenue are earmarked grants and transfers; most of them are passing through transfers from the state budget to all the schools in the territory of the region and social care facilities. About 30% of revenue comes from the shared income and value-added tax. The shares of the indi- vidual regions have been stipulated by law since 2005 and roughly followed the estimated level of costs associated with delivering delegated services and functions. The individual regions cannot influence the volume of shared tax revenue they receive, so these revenues resemble more unconditional block grants than taxes (Blöchliger and Petzold, 2009). There is a debate to replace the fixed share by a formula now that would better reflect the needs of individual regions. Czech legislation provides a general framework for the local government’s budgetary process, including budget amendments, information disclosure, and roles that different subjects play in the budgetary process. Regions use detailed and binding economic and functional classifications of revenues and expenditures, which are uniform for all public budgets. The key parameters are summarized in Table 1. The regional budget is prepared and debated for several months by both elected and professional regional officials, heads of regional organizations, and other relevant subjects (Memeti and Kreci, 2016). The regional assembly approves by most of all representatives the budget in a public meeting after the budget proposal is available online for at least 15 days. If the budget is not approved by the end of the previous year, special rules (the so-called budget provisory) are applied. Budget provisory is very rare in the regions’ case. The authority to implement budget amendments is divided between the re- gional assembly and the regional committee when the assembly decides on the extent of delegation of the authority to the committee. This decision is taken annually as part of the budget approval process. Four regions approve unlimited delegations, five define precise limits, usually limited by a specific amount (CZK 2 or 5 million, which allows approval of majority of amendments needed), and four define the scope of the power to make amendments, such as a specific list of operations. Only one region (South Bohemia) also dele- gates powers to the regional president and deputy in case of using reserves and other necessary measures. There were no changes in the extent of dele- gation between 2019 and 2022. Central European Public Administration Review, Vol. 23, No. 2/2025 13 Lucie Sedmihradská, Eduard Bakoš Table 1: Local governments budgetary process Fiscal year The fiscal year is given by law and is equal to the calendar year for all public budgets. Single budget The annual budget contains both current and capital operations. Balanced budget requirement The budget should be prepared as balanced. A deficit is allowed only if it can be covered by surplus from previous years or repayable resources, guaranteed by contract. Local governments are subject to debt regulation. Budget classification The uniform economic and functional budget classification applies to all public budgets. Accounting standard Budgetary documents and reports use cash accounting. Next to it accrual ac- counting and the double entry system are required for all local governments. Multi-annual outlook It is compiled mandatory and contains aggregated data on revenues, expen- ditures, debts, financial resources, and needs for a period of two to five years. Budget preparation The preparation of the budget draft must reflect the relationship with other public budgets. The draft budget must be available to the public before approv- al. Citizens can submit their comments in writing or orally at the council session. Budget approval The budget is approved by the regional council, i.e., the majority of all council members. Budget amendments Amendments are obligatory in the event of any changes in financial relations with other public budgets, at the legal level of control, or in the case of a danger of a deficit increase. Year-end report The year-end report includes budget reports, accounting statements, and infor- mation on the management of all local government organizations. Audit Audit of financial and legal compliance is obligatory for all local governments. In the case of regions, it is provided by the Ministry of Finance or private auditors, in the case of municipalities by regions or private auditors. Financial reporting Local governments submit monthly budget reports and quarterly accounting statements to the Ministry of Finance in a uniform format. These reports are publicly available through the application Monitor. Information disclosure Local governments publish on the Internet the budget and year-end report 15 days before their approval, and the approved budget, year-end report, and bud- get amendments within 30 days after their approval. Source: Budgetary rules for local governments (250/2000 Coll.), Law on the Regions (129/2000 Coll.), Budget classification (412/2021 Coll.) 14 Central European Public Administration Review, Vol. 23, No. 2/2025 Budget Punctuations in Czech Local Government Rebudgeting is a consequence of specific organizational cultures, as the praxis among local governments differs (Anessi-Pessina et al., 2012) and the Covid-19 pandemic was expected to bring an unprecedented magnitude of rebudgeting (Anessi-Pesina et al., 2020). This expectation was not confirmed in the case of the Czech regions as all the regions showed only minor variabil- ity in both the number (Figure 1) and magnitude (Figure 2) of budget amend- ments over the period 2019-2022. Figure 1: Number of budget amendments (12 regions, 2019-2022) 1000 900 800 700 600 500 400 300 200 100 0 ST PL ZL JC PA LI MS KV HK VY JM OL 2019 2020 2021 2022 Source: authors, based on data provided by the regions on their respective webpages Note that abbreviations represent the names of individual regions: HK = Královehradecký, JC = Jihočeský, JM = Jihomoravský, KV = Karlovarský, LI = Liberecký, MS = Moravskoslezský, OL = Olomoucký, PA = Pardubický, PL = Plzeňský, VY = Kraj Vysočina, ZL = Zlínský; Ústecký kraj is not shown as it uses an incomparable numbering system, i.e., it approved between 18 and 21 amendments between 2020 and 2022; data for Středočeský kraj (ST) for 2019 are not available due to changes in the reporting system. Despite the information disclosure mandate on budget amendments (in force since 2017), rebudgeting is much less transparent than budgeting. It compris- es several (many) minor amendments which are difficult to monitor and con- trol both for the council members and the public (Anessi-Pessina et al., 2012). This is further strengthened in the Czech case by delegating the authority from the legislative to the executive body, which decides in closed meetings. Rebudgeting is, to a great extent, an informal and elusive process (Alesani, 2012). Rebudgeting complements the initial budget formulation (Anessi-Pes- sina et al., 2012) and can significantly change the initial budget (Anessi-Pessi- na et al., 2013). Different regions use different budgeting practices allowed by law, which differ in comprehensiveness. Comprehensiveness is a basic principle in pub- lic budgeting and requires that all resources are allocated through the same process (Tommasi, 2013) and rebudgeting may violate this principle (Lauth, 2002). The level of comprehensiveness is related to the way expected trans- Central European Public Administration Review, Vol. 23, No. 2/2025 15 number of budget amendments Lucie Sedmihradská, Eduard Bakoš fers are or are not included in the approved budget. Figure 2 shows the mag- nitude of rebudgeting, i.e. (amended – approved expenditure)/amended ex- penditure. Here we can observe two clusters: The low cluster with eight regions in 2023, where the rebudgeting of current expenditure is below 30%, and the high cluster with five regions, where the rebudgeting is between 70 and 80%. Two regions did move from the high cluster to the low one: Karlovarský kraj (KV) in 2010 and Pardubický kraj (PA) in 2021. A more detailed analysis shows that the primary reason for both the volume of rebudgeting and differences among the regions is related to how the ap- proved budget deals with transfers from the central level. Regions in the low cluster estimate expected transfers based on the current budget year and information provided in the state budget proposal for the next year. These estimates are approved in the budget, as well as expenditure financed from these transfers. Rebudgeting thus concerns only a small frac- tion of both transfers and related expenditures. Regions in the high cluster do not budget for current transfers, and most or all transfers are included in the budget as rebudgeting in the first months of the year. Thus, the volume of rebudgeting of both transfers and the matching expenditure is above 70%. Figure 2: Magnitude of rebudgeting of current expenditure (13 regions, 2006-2023) 80% HK 70% JM 60% LI 50% OL MS 40% PL 30% VY 20% KV PA 10% ST 0% US -10% ZL JC Source: authors, based on data from Monitor Note: HK = Královehradecký, JC = Jihočeský, JM = Jihomoravský, KV = Karlovarský, LI = Liberecký, MS = Moravskoslezský, OL = Olomoucký, PA = Pardubický, PL = Plzeňský, ST = Středočeský, US = Ústecký, VY = Kraj Vysočina, ZL = Zlínský; the legend is ordered according to rebudgeting in 2023 Rebudgeting = (amended – approved expenditure)/amended expenditure 16 Central European Public Administration Review, Vol. 23, No. 2/2025 rebudgeting Budget Punctuations in Czech Local Government While the regions in the low cluster comply with the principle of complexity and the budget debate concerns the full budget, the regions in the high clus- ter debate do not. Division of the decision-making into two periods – the allo- cation of own resources before budget approval and the allocation of trans- fers during rebudgeting – limits the complexity of the first period. 4 Data and Methods The center of our attention is budget punctuation in current expenditure, i.e. a large annual change in a functional budget line in approved (B_PUN), amended (A_PUN), and executed (E_PUN) regional budgets. The percentage change for each functional line is calculated as 𝑐𝑐ℎ𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑡𝑡 = 𝑏𝑏𝑏𝑏𝑏𝑏𝑎𝑎𝑎𝑎𝑏𝑏𝑡𝑡 − 𝑏𝑏𝑏𝑏𝑏𝑏𝑎𝑎𝑎𝑎𝑏𝑏𝑡𝑡−1 𝑏𝑏𝑏𝑏𝑏𝑏𝑎𝑎𝑎𝑎𝑏𝑏 (1), 𝑡𝑡−1 where the budget is either approved (B), amended (A), or executed (E). Functional line represents current expenditure for a given function. Current expenditure corresponds to the highest aggregation of economic classifica- tion, i.e., class 5, and to define a function we use the second lowest level of functional classification, e.g., 311x Preschool and elementary education, 312x Secondary education, 313x Institutional educational facilities, etc. In total, our analysis includes 113 different functional lines, in the case of the individual regions there are between 33 and 59 functional lines in the approved budget, 42 and 68 lines in the amended budget, and 40 and 64 lines in the actual execution (Figure 3). Data on 13 regional budgets come from Monitor, a data portal provided by the Ministry of Finance. We use annual data for the period 2005 to 2023. The Monitor includes budget data using de- tailed economic and functional classifications. Both classifications use a 4-lev- el coding system. Data for approved and amended budgets and for actual execution are provided. To set threshold values, we follow Jordan (2003), i.e., a percentage decrease of more than 25 percent or a percentage increase of more than 35 is a punctu- ation. Budget punctuation is a discrete variable that can take a value 1 in the case of punctuation or 0 in the case of incremental change. Similarly, to Kovari (2016), we observe functional lines with zero values in some years, which makes it impossible to calculate a percentage change due to a zero denominator (budgett-1) in the percentage change formula (1). In that case, if budgett-1 does not equal zero, this change is labelled as punc- tuation. Central European Public Administration Review, Vol. 23, No. 2/2025 17 Lucie Sedmihradská, Eduard Bakoš Figure 3: Distribution of budget changes in approved and amended budget (2005-2023) 3500 3000 2500 2000 1500 1000 500 0 B_CHANGE E_CHANGE Source: authors, based on data from Monitor Note: B_CHANGE is the annual change in the approved budget and E_CHANGE is the annual change in the executed budget, both calculated using formula (1) To test H1 (Approved budget has more punctuations than the amended bud- get) and H2 (Actual spending has less punctuations than approved budget) we compare if the share of budget punctuations in functional budget lines differs in the approved (B_PUN), amended (A_PUN), and executed (E_PUN) regional budgets. We use the two-sample Z-Test to determine if the meaning of two variables are equal. To test H3 (Exogenous shocks lead to more punctuations), H4 (Electoral change leads to more punctuations) and H5 (Complexity in the budgetary process leads to more punctuations) we use the binary logit model for the es- timation of factors influencing the dependent variable. The dependent vari- able is a discrete one and therefore this model is appropriate in this case. It is based on the maximum likelihood principle. We estimate this equation: 𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃 = 𝑓𝑓(𝑃𝑃𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶, 𝑃𝑃𝑈𝑈𝑈𝑈, 𝐸𝐸𝐸𝐸𝐸𝐸𝑃𝑃𝐸𝐸1, 𝑃𝑃𝐸𝐸𝑈𝑈𝑃𝑃𝐶𝐶𝑃𝑃, 𝑃𝑃𝑃𝑃𝑈𝑈𝐸𝐸𝑃𝑃, 𝐸𝐸𝐸𝐸𝐸𝐸𝑃𝑃𝐸𝐸, 𝑃𝑃𝐶𝐶𝐶𝐶𝑃𝑃, 𝑃𝑃) +  (2) where PUNC is punctuation in a functional line in a given budget process phase, COVID and UKR capture exogenous shock to test H3, ELECT1, PERSON, PARTY and ELECT represent electoral change to test H4 and COMP character- izes budget process complexity to test H5. C is a vector of control variables. A similar approach was used by Robinson et al. (2007) to analyze the effects of organizational size and centralization on the budgetary process, by Flink (2017) to examine the impact of organizational performance and teacher turnover, and by Sebők and Berki (2017) to investigate factors influencing Hungarian state budget punctuations. 18 Central European Public Administration Review, Vol. 23, No. 2/2025 functional lines Budget Punctuations in Czech Local Government Czech regions play an important role in emergency management when they, among others, coordinate the delivery of health care services, provision for public health safety, emergency accommodation, and drinking water and food supply (Vilášek and Fus, 2023) so they have played a crucial role during the two recent unforeseen and unprecedented events: the COVID-19 pan- demic starting in 2020 and the refugee wave after Russia invaded Ukraine in February 2022. To test H3 (Exogenous shocks lead to more punctuations), we introduce variables COVID and UKR. Both are dummy variables and are equal to 1 in the years 2020 and 2022, respectively. Elections and their results, i.e., change in the party control of the assembly, are exogenous forces that may cause a change in the decision design and lead to a major change in choice (True et al., 2007). To test H4 (Electoral change leads to more punctuations), we introduce a set of dummy variables indicat- ing the first post-election year (ELECT1), change in the party of the regional president (PARTY), and change of the regional president (PERSON). Data on regional presidents and their party affiliation come from the webpages of the individual regions. According to the literature on political business cycle, governments strategi- cally time policies following the electoral cycle to maximize their re-election chances (Nordhaus, 1975). Therefore, major reforms do not take place late in the election cycle, e.g., austerity reforms (Strobl et al., 2021), tax reforms (David and Sever, 2024), or welfare reforms (Wenzelburger et al., 2020). Con- sequently, there will likely be less punctuations in the election year. We intro- duce the dummy variable ELECT to test this assumption. To test the impact of decision complexity or budget process comprehensive- ness (H5) we introduce a dummy variable COMP, which reflects the region’s praxis when budgeting transfers. Hence, COMP =1 if the approved budget of the region is comprehensive, i.e., it includes transfers, COMP =0 otherwise. Additional control variables characterize the individual functional budget lines regarding their volume and their changes over the budget cycle. Volume of the functional line in the different budget phases - budgeted spending (B), spending it the amended budget (A) and actual or executed spending (E) - is expressed in millions CZK. Changes in the functional lines over the budget cy- cle are expressed as ratios when rebudgeting (REB) is amended to approved budget and execution (EXE) is actual to amended spending. Table 2 provides detailed specification of all the variables and Table 3 shows the major descriptive statistics. Central European Public Administration Review, Vol. 23, No. 2/2025 19 Lucie Sedmihradská, Eduard Bakoš Table 2: List of variables Variable Description Dummy B_PUNC=0 if the approved budget annual change is B_PUNC between -0.25 and 0.35, B_PUNC=1 otherwise Dummy A_PUNC=0 if the amended budget annual change is A_PUNC between -0.25 and 0.35, A_PUNC=1 otherwise Dummy E_PUNC=0 if the actual spending budget annual change is E_PUNC between -0.25 and 0.35, E_PUNC=1 otherwise REB Rebudgeting = amended budget/approved budget EXE Execution = actual spending/amended budget B Budgeted spending in millions CZK E Actual spending in millions CZK A Amended budget spending in millions CZK COVID Dummy COVID=1 in the year 2020, COVID=0 otherwise UKR Dummy UKR=1 in the year 2022, UKR=0 otherwise Dummy ELECT=1 in the years of election, i.e., 2008, 2012, 2016, and ELECT 2020, ELECT=0 otherwise Dummy ELECT1=1 in the first year after the election, ELECT=0 ELECT1 otherwise Dummy PERSON=1 in the first year after the regional president PERSON has changed, i.e., his/her first complete budget year, PERSON=0 otherwise Dummy PARTY=1 in the first year after the party of the regional PARTY president has changed, i.e., his/her first complete budget year, PARTY=0 otherwise Dummy COMP =1 if the region includes transfers into the approved COMP budget, COMP =0 otherwise Source: authors 20 Central European Public Administration Review, Vol. 23, No. 2/2025 Budget Punctuations in Czech Local Government Table 3: Descriptive statistics average median min max st. dev. skewness kurtosis B_CHANGE 1.34 0 -1 3,333 41.233 62.632 4,465.6 A_CHANGE 4.07 0.0304 -1 11,495 133 64.948 4,952.7 E_CHANGE 6.03 0.0269 -1 18,121 209.96 66.637 5,131.5 B_PUNC 0.46 0 0 1 0.4982 0.1709 -2.0 A_PUNC 0.44 0 0 1 0.4959 0.2587 -1.9 E_PUNC 0.42 0 0 1 0.4935 0.3263 -1.9 REB 16.43 1.14 0 14,056 213.75 51.768 3,149.2 EXE 0.83 0.97 0 2.5235 0.26501 -1.8344 2.6 B 130.74 5.11 0 17,986 578.97 12.514 238.3 A 233.69 12.37 0 18,975 832.71 8.4155 106.3 E 226.09 9.75 0 18,973 830.02 8.4926 107.9 COVID 0.06 0 0 1 0.2308 3.8445 12.8 UK 0.06 0 0 1 0.2292 3.8769 13.0 ELECT 0.22 0 0 1 0.4159 1.3344 -0.2 ELECT1 0.22 0 0 1 0.4154 1.3399 -0.2 PERSON 0.18 0 0 1 0.3808 1.7017 0.9 PARTY 0.14 0 0 1 0.3521 2.0172 2.1 COMP 0.46 0 0 1 0.4981 0.1741 -2.0 Source: authors The description of the budgeting and rebudgeting process in 13 Czech re- gions is based on review of the valid legislation and information provided by the individual regions. We have approached the heads of the economic or similar departments with an e-mail request for budget guidelines (May 2023). The rest of the needed information (list of budget changes, delegation of responsibility from council to commission, or date of budget approval) was provided on the respective web pages or e-mail requests. 5 Results The share of punctuations differs in the different budget phases. The highest (46%) is in the case of the approved budget, the punctuations in the amended and executed budgets are present in 39% and 39,8% of the functional lines, respectively. The two-sample Z-Test confirmed statistically significant differ- Central European Public Administration Review, Vol. 23, No. 2/2025 21 Lucie Sedmihradská, Eduard Bakoš ences between the approved and amended and approved and executed bud- get, but no significant difference between the amended and executed bud- get. The high number of punctuations is related to the further complexity of decision-making caused by the intergovernmental relationships (Meza, 2022). The above-presented results confirm both H1 (Approved budget has more punctuations than the amended budget) and H2 (Actual spending has less punctuations than approved budget) and are in line with the predictions of the punctuated equilibrium theory. Punctuations are more common if the in- stitutional, mostly the decision costs are high: approved budget is a result of demanding political negotiations and finding a coalition agreement for a sin- gle vote. This hinders smooth, incremental changes with a normal distribution and leads to many punctuations. The amended and executed budgets are adjusted through many small decisions which are more flexible and result in fewer punctuations. During the budget year, many of the originally approved punctuations do not materialize. Results of the binary logit models show factors that influence the occurrence of budget punctuations in the different phases of the budget process (Table 4). The approved budget is a result of budget preparation and debate that took place in the last months of the previous year. Punctuations in the approved budget B_PUNC are more common in regions with comprehensive budgeting COMP and less common in the election years ELECT. The role of the volume of current expenditure in a functional line is negative, i.e., functional lines, with a small volume of current expenditure, experience punctuations more often than functional areas with a higher volume. This relationship is confirmed in all the models and variables budgeted spend- ing B, amended spending A, and executed spending E. A similar situation was observed by Klase et al. (2001) in the case of West Virginia cities when extra money went into smaller departments during the within-year budget adjustments. Punctuations in the amended budget A_PUNC are strongly positively influ- enced by the existence of the punctuations in the approved budget B_PUNC. The impact of the comprehensiveness of the budgeting approval is a little weaker than in the case of the approved budget, but still positive and sig- nificant. Both unexpected situations – Covid-19 and the Ukrainian refugee wave – led to significant growth of punctuations in the amended budget. The magnitude of rebudgeting, expressed as an amended budget to an approved budget, did not have a significant effect on the existence of punctuation. 22 Central European Public Administration Review, Vol. 23, No. 2/2025 Budget Punctuations in Czech Local Government Table 4: Results of the binary logit models Dependent B_PUNC A_PUNC E_PUNC_B_PUNC E_PUNC_A_PUNC variable 0.1507*** -1.0440*** 0.9236*** Const (0.000) (0.0461) (0.0879) x 0.2024** 0.3222*** COVID (0.0981) (0.0036) x 0.1660* UKR (0.0979) -0.1174** −0.1291** ELECT (0.0137) (0.0364) 0.1803*** 0.1179*** 0.0813* COMP (0.000) (0.0445) (0.0755) x 1.5440*** 1.2678*** x B_PUNC (0.0468) (0.000) x x x 3.6584*** A_PUNC (0.0651) x x −2.1531*** −2.1276*** EXE (0.000) (0.0458) -0.0053*** x x x B (0.0000) x -0.0023*** x x A (0.0000) x x -0.0023*** -0.0017*** E (0.0000) (0.0000) N 10772 10730 10653 12014 McFadden R2 0.0873 0.1752 0.2090 0.4906 Log-likelihood −6783.693 −5912.323 −5651.394 −4158.695 Overall predicted 7314 7765 7752 10521 cases (67.9%) (72.4%) (72.8%) (87.6%) Likelihood ratio 1298.87*** 2511.71** 2987.16** 8010.82** statistics Source: authors Note: * denotes 90%, ** 95 % and *** 99% of statistical significance respectively, standard error in parenthesis; x denotes variables that were not included in the model, blank spaces show variables that were not statistically significant, variables REB, ELECT1, PARTY, and PERSON were not statistically significant in any model and, therefore are not shown Central European Public Administration Review, Vol. 23, No. 2/2025 23 Lucie Sedmihradská, Eduard Bakoš There are two models estimating E_PUNC, one uses as the starting point the approved budget E_PUNC_B_PUNC and the other uses amended budget E_ PUNC_A_PUNC. Punctuations in the executed budget E_PUNC are again strongly positively influenced by the existence of the punctuations in the approved budget B_ PUN. There is a positive influence of the complexity of the budget approval COMP and Covid-19 and a negative of the election year ELECT. Compared to the punctuations in the amended budget A_PUNC we can observe the signifi- cant impact of the election year ELECT but not the refugee wave UKR. The difference between amended and executed budget is caused by the exe- cution of the spending (executed spending to amended spending) and its role is strongly negative. If the amended budget is fully spent EXE = 1. The more remains unspent, the smaller is EXE. EXE’s statistically significant negative impact on E_PUNC means that underspending leads to more punctuation. If we consider budget execution EXE as a component of performance, i.e., underspending is a sign of low performance, then this negative relationship between execution EXE and punctuations in the executed budget E_PUNC is in line with the findings of Flink (2017), who found that low levels of perfor- mance are associated with non-incremental (punctual) changes. The last model E_PUNC_A_PUNC shows a very strong and positive relation- ship between punctuations in executed and amended budgets and again neg- ative impact of budget execution EXE. None of the other factors is significant. While the results shown in Table 4 confirm H3 (Exogenous shocks lead to more punctuations) and H5 (Complexity in the budgetary process leads to more punctuations) they do not give any support for H4 (Electoral change leads to more punctuations). Regarding H3, extraordinary situations experienced in 2020 (COVID) and 2022 (Ukrainian refugee wave UKR) led to more punctuations in amended and/or executed budgets. Our finding on the impact of Covid-19 is stronger than suggested by Cavelieri (2025) in the case of European countries. Despite the expectations from the literature (Jones et al., 2009 and Kwak, 2017) we did not confirm H4. None of the variables (ELECT1, PARTY, PER- SON) which capture the changes in the government were significant. Re- straint to changes before election was on the other hand a significant factor lowering the number of punctuated budget changes in approved and exe- cuted budgets. We found strong support for H5 in all budget phases. The difference in the praxis among the regions regarding the complexity of the budgeting process has a sizable impact on the occurrence of punctuations. It is in line with the predictions of the punctuated equilibrium theory: complex decision-making is limited by disproportionated information processing and is more prone to punctuations. 24 Central European Public Administration Review, Vol. 23, No. 2/2025 Budget Punctuations in Czech Local Government 6 Discussion and Conclusions The punctuated equilibrium theory explains the pattern of annual budget changes we observe almost universally and worldwide. It proves the ability of organizations to hold steady policies as well as being able to adapt to changed needs at the same time. Existing literature offers limited research that links directly the punctuated equilibrium theory to financial management practic- es (Xiao et al., 2020). Our research addresses this issue and offers a novel integration of these findings with detailed knowledge of the budget process and its major phases in a local government setting. Punctuations in the current expenditures are present in all the budgeting phases, however, during the rebudgeting and execution phase their num- ber declines. This is supported by the confirmed hypotheses H1 (Approved budget has more punctuations than the amended budget) and H2 (Actual spending has less punctuations than approved budget). It corresponds to the estimated institutional costs associated with the different budget phases, ex- isting procedural rules and the roles politicians and professional bureaucrats have during the different budget phases. While policy change is more likely to occur in case of exogenous shocks and turnover in the composition of the decision-making body, our analysis using Czech regional data did confirm only the former one. Czech regions respond- ed during their rebudgeting phase to two unexpected events which occurred in February: the COVID-19 pandemic starting in 2020 and the refugee wave after Russia invaded Ukraine in 2022. And this response manifested itself in a higher number of budget line punctuations. Here we can confirm H3 - Exoge- nous shocks lead to more punctuations. Unlike theoretical predictions and results from other countries, changes in the political leadership did not have any impact on budget punctuations in any budget phase. Neither change in the person of the regional president, leading party or starting a new election term did lead to substantial policy change. The election year is manifested by less punctuations in approved bud- get and budget execution confirming the expectation that significant policy change rarely takes place at the end of the budget cycle. H4 - Electoral change leads to more punctuations was not confirmed. Czech regions use a different approach when including intergovernmental transfers into the approved budget. This praxis influences the complexity and comprehensiveness of the budget and budget process and has a significant impact on budget punctuations in all budgeting phases. Comprehensiveness of the public budget process leads to more friction and limiting comprehen- siveness may ease the decision-making process. H5 – Complexity leads to more punctuations was confirmed. Presented results are limited by the applied definition of budget punctua- tion, i.e., a percentage decrease of more than 25 percent or a percentage increase of more than 35 percent is a punctuation. Sectoral analysis, reflect- Central European Public Administration Review, Vol. 23, No. 2/2025 25 Lucie Sedmihradská, Eduard Bakoš ing the high heterogeneity among the 113 analyzed functional budget lines, could consider the complex intergovernmental setting where Czech regions operate and bring more insight into the factors influencing policy change at this local government level. Our findings confirm again that budget institutions influence budget out- comes. Therefore, it calls for further research. Do changes in budgeting com- prehensiveness take place over time and what is their impact? Do other bud- get process rules or practices influence the budget behavior as predicted by the punctuated equilibrium theory as well? Decisions leading to policy change, expressed as budget punctuation, occur more often in the case of higher institutional friction. Institutional friction stems from higher decision costs or disproportionate information processing. Our analysis showed that declining decision costs during the budget process led to less budget punctuations in the letter phases of the budgetary process. The impact of disproportionate information processing manifested itself in reaction to a crisis and complexity or comprehensiveness of the budget ap- proval. No impact of the change in political leadership was observed. This research was carried out with the institutional support of the Prague Univer- sity of Economics and Business, No. IP 100040, research grant of the Faculty of Finance and Accounting at the University of Economics and Business “Challenges for Public Finances During a Polycrisis“ No. F1/4/2025 and the Masaryk Universi- ty project “Sustainable development and effectiveness of public policy (SDEPP)” No. MUNI/A/1644/2023. No potential conflict of interest was reported by the author. 26 Central European Public Administration Review, Vol. 23, No. 2/2025 Budget Punctuations in Czech Local Government References Alesani D. (2012). Rethinking budgeting as a continuous process. Public Admini- stration Review, 72(6), pp. 885–886. https://doi.org/10.1111/j.1540-6210.20 12.02644.x Anessi-Pessina, E. et al. (2020). Reconsidering public budgeting after the COVID-19 outbreak: key lessons and future challenges. 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Policy Studies Journal, 48(4), pp. 873–895. https:// doi.org/10.1111/psj.12362 Central European Public Administration Review, Vol. 23, No. 2/2025 29 DOI: 10.17573/cepar.2025.2.02 1.01 Original scientific article Advancing the Legal Competences of Public Officials through the Administrative Consultation Platform: A Conceptual and Empirical Approach Špela Mar University of Ljubljana, Faculty of Public Administration, Slovenia spela.mar@fu.uni-lj.si https://orcid.org/0000-0002-1698-4273 Nina Kristl University of Ljubljana, Faculty of Public Administration, Slovenia nina.kristl@fu.uni-lj.si https://orcid.org/0000-0002-1297-3796 Eva Murko University of Ljubljana, Faculty of Public Administration, Slovenia eva.murko@fu.uni-lj.si https://orcid.org/0000-0002-2868-3726 Jernej Buzeti University of Ljubljana, Faculty of Public Administration, Slovenia jernej.buzeti@fu.uni-lj.si https://orcid.org/0000-0001-8985-8190 Polonca Kovač University of Ljubljana, Faculty of Public Administration, Slovenia polonca.kovac@fu.uni-lj.si https://orcid.org/000000277430514 Received: 20. 7. 2025 Revised: 25. 9. 2025 Accepted: 8. 10. 2025 Published: 11. 11. 2025 ABSTRACT Purpose: This article examines the development of the legal competenc- es of public officials within the Slovenian public administration who use the Administrative Consultation Platform (ACP) when conducting proce- dures under the General Administrative Procedure Act (GAPA). The ACP is an open-access legal clinic that serves as a supplementary source for Mar, Š., Kristl, N., Murko, E., Buzeti, J., Kovač, P. (2025). Advancing the Legal Competences of Public Officials through the Administrative Consultation Platform: 31 A Conceptual and Empirical Approach. Central European Public Administration Review, 23(2), pp. 31–61 2591-2259 / This is an open access article under the CC-BY-SA license https://creativecommons.org/licenses/by-sa/4.0/ Špela Mar, Nina Kristl, Eva Murko, Jernej Buzeti, Polonca Kovač interpreting procedural rules. To this end, a conceptual framework de- lineating legal competences for public officials was developed to assess how the use of the ACP affects the development of their acquired legal competences for the purposes of conducting administrative procedures. Based on this framework, a structural model was created to enable em- pirical testing of the impact of public officials’ affinity for the ACP and the frequency of its use on the development of their technical-legal and entrepreneurial-relational competences. Design/methodology/approach: The theoretical component employs normative, doctrinal, and comparative research methods to study legal competence models in the existing literature. The empirical component includes statistical analysis of data collected using a questionnaire meas- uring the technical-legal and entrepreneurial-relational competences of public officials who use the ACP, combined with an axiological-deonto- logical evaluation of the results. Structural equation modelling was used to verify how affinity for the ACP and the frequency of its use when con- ducting administrative procedures affect the development of their legal competences. Findings: The empirical study conducted in spring 2025 involved 112 pub- lic officials who conducted administrative procedures in administrative bodies and used the ACP between 2023 and 2025. The results indicate that the use of the ACP contributed significantly to the development of public officials’ legal competences, particularly relational competences, such as the ability to communicate effectively and respectfully with par- ties involved in the administrative procedure, and entrepreneurial compe- tences, especially the ability to uphold core ethical principles (e.g., integ- rity) and proactively seek solutions that balance the public interest with parties’ rights. However, they developed technical-legal competences— such as legal reasoning for resolving procedural issues, understanding of the GAPA, and data protection regulation—to a lesser, though still not negligible, degree. Academic contribution to the field: The article focuses on relatively under-explored aspects of public officials’ legal competences. The con- ceptual framework represents an original contribution, complementing existing research on legal competences in a narrower context, while in a broader context it can be categorised as dealing with the subjects of ad- ministrative law and public administration. The empirical study advances scientific understanding of the impact of public officials’ affinity for the ACP and the frequency of its use on the development of their legal com- petences, providing key feedback for ACP stakeholders. Research/practical/social implications: The conceptual framework of le- gal competences serves as the foundation for further scholarly examina- tion of the legal competences possessed by public officials and functions as a baseline for the systematic upgrading of the ACP to continue foster- ing the development of public officials’ legal competences while they use it. From a societal perspective, this article contributes to raising aware- ness of the critical importance of cultivating legal competences and of the effective utilisation of the ACP as an instrument for more participatory and problem-solving-oriented administrative decision-making processes. Originality/significance/value: The article offers an original contribution by (1) establishing a conceptual framework that advances the study of le- gal competences among public officials who use the ACP when conduct- ing administrative procedures, and (2) demonstrating the pivotal role of 32 Central European Public Administration Review, Vol. 23, No. 2/2025 Advancing the Legal Competences of Public Officials through the Administrative Consultation Platform: A Conceptual and Empirical Approach the ACP as a repository of accumulated collective knowledge, which aids public officials in developing their legal competences and facilitates the networking of stakeholders engaged in addressing administrative law challenges. The findings provide guidelines for enhancing the effective- ness of public officials and for fulfilling the objectives and principles of Good Governance in modern public administration. Keywords: public officials, legal competences, Administrative Consultation Platform, legal clinic, administrative procedural law Nadgradnja pravnih kompetenc javnih uslužbencev prek Upravne svetovalnice: konceptualni in empirični pristop POVZETEK Namen: članek preučuje razvoj pravnih kompetenc uradnih oseb v sloven- ski javni upravi, ki pri vodenju postopkov po Zakonu o splošnem uprav- nem postopku (ZUP) uporabljajo Upravno svetovalnico (US). US je odpr- todostopna pravna klinika, ki je dopolnilni vir za razlago procesnih pravil. V ta namen je bil razvit konceptualni okvir pravnih kompetenc uradnih oseb, s katerim se ocenjuje, kako uporaba US vpliva na razvoj njihovih pri- dobljenih pravnih kompetenc za potrebe vodenja upravnih postopkov. Na podlagi tega okvirja je bil oblikovan strukturni model, ki omogoča empi- rično preverjanje vpliva naklonjenosti uradnih osebdo US in pogostosti njene uporabe na razvoj njihovih tehnično-pravnih ter podjetniško-odno- snih kompetenc. Zasnova/metodologija/pristop: teoretični del uporablja normativne, doktrinarne in primerjalne raziskovalne metode za proučevanje modelov pravnih kompetenc v literaturi. Empirični del vključuje statistično analizo podatkov, zbranih z vprašalnikom za merjenje tehnično-pravnih in podje- tniško-odnosnih kompetenc uradnih oseb, ki uporabljajo US, v kombinaciji z aksiološko-deontološko oceno rezultatov. Za preverjanje, kako naklo- njenost US in pogostost njene uporabe pri vodenju upravnih postopkov vplivata na razvoj njihovih pravnih kompetenc, je bilo uporabljeno mode- liranje strukturnih enačb. Ugotovitve: empirična raziskava, izvedena spomladi 2025, je zajela 112 uradnih oseb, ki so v obdobju 2023–2025 vodili upravne postopke v uprav- nih organih in uporabljali US. Rezultati kažejo, da je uporaba US pomemb- no pripomogla k razvoju pravnih kompetenc uradnih oseb, zlasti odnosnih kompetenc, kot so zmožnost učinkovitega in spoštljivega komuniciranja s strankami v postopku, ter podjetniških kompetenc, predvsem zmožnosti spoštovanja temeljnih etičnih načel (na primer integritete) in proaktiv- nega iskanja rešitev ob upoštevanju ravnotžja med javnim interesom in pravicami strank. Tehnično-pravne kompetence – kot so sposobnost prav- nega argumentiranja, rešitev procesnih problemov, razumevanje ZUP in predpisov o varstvu podatkov – so se razvijale v manjši, toda kljub temu ne zanemarljivi meri. Akademski prispevek k področju: članek se osredotoča na razmeroma premalo raziskane vidike pravnih kompetenc uradnih oseb. Konceptual- ni okvir je izviren prispevek, ki dopolnjuje obstoječe raziskave o pravnih kompetencah v ožjem kontekstu, v širšem pa ga je mogoče uvrstiti med tematike upravnega prava in javne uprave. Empirična raziskava poglablja Central European Public Administration Review, Vol. 23, No. 2/2025 33 Špela Mar, Nina Kristl, Eva Murko, Jernej Buzeti, Polonca Kovač znanstveno razumevanje vpliva naklonjenosti do US in pogostosti njene uporabe na razvoj pravnih kompetenc uradnih oseb ter zagotavlja ključno povratno informacijo deležnikom US. Raziskovalne/praktične/družbene implikacije: konceptualni okvir prav- nih kompetenc je temelj za nadaljnje znanstveno proučevanje pravnih kompetenc uradnih oseb in izhodišče za sistematično nadgrajevanje US, da bo tudi v prihodnje spodbujala razvoj pravnih kompetenc uporabnikov. Z družbenega vidika članek pripomore k dvigu zavedanja o ključnem po- menu razvoja pravnih kompetenc in učinkovite uporabe US kot orodja za bolj participativne in k reševanju problemov usmerjene upravne postopke. Izvirnost/pomembnost/vrednost: članek ponuja izviren prispevek z (1.) vzpostavitvijo konceptualnega okvira, ki pripomore k preučevanju pravnih kompetenc uradnih oseb, ki pri vodenju upravnih postopkov uporabljajo US, ter (2.) prikazom osrednje vloge US kot vira akumuliranega kolektiv- nega znanja, ki uradnim osebam pomaga razvijati pravne kompetence in olajšuje medsebojno povezovanje deležnikov na področju upravnoprav- nih dilem. Ugotovitve ponujajo smernice za krepitev delovanja uradnih oseb ter za uresničevanja ciljev in načel dobrega upravljanja v sodobni javni upravi. Ključne besede: javni uslužbenci, pravne kompetence, Upravna svetovalnica, pravna klinika, upravnoprocesno pravo JEL: K40, J24, M53, H83 1 Introduction In contemporary society, administrative procedures constitute a cornerstone of public officials’ work with clients within administrative authorities, given that administrative relationships regulate relations between governing bod- ies and individual citizens (Galetta and Ziller, 2024). Pursuant to the General Administrative Procedure Act (GAPA; Official Gazette of the Republic of Slo- venia, No. 80/99, 1 October 1999, as amended), administrative bodies in Slo- venia address several million administrative matters annually. Accordingly, it is imperative that public officials who conduct these procedures are profes- sionally trained (Kovač, 2024; Kovač and Jerovšek, 2024) and possess well-de- veloped relevant legal and other competences (Hamilton and Bilionis, 2022; Carrel, 2019). Public officials acquire said legal competences primarily dur- ing education in accredited academic programmes (Kovač and Stare, 2014), and further refine them through continuous professional development, in- cluding access to and use of the Administrative Consultation Platform (ACP) (Kovač et al., 2023). The ACP is a joint initiative of the Faculty of Public Administration (FPA UL) and the Ministry of Public Administration (MPA), specifically designed to pro- vide principled interpretations of issues arising in administrative procedural law and administrative practice, particularly concerning the application of the GAPA. Established in 2009 as a research project addressing complex adminis- trative procedure-related challenges encountered in administrative practice 34 Central European Public Administration Review, Vol. 23, No. 2/2025 Advancing the Legal Competences of Public Officials through the Administrative Consultation Platform: A Conceptual and Empirical Approach (Kovač and Stare, 2014), the ACP experienced partial suspension in 2014 and was reinstated in 2022 in response to substantial demand, with new inquiries accepted since spring 2023 (Kovač et al., 2023). Following its overhaul, the ACP is defined as a research and pedagogical project under the governance of the FPA UL and the MPA, supervised by mentors from the faculty and officials from administrative bodies. It provides principled explanations of dilemmas concerning the application of the GAPA in individual situations. The project interprets the provisions of sector-specific regulations and the GAPA with due consideration of the fundamental principles of public administration. The ACP gathers and addresses dilemmas in the implementation of the GAPA across various administrative authorities and fields. Since 2009, the ACP has made available over 1,200 documented cases, with approximately 120 views and 300 daily user interactions recorded in the 2023–2025 period. Access to the platform’s comprehensive repository – comprising published questions and answers, alongside the facility to submit new queries – is provided free of charge to users. Three-quarters of ACP users are public officials who conduct administrative procedures across various administrative domains (e.g., for- eigners, taxation, construction, social affairs, data protection). In this context, the question arises regarding the nature of the legal competences possessed by public officials conducting administrative procedures, and the extent to which their affinity for and frequency of use of the affect the development of their legal competences. The purpose of this study is to examine how the use of the ACP affects the development of legal competences among public officials conducting admin- istrative procedures within Slovenian public administration, while also under- standing how the perceived performance and effort expectancy of the ACP, social influence, and facilitating conditions impact the frequency of ACP use. The objectives of the paper are: (1) to develop a conceptual framework of the legal competences of public officials conducting administrative procedures; (2) to investigate the acquired legal competences of public officials as ACP users; and (3) to analyse the extent to which public officials’ affinity for and frequency of use of the ACP contribute to the development of their legal competences. The following research question was formulated: How does the use of the ACP affect the acquisition and development of legal compe- tences among public officials conducting administrative procedures within the Slovenian public administration? In line with the research question, the following hypotheses are posited: H1: The acceptance of the ACP (measured through performance expectan- cy, effort expectancy, social influence, facilitating conditions) among public officials influences the frequency of ACP use in the conduct of administrative procedures. H2: The frequency of ACP use among public officials conducting administra- tive procedures affects the development of their legal competences. The remainder of the paper is structured as follows. Section 2 elaborates on the concept of legal competences, the findings of studies concerning the sig- Central European Public Administration Review, Vol. 23, No. 2/2025 35 Špela Mar, Nina Kristl, Eva Murko, Jernej Buzeti, Polonca Kovač nificance of legal competence development for students and legal profes- sionals (Finch and Fafinski, 2020; Isaacs et al., 2016; Hamilton, 2014; Shultz and Zedeck, 2011), and legal competence models (Hamilton and Bilionis, 2022; Carrel, 2021; Carrel, 2019; Mak, 2017). To this end, normative, doctrinal, and comparative research methods were employed. Section 3 outlines the methodological design in three subsections, namely the conceptual frame- work of legal competences, data collection and sampling, and the reliability and validity of the measurement model. The results of the empirical study are presented in Section 4, followed by discussion and recommendations in Section 5, and concluding remarks in Section 6. The core contribution of this study is the developed conceptual framework of legal competences for public officials, specifically tailored for the empirical investigation of their technical- legal, entrepreneurial, and relational competences essential for conducting administrative procedures. The conceptual framework concurrently serves as the groundwork for the structural model to empirically test the influence of public officials’ affinity for the ACP and the frequency of its use on the devel- opment of these three dimensions of legal competences. This research con- stitutes a foundation for further studies and measures aimed at acquiring and fostering the appropriate legal competences among public officials. 2 Literature Review 2.1 Legal Competences of Public Officials Competences encompass all those skills, abilities, and attitudes of employees that are essential for the successful execution of work tasks in general (Schaf- far, 2021; Kruyen and Van Genugten, 2020; Arzenšek et al., 2019), including within public administration (Džinić and Manojlović, 2018), as they have an important effect on whether the established objectives are achieved (Buzeti and Stare, 2010). The study of competences using competence models, which represent an organisational framework for defining the competences, tasks, and responsibilities of employees to ensure effective work and performance evaluation subject to the strategic goals of the organisation (Mikhridinova et al., 2024), began in the latter half of the 20th century (Sommerman et al., 2025). In line with public administration reforms, various competences of public officials have been prioritised (Kruyen and Van Genugten, 2020). In traditional public administration, the competences of public officials com- prised professional knowledge and technical skills, whereas during the New Public Management era, competences highlighting the importance of effi- ciency and effectiveness in public administration came to the fore (Kruyen and Van Genugten, 2020). With the implementation of Good Governance (Kovač, 2018) and influenced by social changes, digitalisation, and artificial in- telligence, contemporary public administration has become complex (Galetta and Ziller, 2024), thereby increasingly accentuating those competences with which public officials effectively address individual and societal challenges (Vitello et al., 2021; Schneider, 2019). 36 Central European Public Administration Review, Vol. 23, No. 2/2025 Advancing the Legal Competences of Public Officials through the Administrative Consultation Platform: A Conceptual and Empirical Approach When conducting administrative procedures, public officials must demon- strate appropriate professional qualifications, as evidenced by fulfilling the statutory requirements under Article 31 of the General Administrative Proce- dure Act (GAPA), which include: (1) employment within the competent authority (knowledge, attitudes); (2) relevant education (knowledge, skills); (3) state pro- fessional examination in administrative procedure (knowledge, skills, attitudes); (4) authorisation (knowledge, attitudes); and (5) impartiality (knowledge, at- titudes) (Kovač and Jerovšek, 2024). However, since public officials decide on the rights, obligations, or legal interests of individuals, legal entities, or other parties when conducting administrative procedures, it is of paramount impor- tance that their acquired legal competences are adequately developed. Legal competences are those that enable public officials, within the scope of legal regulations, to effect changes to their own or others’ legal status through le- gal acts within the legal system (Villa-Rosas and Spaak, 2023). Typically, these encompass legal knowledge, skills, and abilities that empower public officials to actively and responsibly participate in societal development. Public offi- cials achieve this by respecting the rule of law, exercising rights and obliga- tions, and cooperating with state authorities and other key societal actors (Korotun and Bogdanova, 2020). Existing research (Hamilton and Bilionis, 2022; Finch and Fafinski, 2020; Car- rel, 2019; Gerkman and Cornett, 2016; Hamilton, 2014; Shultz and Zedeck, 2011) mostly examines the legal competences acquired by law students during their education and those further developed by practising lawyers through their professional work. However, very few studies directly address the development of legal competences among public officials after the com- pletion of their formal education, particularly at the intersection of legal and administrative domains. For example, Kovač and Stare (2014) examined the general competences of students and graduates of public administration who participated in the ACP, while the Tuning project (Krogt and Reichard, 2012) is recognised as a key initiative for public administration. There is, however, no research that focuses specifically on those already employed in public administration and their legal and other relevant competences, which is a significant research gap in the study of legal competences among pub- lic officials. Given the substantive similarities in the work of public officials when conducting administrative procedures, especially regarding the inter- pretation and application of (procedural) law, the following section employs doctrinal analysis and synthesis to examine the legal competences of law stu- dents and practising lawyers (Bedner et al., 2020; Finch and Fafinski, 2020; Gerkman and Cornett, 2016; Isaacs et al., 2016; Hamilton, 2014; Kovač and Stare, 2014; Shultz and Zedeck, 2011) alongside existing legal competence models (Hamilton and Bilionis, 2022; Carrel, 2021; Carrel, 2019; Mak, 2017). These studies provide the basis for developing a conceptual framework of le- gal competences tailored to public officials using the ACP and for the further empirical examination of their legal competences. Central European Public Administration Review, Vol. 23, No. 2/2025 37 Špela Mar, Nina Kristl, Eva Murko, Jernej Buzeti, Polonca Kovač 2.2 Legal Competences and Legal Competence Models According to analyses by various authors (Bedner et al., 2020; Finch and Fa- finski, 2020; Gerkman and Cornett, 2016; Isaacs et al., 2016; Hamilton, 2014; Kovač and Stare, 2014; Shultz and Zedeck, 2011), law students must develop appropriate competences during their studies that then form the basis for further enhancement and deepening throughout their professional careers, enabling them to be fully competent in their respective fields. Shultz and Zedeck (2011), in collaboration with alumni, students, professors, clients, and judges, identified 26 of the most important legal competences required during law studies and legal practice. These competences – e.g., analysis and reasoning, creativity, problem solving, practical judgment, legal research, writing, speaking, listening, organising and managing, negotiation skills, networking and business development, and stress management – are crucial in practice, as they contribute to employees’ work performance. Similarly, Hamilton (2014), drawing from a range of sources (Consulting Group – BTI, 2013; Survey of Newly Licensed Lawyers – NCBE, 2012; Association of Corporate Counsel – ACC, 2009), concluded that students aspiring to work as lawyers, especially in client-facing roles, should possess well-developed technical-legal competences (e.g., knowledge of doctrinal law, legal analysis, written and oral communication) as well as other competences (e.g., integrity, honesty, good judgment, problem solving, work ethic, dedication to client ser- vice, responsiveness to clients, seeking feedback). These competences should be acquired during their studies to such a degree that graduates already meet employer expectations upon entering the labour market, and they are then further developed during professional practice. However, Gerkman and Cor- nett (2016) found that law graduates often do not adequately develop certain legal competences (e.g., integrity, work ethic, resilience) which employers re- gard as essential and expect young lawyers to demonstrate in professional settings. To address this, they developed within the Whole Lawyer conceptual framework a set of the most important legal competences categorised for the short term as professional competencies (professionalism, emotional and interpersonal intelligence, communication) and characteristics, and for the longer term or throughout a legal career as legal skills (transactional practice, litigation practice, legal thinking and application, workload management) and professional competencies (professional development, workload manage- ment, and collaboration with others). Law graduates are expected to master several categories of legal compe- tences, such as sources of law (e.g., understanding legislation, locating and applying legislation and case law), academic legal skills (e.g., writing, refer- encing/avoiding plagiarism, answering problem questions), and practical le- gal skills (e.g., presentation skills, mooting, and negotiation skills) (Finch and Fafinski, 2020). Similarly, Bedner et al. (2020) categorised the legal compe- tences and associated legal skills of law graduates – who are expected to be- come lawyers, judges, or public officials – into two groups. Group 1, general skills (e.g., critical thinking, juridical analytical skills) and primary legal skills 38 Central European Public Administration Review, Vol. 23, No. 2/2025 Advancing the Legal Competences of Public Officials through the Administrative Consultation Platform: A Conceptual and Empirical Approach (e.g., case analysis, legal reasoning), provide law graduates with the founda- tion for the development of legal thinking. Whereas Group 2, secondary le- gal skills (e.g., legal writing, constructing legal arguments, legal drafting, and contract drafting), equip them with the ability to apply acquired knowledge in concrete legal practices. The importance of developing legal competences among law students has also been emphasised in the Tuning pilot project, aimed at harmonising edu- cational programmes in Europe for the field of public administration follow- ing the implementation of the Bologna process (Krogt and Reichard, 2012). Slovenia participated in the TuCAHEA task group within this project (Isaacs et al., 2016). Within this context, law students and graduates are expected to demonstrate, in addition to their general legal knowledge (e.g., regula- tory and legal governance of social relations; legal and state development of the society; drafting and implementation of legislation), the legal knowledge of societal norms, legal forms of organisations, state functions, and specific legal fields (e.g., administrative law, civil law), alongside appropriately devel- oped legal competences. The TuCAHEA project used the input from academ- ics, employers, students, and graduates to classify 30 general competences and 20 subject-specific competences according to the importance of develop- ing the respective competences during law studies. Among the most impor- tant general competences were the ability to apply knowledge in practice, autonomous learning, and the use of logic and critical thinking to solve prob- lems. The most important elements among subject-specific competences were knowledge of current norms, statutes, and regulations as well as other sources of law, knowledge of and ability to apply national and international instruments to protect and promote human rights, skills to draw up legal documents and the like. Following the Tuning project, Kovač and Stare (2014) examined the general competences of postgraduate public administration students at the Faculty of Public Administration in Ljubljana participating in the ACP. They found that the ACP contributed to students’ development of the ability to apply knowl- edge in practical situations, deepen knowledge and understanding of the subject area and profession, demonstrate determination and perseverance in tasks and responsibilities, among other competences. According to them, the ACP is pivotal in developing these student competences, although they also highlighted the need to boost ties with employers and expand cooperation with various administrative bodies – a measure introduced during the ACP overhaul in 2022 (Kovač et al., 2023), although the results of this were not yet measured by the time of the present study. For the purposes of the systematic study of the legal competences of stu- dents and legal professionals, a number of authors have developed various legal competence models, notably the T-shaped Lawyer (Carrel, 2021; Carrel, 2019; Mak, 2017), the Delta Lawyer Competency Model (Carrel, 2019), and the Foundational Competences Model (Hamilton and Bilionis, 2022). Using any of these models, organisations – including administrative bodies – can analyse Central European Public Administration Review, Vol. 23, No. 2/2025 39 Špela Mar, Nina Kristl, Eva Murko, Jernej Buzeti, Polonca Kovač the level of development of legal competences acquired by law students and practitioners in their client-facing work (Hamilton and Bilionis, 2022). This ap- proach is also applicable to graduates of law-related programmes, such as public administration, since this field is inherently bound to act in line with legal rules and principles due to its authoritative intervention into individuals’ legal status (Stare and Pečarič, 2021). According to the T-shaped Lawyer model (Carrel, 2021; Carrel, 2019; Mak, 2017), law students and legal professionals – including lawyers, judges, and academics – adapt to societal changes, digitalisation, and globalisation by ac- quiring appropriate legal knowledge alongside capabilities such as data ana- lytics, technology use, and project management. This model delineates three distinct but overlapping lawyer profiles: 1) the lawyer-statesman, a traditional lawyer who emphasises the rule of law and justice, acting for the public good with moral integrity, sound judgment, and the ability to apply broad legal knowledge in practice; 2) the rational legal professional reflects the new public management influence, prioritising economic values (e.g., efficiency, effec- tiveness, transparency); this profile specializes in legal fields (e.g., commercial law, criminal law) while also mastering other disciplines (e.g., management, psychology) and is able to adapt to an organisation’s goals and ethical frame- works; and 3) the t-shaped lawyer epitomises the modern 21st-century lawyer who responds to social changes, possesses relevant legal knowledge, is client- focused, demonstrates highly developed social and relational competences (e.g., empathy), interdisciplinary competences (e.g., sustainability, social jus- tice), is technologically proficient, and acts in accordance with personal ethi- cal standards (Mak, 2017). These profiles primarily describe lawyers, judges, and legal scholars, as law students are still developing these characteristics. However, Carrel (2019) critiqued the model as being deficient for insuffi- ciently promoting the development of traditional legal competences among law students and professionals within organisations. She proposed an en- hancement through the Delta Model of Lawyer Competence (Delta Model), according to which graduates and lawyers systematically develop their legal competences when performing client-facing work and while effectively solv- ing legal problems. The Delta Model exists in multiple iterations, simplified and adapted over time in response to societal changes. This article summa- rises the original triangular version, which categorises legal competences as follows: legal knowledge and skills (legal analysis, legal judgment, legal re- search) enabling lawyers to understand client’s problems; personal effective- ness skills (PES) (e.g., emotional intelligence, relationship management, com- munication); and process, data and technology (technology and social media, data analytics, data security), covering the business and operational aspects of legal service delivery. Consistent with the Delta Model, Hamilton and Bilionis (2022) developed the Foundational Competences Model aimed at enhancing law students’ legal com- petences for academic success and lawyers’ competences in delivering client services and career advancement. Their model also depicts legal competenc- 40 Central European Public Administration Review, Vol. 23, No. 2/2025 Advancing the Legal Competences of Public Officials through the Administrative Consultation Platform: A Conceptual and Empirical Approach es as a triangle divided into three categories. At the core are foundational legal competences (responsible conduct and trust-building in client dealings), which influence the growth of other competences (e.g., social responsibility). The triangle’s base includes traditional technical competencies – those empha- sized by law schools and expected by employers and clients. On the left are client-centred relational skills and problem-solving competences, fostering cli- ent focus, while the right side emphasizes ownership of professional develop- ment (initiative-taking) of essential competences, emphasising continuous pro- fessional growth. Existing legal competence models are not fully adequate to identify the nec- essary legal competences among public officials participating in the ACP, as they primarily target the educational phase or perspectives of lawyers, em- ployers, and clients, and are developed within academic and professional mi- lieus. Due to the absence of directed research in this domain and given the substantial role overlap between lawyers and officials, it was necessary to develop an adapted conceptual framework that would consider the specific legal competences of public officials whose work focuses on conducting ad- ministrative procedures. 3 Methodological Outline of the Theoretical Legal Competences Model and Its Empirical Verification 3.1 Designing a Conceptual Framework of Public Officials’ Legal Competences The conceptual framework of legal competences for public officials devel- oped here is based on the three-dimensional structure of the Foundational Competences Model (Hamilton and Bilionis, 2022), which itself was based on the Delta Model (Carrel, 2019), comprising the technical-legal, entrepreneurial, and relational dimensions. It encompasses a set of specific legal competenc- es that can be empirically examined by taking a comprehensive view of the professional, ethical, and socially responsible conduct of legal practitioners. Another foundational approach in the conceptual framework is derived from the TuCAHEA project under the Tuning initiative (Isaacs et al., 2016), which systematically defines general competences and subject-specific competences. This approach is employed due to its recognition and established use in im- plementing Bologna Process higher education programmes within the field of public administration. Additionally, it has been utilised by other authors to study student competences (cf. Kovač and Stare, 2014), and for its content as it covers a broad range of legal competences relevant to the ACP. The Foun- dational Competences Model and the Tuning/TuCAHEA framework together serve as the essential groundwork for the conceptual framework, since the former synthesises existing empirical studies in the field of law, while the lat- ter specifies the particularities of legal competences within legal and public administration education. Although originally developed to enhance higher education in law and public administration, they are adapted in the conceptu- Central European Public Administration Review, Vol. 23, No. 2/2025 41 Špela Mar, Nina Kristl, Eva Murko, Jernej Buzeti, Polonca Kovač al framework to define the legal competences of public officials that are criti- cal for the effective discharge of their administrative duties, such as conduct- ing administrative procedures, which substantively and functionally lie at the intersection of law and public administration. Therefore, it is vital for public officials to develop these competences through lifelong learning. Within the conceptual framework, competences irrelevant to conducting administrative procedures (e.g., ability to innovate, teamwork/collaboration, conscientious- ness/attention to detail, grit/resilience) are excluded, whereas others (e.g., use of necessary technology for information retrieval in juridical practice and work ethic) are adjusted in accordance with the requirements of Article 31 of the General Administrative Procedure Act (GAPA). Table 1 illustrates the conceptual framework of legal competences for public officials, structured across three dimensions and competences, where sub- ject-specific competences are contained within the 1) technical-legal dimen- sion, and general competences form parts of the 2) entrepreneurial and 3) relational dimensions. The conceptual framework of legal competences for public officials present- ed in Table 1 provides a structured and comparable overview of diverse re- search underpinning, offering a more comprehensive understanding of the complexity of public officials’ work. Based on this framework, propositions were developed for the empirical study of legal competences (for example, the legal competence is understanding of administrative procedures, and the corresponding proposition to investigate is to understand the GAPA and sec- tor-specific procedures). 42 Central European Public Administration Review, Vol. 23, No. 2/2025 Advancing the Legal Competences of Public Officials through the Administrative Consultation Platform: A Conceptual and Empirical Approach Central European Public Administration Review, Vol. 23, No. 2/2025 43 Table 1: Conceptual framework of legal competences for public officials Legal Competences of Public Officials Competence Entrepreneurial Technical-legal dimension Relational dimension model dimension Subject-specific competences: • Knowledge of current norms, statutes, regulations and other sources of law. • Capacity to apply a legal rule to a particular legal case. • Understanding of administrative procedures. • Skills to draw up legal documents. General competences: • Ability to understand professionally and explain legal • Ability to learn. norms in the process of their application. General competences: • Ability to communicate in offi- Tuning/ • Ability to produce effective written or oral legal deci- • Ability to model, de- cial, state, and foreign languag- TuCAHEA sions and advice. sign and forecast. es. • Capacity to identify the legal interests of the parties. • Ability to prevent and resolve • Capacity to use the technology necessary for informa- conflicts. tion searches in juridical practice. • Ability to apply knowledge in practice. • Ability to use logic and critical thinking for solving problems. • Knowledge of the professional field. • Superior client focus, respon- • Knowledge of doctrinal law in the basic subject areas. • Work ethic. siveness to the client. • Legal analysis. • Organisation and • Exceptional understanding of Foundational • Legal research. management of legal the client’s context/business. Competences • Written/oral communication in the legal context. work. • Client-tailored communication. Model • Legal judgment . • An entrepreneurial • Creative problem solving/ good • Knowledge of the law-of-lawyering, responsibilities to mindset to serve professional judgment synthe- clients and the legal system. clients. sising all the competences. Source: Based on Hamilton and Bilionis (2022); Tuning TUCAHEA (2012-2016) Špela Mar, Nina Kristl, Eva Murko, Jernej Buzeti, Polonca Kovač 3.2 Data Collection and Sampling for the Empirical Analysis through an Online Survey In order to investigate the legal competences acquired through the use of the ACP by public officials who conduct administrative procedures in Slovenian public administration, and to understand the extent to which their attitude toward and frequency of ACP use contribute to the development of their legal competences, we employed a self-designed survey questionnaire. The questionnaire was developed on the basis of our conceptual framework of legal competences, as presented in Section 3.1. Both the questionnaire and framework draw upon the Foundational Competences Model (Hamilton and Bilionis, 2022) and the Tuning/TuCAHEA approach (Isaac et al., 2016). At the same time, they account for the specific intersection of law, public adminis- tration, and the ACP, while deliberately excluding formal educational aspects. Instead, the focus is placed on career-long training and adaptation to the spe- cific professional demands faced by public officials responsible for conduct- ing administrative procedures. The questionnaire was structured into several sections. The first part focused on measuring legal competences, followed by items assessing respondents’ attitudes and dispositions toward the use of the ACP. In addition, demograph- ic data were collected to enable an analysis of the state and development of individual (and group) legal competences against reference benchmarks across multiple indicators. The questionnaire comprised 32 items, organised into several thematic sections. The first section measured technical-legal competences (7 items), including understanding of the GAPA and sector- specific procedures, knowledge of administrative case law on procedural rules, analytical thinking when solving administrative problems, legal reason- ing when solving procedural problems, application of general rules to spe- cific cases, and awareness of the fact that the processing of personal data is regulated by law and that digital content is protected by copyright law. The second section, entrepreneurial dimension (3 items), assessed adherence to fundamental ethical principles (integrity, impartiality, confidentiality) when performing duties or conducting administrative procedures, the accuracy in conducting administrative procedures, and proactive solution-seeking while balancing the public interest and the rights of the parties. The third section, relational competences (5 items), evaluated the effectiveness and respectful- ness of communication with participants in the administrative procedure and with parties, a parties-centred focus, recognition of parties’ legal interests in individual cases, and the ability to learn. For the purposes of data collection, the questionnaire was transformed into an online survey using the open-source application 1KA (One Click Survey; www.1ka.si). Data were collected between March and April 2025. The target population consisted of 226 public officials employed in Slovenian public ad- ministration who conduct administrative procedures and who, between 2023 and 2025, had submitted at least one question to the ACP and received an an- swer as active users of the platform. Respondents participated on a voluntary 44 Central European Public Administration Review, Vol. 23, No. 2/2025 Advancing the Legal Competences of Public Officials through the Administrative Consultation Platform: A Conceptual and Empirical Approach basis through self-selection, employing a non-probability sampling approach. Out of the 226 invited public officials, 112 completed the survey in full, yield- ing a 49.6% response rate, which is sufficient to allow extrapolation of the results and support valid conclusions. To uphold the integrity of the research process, special attention was devoted to ensuring the anonymity of the re- spondents’ data. The collected demographic indicators show that 74% of respondents were women, with approximately 57% from Generation X (born between 1965 and 1980), with around 17% older and the remainder younger. This distribution broadly reflects the composition of employees in the Slovenian public adminis- tration (Kovač and Stare, 2014). Age distribution also aligns with national data: in 2023 only 8% of central administration employees were aged 18–34, while 29% were aged 55 or older (OECD, 2025). Taken together, these comparisons support the representativeness of our sample and uphold the legitimacy of the inferences. In line with formal entry requirements, the vast majority of respondents hold a university degree, with 21% possessing a postgraduate qualification. Among them, 37% are law graduates, while 35% hold a degree from the Faculty of Public Administration, forming a relatively homogeneous group whose legal competences were, to a large extent, acquired through for- mal education prior to employment. This provides a solid basis for assessing which competences have subsequently been developed through the use of the ACP. Despite this common background, respondents are currently distrib- uted across a variety of administrative domains: nearly 30% across multiple policy areas, about 19% in environment, construction, and agriculture, 17% in inspection services, 13% in internal affairs, and 6% in social affairs. Further on, to assess the extent to which public officials’ attitudes towards and frequency of use of the ACP contribute to the development of their legal competences, the questionnaire incorporated the Unified Theory of Accept- ance and Use of Technology (UTAUT) developed by Venkatesh et al. (2003). The UTAUT synthesises insights from eight earlier technology acceptance models and identifies four core determinants of technology adoption: per- formance expectancy, effort expectancy, social influence, and facilitating conditions. These constructs have consistently demonstrated strong explana- tory power for predicting both behavioural intention and actual system use, accounting for up to 70% of variance in intention and around 50% in use (Ven- katesh et al., 2003). In this study, each construct was operationalised with four items measuring respondents’ perceptions of the ACP’s usefulness, ease of use, organisational and peer influence, and the availability of institutional support. Additionally, one item assessed the frequency of ACP use to browse existing cases, with response categories ranging from “daily” to “never”. The use of the UTAUT was particularly well suited to this research context for two reasons. First, the ACP represents a digital tool, available to public officials from the Slovenian public administration, for which adoption and consistent use are not guaranteed despite the potential for gaining legal competency. And secondly, the UTAUT has been successfully applied in com- Central European Public Administration Review, Vol. 23, No. 2/2025 45 Špela Mar, Nina Kristl, Eva Murko, Jernej Buzeti, Polonca Kovač parable contexts where public officials’ or employees’ acceptance of various e-government tools was examined, thereby providing a validated lens to measure attitudes and usage behaviour (Salah et al., 2025; Zeebaree et al., 2022). These studies confirm the UTAUT’s robustness and transferability to public administration settings, reinforcing its suitability for examining how ACP acceptance and usage contribute to the development of legal compe- tences among Slovenian public officials. All items in the questionnaire were formulated as statements. Respondents expressed their agreement using a 5-point Likert scale: 1 – Strongly disagree, 2 – Disagree, 3 – Neutral, 4 – Agree, 5 – Strongly agree, with the option to se- lect “I do not have enough information”. For competences, a separate 5-point scale was used to indicate the extent of competence development as a result of ACP usage (not at all, slightly, moderately, considerably, fully developed). The Likert scaling method is a widely recognised approach for measuring re- sponses, and is also widespread in public administration research (Croasmun and Ostrom, 2011). 3.3 Measurement Model Reliability and Validity Data analysis involved both descriptive and inferential statistical methods. Summary statistics such as means and standard deviations were used to pro- vide an overview of the variables. Structural equation modelling (SEM) was used to test hypothesised relationships among latent constructs. Descrip- tive analyses were performed in IBM SPSS 29, and SEM was conducted using IBM SPSS AMOS 29.0 (Arbuckle, 2021). Prior to evaluating the measurement model, an exploratory factor analysis (EFA) was conducted specifically on the items measuring legal competences, as this scale was newly developed for the purposes of this study and had not been previously validated. The EFA indicated that legal competences are best represented by two un- derlying factors. The analysis revealed that the theoretically proposed dimen- sions of entrepreneurial and relational competences, did not emerge as distinct factors. Instead, the items intended initially for these two dimensions were grouped into one coherent factor. This factor reflects a broader competence related to professional responsibility and interpersonal conduct within admin- istrative procedures. Considering the content of these items (e.g., respect for ethical principles, accuracy in procedural actions, respectful communication, balancing public and individual interests), this factor was labelled entrepre- neurial-relational competences. The second factor included items measuring legal reasoning and procedural expertise, such as understanding procedural law, applying general rules to specific cases, and analytical reasoning; hence, this factor was labelled technical-legal competences. Two items, to reason legally when solving procedural problems and to focus on the parties, cross loaded on both factors, suggesting that these competences are not exclusive- ly tied to the dimensions mentioned above but instead reflect an integration of both. Consequently, these two items were excluded from further analysis. 46 Central European Public Administration Review, Vol. 23, No. 2/2025 Advancing the Legal Competences of Public Officials through the Administrative Consultation Platform: A Conceptual and Empirical Approach Following the EFA, a confirmatory factor analysis (CFA) was conducted to test the fit of the proposed (theoretical) model and evaluate its reliability and va- lidity. The model fit indices suggest that the model provides an acceptable representation of the observed data – the chi-square statistic was statistically significant (χ² = 646.71, df = 335, p < .001). However, the chi-square to degrees of freedom ratio (χ²/df = 1.93) was below the recommended threshold of 3, indicating a good fit between the model and the observed data. Incremental fit indices further supported the adequacy of the model (CFI = .867, IFI = .870, TLI = .838), since the values are close to or exceed the conventional cutoff of .85 for acceptable fit (Hu and Bentler, 1999). Although slightly above the ideal threshold of .08, the RMSEA (.092) remains within the range of reasonable error of approximation. The hypothesis of close fit could not be confirmed (PCLOSE = .000). Parsimony-adjusted indices indicated a reasonably efficient model given its complexity (PNFI = .630, PCFI = .715). To evaluate the reliability and validity of the constructs used in the study, we calculated the Cronbach’s alpha, composite reliability (CR), and average vari- ance extracted (AVE) for each construct. As shown in Table 3, all constructs demonstrated good internal consistency, with Cronbach’s α values ranging from 0.772 to 0.937, and CR values exceeding the recommended threshold of 0.70 (Hair et al., 2010). Table 2: Reliability and validity of the measurement model M SD Cronbach’s α CR AVE 1 2 3 4 5 Performance 1 4.36 .64 .857 .878 .646 - expectancy 2 Effort expectancy 4.41 .66 .929 .933 .779 .608 - 3 Social influence 3.19 .95 .899 .902 .701 .442 .372 - Facilitating 4 4.20 .62 .772 .793 .570 .561 .599 .290 - conditions Technical-legal 5 3.88 .58 .883 .859 .605 .396 .305 .241 .279 - competences Entrepreneurial- 6 relational legal 4.11 .72 .937 .942 .645 .506 .279 .201 .344 .729 competences Note. M = Mean; SD = Standard Deviation; α = Cronbach’s Alpha; CR = Composite Reliability; AVE = Average Variance Extracted. The lower triangle presents correlations among latent factors. Source: Own (2025) The AVE values are above the 0.50 threshold for all constructs, indicating convergent validity. Discriminant validity was assessed using the Fornell and Larcker (1981) criterion, which compares the square root of each construct’s AVE with its correlations to other constructs. The square root of the AVE for each construct (represented on the diagonal) was greater than its correla- tions with other constructs. Central European Public Administration Review, Vol. 23, No. 2/2025 47 Špela Mar, Nina Kristl, Eva Murko, Jernej Buzeti, Polonca Kovač 4 Results of the Empirical Study on the Legal Competences of Public Officials Related to the ACP The results of the study indicate that the respondents generally agree that using the ACP has contributed to the development of key legal competences, such as understanding procedural rules and the protection of personal data. The use of the ACP has positively impacted the development of competences related to the application of rules and analytical thinking in legal tasks. Ethical principles, task precision, and proactive problem solving were strongly impact- ed by the use of the ACP. ACP use also helped to develop competences from the relational dimension, including effective communication with participants and focusing on client needs. Further, regarding the UTAUT part, the survey re- vealed a high agreement on items measuring performance expectancy which suggests that the respondents believe the ACP improves task efficiency and correctness, and is useful in task performance. The respondents reported that the ACP is easy to use, with a significant percentage (89.8%) reporting that they were able to quickly learn how to use it. The high ratings for ease of use and understanding of the tool point to a user-friendly experience. The low av- erage agreement on items measuring social influence indicates that co-work- ers play a relatively minor role in users’ decisions to use the ACP. The respond- ents have the necessary material resources and knowledge to use the ACP, but seem to lack proper internal support when facing difficulties, although they receive support from ACP administrator when needed. A total of 59.8% of the respondents are regular users of the ACP, using it at least once a month. Table 3: Descriptive statistics for items M SD % Performance expectancy PE1 The ACP is useful for performing tasks. 4.61 .607 97.2% PE2 Using the ACP enables me to complete tasks faster. 4.22 .777 80.6% PE3 Using the ACP allows me to perform tasks more accurately. 4.38 .733 88.9% PE4 By using the ACP, I have improved my task performance abilities. 4.28 .807 83.3% Effort expectancy EE1 The ACP is easy to use. 4.36 .767 89.8% EE2 Using the ACP is understandable. 4.46 .676 91.7% EE3 It is not difficult to become proficient in using the ACP. 4.42 .750 88.0% EE4 I quickly learn how to use the ACP. 4.42 .725 89.8% Social influence My colleagues are of the opinion that I should use the ACP when SI1 3.27 1.065 44.3% conducting administrative procedures. My colleagues expect me to use the ACP when conducting SI2 2.89 1.081 29.2% administrative procedures. 48 Central European Public Administration Review, Vol. 23, No. 2/2025 Advancing the Legal Competences of Public Officials through the Administrative Consultation Platform: A Conceptual and Empirical Approach My superiors expect me to use the ACP when conducting SI3 2.93 1.173 33.0% administrative procedures. SI4 My superiors are in favour of me using the ACP. 3.65 1.015 55.7% Facilitating conditions FC1 I have all necessary equipment and resources to use the ACP. 4.42 .688 94.3% FC2 I know how to use the content of the ACP effectively. 4.30 .733 87.7% If I encounter problems using the ACP, I can turn to a colleague at FC3 3.32 1.143 49.1% work for help. If I encounter problems using the ACP, I can contact the ACP FC4 3.88 .825 67.0% administrator at the FPA UL. Frequency of use FREQ Frequency of using the ACP for browsing existing cases. 3.80 .890 59.8% Technical-legal dimension OTPK1 To understand the GAPA and sector-specific procedures.  3.92 .590 85.6% OTPK2 To be familiar with administrative case law on procedural rules. 3.67 .679 65.8% OTPK3 To think analytically when solving administrative problems.  3.87 .788 75.0% OTPK4 To reason legally when solving procedural problems.  3.88 .871 81.3% OTPK5 To apply general legal rules to specific cases.  3.96 .709 80.4% OTPK6 To be aware that the processing of personal data is regulated by law. 4.14 .994 80.4% OTPK7 To be aware that digital content is protected by copyright law.  3.99 .704 72.3% Entrepreneurial dimension To respect fundamental ethical principles (integrity, impartiality, PM1 confidentiality) when performing duties or conducting administrative 4.13 .969 83.9% procedures. To perform actions accurately when conducting administrative PM2 3.84 .954 91.1% procedures. To proactively seek solutions while balancing the public interest and PM3 4.17 .889 79.5% the rights of the parties. Relational dimension To communicate effectively with the parties involved in the OD1 4.26 .720 73.2% administrative procedure. OD2 To communicate respectfully with the parties involved. 4.12 .836 78.6% OD3 To focus on the parties involved. 3.96 .750 83.0% OD4 Identify the legal interests of the parties in individual cases. 4.00 .783 77.5% OD5 Ability to learn. 4.22 .744 87.4% Note. M = Mean; SD = Standard Deviation; % = Proportion of respondents who selected “agree” or “completely agree” on UTAUT items, proportion of those who reported using the ACP regularly (at least monthly), and proportion of those who indicated that ACP use had a “significant” or “very significant” impact on their development of legal competences. Source: Own (2025) Central European Public Administration Review, Vol. 23, No. 2/2025 49 Špela Mar, Nina Kristl, Eva Murko, Jernej Buzeti, Polonca Kovač The use of the ACP was associated with substantial improvements in techni- cal-legal and entrepreneurial-relational competences among public officials responsible for administrative procedures. Specifically, the most pronounced gain in the technical-legal competences concerned legal reasoning for resolving procedural problems, where the mean score increased from 3.47 to 4.07. Before using the ACP, 47.9% of public officials reported this competence as developed to a large extent or fully; after the ACP, this share rose to 87.7%. Understanding of the GAPA and sector-specific regulations also improved, with the mean rising from 3.59 to 3.97. Although more than half of public officials (54.8%) already reported this competence as largely or fully developed, the 87.5% figure after using the ACP indicates a significant improvement. Application of general rules to indi- vidual cases strengthened as well (M = 4.05), with 83.6% reporting substan- tial or complete development, compared to 58.9% at baseline. Awareness of data-protection regulation was already very high before ACP (M = 4.21; 79.5% largely or fully developed, including 42.5% fully developed), yet still improved for 86.3% of public officials. Awareness that digital content is protected by copyright increased from a mean of 3.74 to 3.95, with 57.5% reporting high competence before using the ACP and 76.8% afterwards. Analytical thinking improved from 3.45 to 3.85, with the proportion reporting strong compe- tence rising from 50.7% to 75.3%. Knowledge of administrative case law was comparatively the weakest competence, however, the mean rose from 3.23 to 3.71, and the share with high competence increased from 42.5% to 68.0%. Under entrepreneurial competences, accuracy in conducting administrative procedures reached the highest overall level, rising from 3.99 to 4.32. While 74.0% already reported strong competence before using the ACP, almost all officials (94.5%) improved further. Ethical conduct and confidentiality started at a high level (M = 4.27; 86.3% reporting strong competence) and improved for 87.7% of officials. Proactivity in finding solutions was initially less devel- oped (M = 3.73; 54.8% at baseline), but rose to 4.05, with four in five respond- ents (80.9%) reporting a significant improvement. Using the ACP also lead to an improvement in relational competences, where- by recognition of parties’ legal interests specifically improved from 3.79 to 4.11, with the share of officials reporting high competence increasing from 63.0% to 86.1%. Effective communication with participants, initially rated at 3.85, rose to 4.03, with improvements reported by 79.5% of respondents. Cli- ent orientation, already developed in 78.1% of respondents, was further im- proved to 89.0%. Respectful communication began at an especially high level (M = 4.38; 83.6% largely or fully developed), so overall change was limited, although 87.7% still reported some improvement, and more than half (52.1%) reported full development. The ability to learn was already present in 80.8% of officials and was further enhanced in nearly all cases (93.2%). Overall, the findings confirm that ACP use makes a significant contribution to legal competence development among public officials. The strongest devel- opment was observed in five key areas: accuracy in conducting procedures, 50 Central European Public Administration Review, Vol. 23, No. 2/2025 Advancing the Legal Competences of Public Officials through the Administrative Consultation Platform: A Conceptual and Empirical Approach ability to learn, legal reasoning in addressing procedural issues, application of general rules to specific cases, and proactive problem solving. Effective com- munication with participants also exceeded the threshold of strong compe- tence development. These results highlight the ACP as not only a tool for sup- porting legal expertise, but also as a mechanism that strengthens the broader professional competences that are crucial for quality public service delivery. Furthermore, the hypothesised relationships among UTAUT constructs, the frequency of using the ACP, and the perceived development of legal com- petences as a result of ACP use were tested with structural equation model- ling (see Figure 1). The model assessed the acceptance of the ACP measured through predictive power of performance expectancy, effort expectancy, social influence and facilitating conditions on the frequency of use (H1), and subsequently, the effect of frequency of use on the perceived development of legal competences (H2). Figure 1: The structural model Performance expectancy Technical-legal .35* competences R2 = 0.054 Effort .23* expectancy -.03 d Frequency of use R2 = 0.200 .09 Social .17 influence Entrepreneurial and .11 relational competences R2 = 0.027 Facilitating c conditions Note. * = p < 0.05. Source: Own (2025) The model explained 20% of the variance in usage frequency, 5.4% in techni- cal-legal competences, and 2.7% in entrepreneurial-relational competences, suggesting an overall weak explanatory power. While the statistical explana- tory power of the model is modest, the results still provide meaningful in- sights. They show that the most important factor driving public officials to use the ACP regularly is their belief that it is useful for their work. In other words, if public officials clearly see practical benefits, they are more moti- vated to integrate the ACP into their daily procedures. More frequent use, in turn, is associated with stronger development of technical-legal compe- tences, while the effects on broader entrepreneurial-relational competences are weaker. This pattern suggests that the ACP is most effective as a tool for strengthening core technical-legal competences, but its potential to support Central European Public Administration Review, Vol. 23, No. 2/2025 51 Špela Mar, Nina Kristl, Eva Murko, Jernej Buzeti, Polonca Kovač entrepreneurial-relational competences development may depend on addi- tional organisational or contextual factors. 5 Discussion and Recommendations In modern public administration, conducting administrative procedures un- der the General Administrative Procedure Act (GAPA) requires public officials to not only be professionally trained (Kovač and Jerovšek, 2024; Džinić, 2018), but to also possess appropriately developed competences (Sommerman et al., 2025; Kruyen and Van Genugten, 2020; Schneider, 2019). Among these, le- gal competences are of central importance, as they demonstrate the officials’ professional competence in their work (Schaffar, 2021). Public administration, grounded in the doctrine of Good Governance, is a vital part of contemporary society, contributing to its development and address- ing social and individual challenges. Within this framework and the concept of Good Administration, public officials hold a key role in contemporary and complex public administration (Galetta and Ziller, 2024), where conducting administrative procedures is a core task (Pečarič and Stare, 2021). Public of- ficials may conduct administrative procedures if they fulfil formal education and other requirements under Article 31 of the GAPA (Kovač and Jerovšek, 2024). However, effective and professional conduct of administrative proce- dures requires them to also possess a variety of skills and abilities, which in turn need to be continuously further developed. This guarantees professional administrative services and contributes to the stable and sound functioning of public administration (Vitello et al., 2021; Arzenšek et al., 2019). Adminis- trative procedures increasingly serve as a critical mechanism in this regard in modern society where the role of authority in administrative relations (Galetta and Ziller, 2024) is defined by procedural law and relevant problem-solving- oriented conduct of administrative procedures. Due to the rapidly changing environment, substantive law and classical work organisation no longer meet the needs of participative public governance (Kovač, 2018). As the complexity of administrative procedures grows, so does the impor- tance of appropriate competences for the public officials conducting these procedures. According to various authors (Villa-Rosas and Spaak, 2023; Ko- rotun and Bogdanova, 2020), public officials who conduct procedures and decide on the rights, obligations, and legal benefits of parties are expected to have acquired and properly developed legal competences. These compe- tences extend beyond administrative-legal expertise to others such as legal analysis, written and oral communication, and legal judgment, gained through legal and public administration studies (Finch and Fafinski, 2020; Isaac et al., 2016; Kovač and Stare, 2014). They continue to develop these competences on the job and through use of the ACP. The ACP, as a pedagogical and re- search project of the FPA UL and the MPA, serves as a knowledge repository, providing stakeholders with generic and frequently usable expert responses to concrete administrative legal dilemmas in line with the proper application of the GAPA and the Decree on Administrative Operations (Official Gazette 52 Central European Public Administration Review, Vol. 23, No. 2/2025 Advancing the Legal Competences of Public Officials through the Administrative Consultation Platform: A Conceptual and Empirical Approach of the Republic of Slovenia [Uradni list RS], Nos. 9/18, 14/20, 167/20, 172/21, 68/22, 89/22, 135/22, 77/23, and 24/24) as well as other regulations. The ACP facilitates networking among diverse stakeholders, with a key role played by academic staff from the FPA UL, the MPA, and experts from administrative bodies as it enables users (such as parties, citizens, companies, NGOs, and civil servants) to identify practical administrative law issues, contributing to their improved functioning and, consequently, societal benefit (Novak et al., 2025; Kovač, 2024). Numerous authors (Bedner et al., 2020; Hamilton, 2014; Shultz and Zedeck, 2011) emphasise that lawyers and public officials must build up their legal competences as this enhances their work efficiency. Others (Hamilton and Bilionis, 2022; Carrel, 2021; Carrel, 2019; Mak, 2017), who examined legal competences through competency models, argue that such individuals are therefore more competent in their work. In this context, it can be concluded that legal competences are crucial specifically for the work of public officials. However, a review of existing research on legal competences shows that such studies are nearly non-existent, with only one exception (cf. Kovač and Stare, 2014). Thus, for the empirical part of the study of ACP use and the develop- ment of legal competences among public officials, it was necessary to design a conceptual framework of legal competences. This framework served as the basis for a structural model based on the (UTAUT), which was then used in the study to examine how public officials’ attitudes toward the ACP and the frequency of its use influence the development of their technical-legal and entrepreneurial-relational competences. The results of the study, as presented in Figure 1 and obtained from 112 pub- lic officials between 2023 and 2025, indicate that performance expectancy has a statistically significant positive effect on the frequency of ACP use (β = 0.349, p = .012). Respondents who perceive the ACP as useful tend to use it more often. In contrast, effort expectancy, social influence, and facilitating conditions do not appear to significantly impact the frequency of ACP use (p > .05). Therefore, H1 is partially accepted. It can thus be assumed that supervi- sors and colleagues did not significantly influence respondents’ frequency of ACP use, nor did they expect its use in the conduct of administrative proce- dures. However, the respondents confirmed that they perceived ACP as use- ful in their work, which gave rise to the possible conclusion that they used it voluntarily when conducting administrative procedures. Additionally, facili- tating conditions (e.g., availability of equipment, access to resources, or the capacity to use the ACP) did not affect usage frequency; when encountering problems with the ACP, respondents typically contacted the ACP administra- tor at the FPA UL. The results also show that the frequency of use significantly predicted tech- nical-legal competences (β = 0.232, p = .023). Regular use of the ACP was associated with greater self-reported development of technical-legal com- petences. The effect on entrepreneurial-relational competences was posi- tive but marginally non-significant (β = 0.165, p = .094). Consequently, H2 is Central European Public Administration Review, Vol. 23, No. 2/2025 53 Špela Mar, Nina Kristl, Eva Murko, Jernej Buzeti, Polonca Kovač accepted. It was hypothesised that the development and enhancement of legal competences through ACP use is indirectly influenced by performance expectancy, effort expectancy, social influence, and facilitating conditions, as mediated by frequency of use. Specifically, it was assumed that better ac- ceptance of the ACP leads to more frequent use, which in turn supports the development and enhancement of legal competences. The findings suggest that only performance expectancy has a statistically significant positive effect on the frequency of ACP use. Furthermore, frequency of use positively influ- ences the development of technical-legal competences, but not the entre- preneurial-relational legal competences. Although public officials developed entrepreneurial and relational competencies most strongly through the use of the ACP, these advances cannot be explained by ACP acceptance. The de- velopment of entrepreneurial and relational competencies appears to be in- fluenced by factors outside the scope of the current model. Descriptive statistics (Table 3) indicate that the use of ACP contributed most strongly to the development of relational competences, particularly the abil- ity to communicate effectively and respectfully with the parties involved in the administrative procedure. Additionally, public officials reported improve- ment in entrepreneurial competences, especially in their ability to uphold core ethical principles (such as integrity, impartiality, and confidentiality) and to proactively seek solutions that balance the public interest with the rights of the parties. These competences help improve the public officials’ dialogue with the parties involved in administrative procedures, enabling the establishment of relevant facts and the harmonisation of interests among all stakeholders. In this way, both public officials and participants are proac- tively involved throughout the entire administrative process. Similarly, the development of entrepreneurial and relational competences is emphasised by several authors (Hamilton and Bilionis, 2022; Finch and Fafinski, 2020; Car- rel, 2021; Carrel, 2019; Shultz and Zedeck, 2011) who identify these as essen- tial for legal professionals working with clients, as understanding, empathy, and more effective communication aid in resolving legal issues and building trustworthy client relationships. The technical-legal competences (e.g. legal reasoning for resolving procedural problems, understanding of the GAPA and sector-specific procedures, application of general rules to individual cases) were developed to a lesser extent as a result of ACP use; however, the extent was in no way negligible. This suggests that public officials already possess adequate legal knowledge (i.e., familiarity with fundamental principles of the GAPA) and understand general elements and structures of administrative procedural law, which they apply to solving concrete administrative procedur- al problems in practice. Several authors (Bedner et al., 2020; Isaac et al., 2016; Hamilton, 2014) stress that it is crucial for students to acquire technical-legal competences (e.g., knowledge of doctrinal law, legal analysis, legislation com- prehension, knowledge of current norms, statutes, and regulations) during their studies, as these form the foundation for their professional work. It is noteworthy that Gerkman and Cornett (2016) found that some students and employees may not have adequately developed legal competences, which could affect the quality and results of their work (Mak, 2017). 54 Central European Public Administration Review, Vol. 23, No. 2/2025 Advancing the Legal Competences of Public Officials through the Administrative Consultation Platform: A Conceptual and Empirical Approach This article thus answers the research question, confirming that ACP use in- fluences the acquisition and development of technical-legal, entrepreneurial, and relational competences among public officials. The results offer relevant insights, demonstrating that the ACP is a crucial resource supporting officials in advancing their legal competences and thereby facilitating more effective resolution of administrative-legal dilemmas. Theoretical and practical implications, limitations and suggestions for future research: This study has several important theoretical and practical implications. The central theoretical implications are the conceptual frame- work of legal competences of public officials and the structural model, which advance the theory of public officials’ legal competences. From a practical perspective, they open possibilities for various studies on legal competences subject to the factors posited by the UTAUT across different ACP users (e.g., students and the parties involved). The findings indicate that the ACP plays a dual role: it aids in resolving administrative-legal dilemmas and enables more participatory and problem-solving-oriented administrative decision-making. Although our study offers useful insights, certain limitations should be ac- knowledged. First, since previous authors (Hamilton and Bilionis, 2022; Carrel, 2021; Bedner et al., 2020; Finch and Fafinski, 2020; Isaac et al., 2016; Hamil- ton, 2014, etc.) investigated the legal competences of law students and law- yers, the legal competences of public officials in our conceptual framework and structural model were interpreted subjectively. Second, the conceptual framework and structural model were only empirically tested on a specific sample of ACP users – public officials conducting administrative procedures – but not on other ACP users (e.g., the parties involved, students, and other members of the public), preventing us from drawing direct generalisations about the results. Third, the results are interpretatively adapted to existing studies on public officials’ legal competences, and since legal competences are socially and individually conditioned they may change over time, limiting the long-term relevance of the conceptual framework and structural model. A number of improvements are proposed based on this work, including the future broadening of research on the impact of ACP use on the development of legal competences among other ACP users. Employing mixed methods in the broadened study would provide data that would broaden the results and aid their comparative analysis as well as the critical evaluation of ACP’s role in legal competence development. Furthermore, it would be advantageous to upgrade the ACP with artificial intelligence tools and a tutorial (educational video) about its use and about the impact on users’ legal competence devel- opment. Generally, this would help ACP users better understand the foun- dational principles and rights laid down by administrative procedural law, especially as administrative procedures become increasingly complex. Ad- ditionally, it would be appropriate to introduce ACP’s usefulness to law and public administration students, who are still developing legal competences during their studies, as well as to newly employed public officials who do not yet meet all professional requirements under Article 31 of the GAPA (e.g., Central European Public Administration Review, Vol. 23, No. 2/2025 55 Špela Mar, Nina Kristl, Eva Murko, Jernej Buzeti, Polonca Kovač those who have not yet passed the professional examination in the adminis- trative procedure). Organising training on ACP use for public officials wishing to advance their legal knowledge and strengthen their existing legal compe- tences would also be beneficial. 6 Conclusion In modern public administration, public officials must possess adequately developed legal competences to address complex societal challenges and conduct administrative procedures effectively. Administrative procedures in Slovenian public administration represent a critical legal interface between the parties involved; therefore, it is essential that public officials master their technical and entrepreneurial-relational legal competences as well as con- tinuously develop them in their work. The ACP, a joint pedagogical-research project of the FPA UL and the MPA, plays a significant role in this context, and supports the development of administrative law and equality before the law through interpretative application of GAPA principles. It represents a syner- gistic form of collaborative governance and serves as a tool for public offi- cials to develop their legal competences, thereby fostering participatory and problem-solving-oriented administrative decision-making and contributing to sustainable societal development. The central contributions of this article are the development of a conceptual framework of legal competences and a structural model. Using these, a study conducted in spring 2025 with public officials from Slovenian administrative bodies showed that, by using the ACP between 2023 and 2025, public officials developed their entrepreneurial and relational competences to a significant extent, and to some extent their technical-legal competences, too. It was also found that both the positive attitude of public officials toward the ACP and the frequency of its use contribute to the development of all three groups of legal competences. This in turn indicates that public officials recognise the importance of the ACP, perceiving it as a quick-to-learn and easy-to-use tool as well as beneficial in their work or in conducting administrative procedures. The importance of developing legal competences using the ACP should con- tinue to be highlighted, for example, by expanding research on the influence of ACP use on the development of legal competences among its other us- ers (e.g., students, the parties involved, and other members of the public), demonstrating ACP’s utility through organised training of students and public officials, and introducing innovations (e.g., AI tools) to the ACP. By develop- ing legal competences more effectively, public officials resolve administrative procedures more efficiently, which is crucial in practice for all the parties in- volved and, in a broader sense, for achieving the goals and principles of mod- ern public administration. 56 Central European Public Administration Review, Vol. 23, No. 2/2025 Advancing the Legal Competences of Public Officials through the Administrative Consultation Platform: A Conceptual and Empirical Approach Bibliography Administrative Consultation (2025). Official webpage. 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Sustainability, 14(9), 5370, pp. 1–24. https://doi.org/10.3390/su14095370 Central European Public Administration Review, Vol. 23, No. 2/2025 59 Špela Mar, Nina Kristl, Eva Murko, Jernej Buzeti, Polonca Kovač Appendix 1: Questionnaire Relational Entrepreneurial Technical-legal competences competences competences 60 Central European Public Administration Review, Vol. 23, No. 2/2025 To what extent, in your To what extent did you have this opinion, is this competence competence developed before Competence developed today due to the Legal Competences using the ACP? pillar use of the ACP? 1 – 2 - 3 – 4 – 5 – 1 – 2 – 3 – 4 – 5 – None Low Moderate Much Completely None Low Moderate Much Completely To understand the GAPA and sector-specific procedures.  To be familiar with administrative case law on procedural rules.  To think analytically when solving administrative problems.  To reason legally when solving procedural problems.  To apply general legal rules to specific cases.  To be aware that the processing of personal data is regulated by law. To be aware that digital content is protected by copyright law.  To respect fundamental ethical principles (integrity, impar- tiality, confidentiality) when performing duties or conducting administrative procedures.  To perform actions accurately when conducting administra- tive procedures. To proactively seek solutions while balancing the public inter- est and the rights of the parties. To communicate effectively with participants in the adminis- trative procedure. To communicate respectfully with parties. To communicate respectfully with parties. Identify the legal interests of the parties in individual cases. Ability to learn. Advancing the Legal Competences of Public Officials through the Administrative Consultation Platform: A Conceptual and Empirical Approach Appendix 2: Structural (UTAUT) Model Performance expectancy Technical-legal .35* competences R2 = 0.054 Effort .23* expectancy -.03 d Frequency of use R2 = 0.200 .09 Social .17 influence Entrepreneurial and .11 relational competences R2 = 0.027 Facilitating c conditions Central European Public Administration Review, Vol. 23, No. 2/2025 61 DOI: 10.17573/cepar.2025.2.03 1.01 Original scientific article Triple Helix Model and Artificial Intelligence in Public Administration Armenia Androniceanu Bucharest University of Economic Studies, Faculty of Administration and Public Management, Romania armenia.androniceanu@man.ase.ro https://orcid.org/0000-0001-7307-5597 Sofia Elena Colesca Bucharest University of Economic Studies, Faculty of Administration and Public Management, Romania sofia.colesca@man.ase.ro https://orcid.org/0000-0002-5590-0589 Received: 1. 7. 2025 Revised: 16. 10. 2025 Accepted: 29. 10. 2025 Published: 11. 11. 2025 ABSTRACT Although the Triple Helix model has been widely analysed in the con- text of innovation ecosystems, its contribution to fostering the adoption of artificial intelligence (AI) within public administration remains insuf- ficiently explored. This study addresses this research gap by examining how interactions among universities, industry, and government facilitate AI integration into digital governance across selected EU countries. Purposes: The main research objectives are to: (a) assess the digital ma- turity of the selected EU countries; (b) evaluate how Triple Helix interac- tions shape AI adoption in public administration; (c) analyse the interre- lationships among the three actors within the context of AI governance; and (d) explore the connections between each country’s AI strategy and its broader governance mechanisms. Design/Methodology/Approach: The research combines both quantita- tive and qualitative methods, utilizing data from AI Watch, the European Commission, Eurostat, Oxford Insights, and the OECD. Findings: The findings reveal significant disparities among the selected EU member states and identify critical factors that either facilitate or constrain AI integration within public administration, offering new insights into the evolving role of the Triple Helix model in the era of algorithmic governance. Practical Implications: The results are particularly relevant for public sec- tor decision-makers, researchers in governance and innovation studies, and policymakers seeking sustainable models for digital transformation and collaborative innovation. Androniceanu, A., Colesca, S.E. (2025). Triple Helix Model and Artificial Intelligence in Public Administration. 63 Central European Public Administration Review, 23(2), pp. 63–91 2591-2259 / This is an open access article under the CC-BY-SA license https://creativecommons.org/licenses/by-sa/4.0/ Armenia Androniceanu, Sofia Elena Colesca Originality/Value: This research presents the first cross-national empiri- cal study linking Triple Helix dynamics to AI-driven innovation in the public sector, incorporating a range of indicators. The originality of this research lies in its conceptual integration of the Triple Helix framework with the transformative capacities of artificial intelligence in reconfiguring public governance and innovation dynamics within a few EU countries. Keywords: Triple Helix model, artificial intelligence, public administration, innovation ecosystems, European Union, comparative analysis, digital transformation, digital governance. Model trojne vijačnice in umetna inteligenca v javni upravi POVZETEK Čeprav je model trojne vijačnice široko analiziran v kontekstu inovacijskih ekosistemov, je njegov prispevek k spodbujanju uvajanja umetne inteli- gence (UI) v javni upravi premalo raziskan. Ta študija zapolnjuje razisko- valno vrzel z analizo, kako interakcije med univerzami, industrijo in vlado pospešujejo vključevanje UI v digitalno upravljanje v izbranih državah EU. Nameni: glavni raziskovalni cilji so: (a) oceniti digitalno zrelost izbranih držav EU; (b) ovrednotiti, kako interakcije v okviru trojne vijačnice obli- kujejo sprejemanje UI v javni upravi; (c) analizirati medsebojna razmerja med tremi akterji v kontekstu upravljanja UI; ter (d) raziskati povezave med nacionalno strategijo za UI posamezne države in njenimi širšimi me- hanizmi upravljanja. Načrt/metodologija/pristop: raziskava združuje kvantitativne in kvali- tativne metode ter uporablja podatke AI Watch, Evropske komisije, Eu- rostata, Oxford Insights in Organizacije za gospodarsko sodelovanje in razvoj (OECD). Ugotovitve: rezultati razkrivajo pomembne razlike med izbranimi drža- vami članicami EU in opredeljujejo ključne dejavnike, ki bodisi omogočajo bodisi omejujejo vključevanje UI v javno upravo, pri čemer ponujajo nove vpoglede v razvijajočo se vlogo modela trojne vijačnice v dobi algoritmič- nega upravljanja. Praktične implikacije: rezultati so posebej relevantni za odločevalce v javnem sektorju, raziskovalce s področja upravljanja in inovacijskih študij ter za oblikovalce politik, ki iščejo trajnostne modele za digitalno preo- brazbo in sodelovalne inovacije. Izvirnost/vrednost: gre za prvo čeznacionalno empirično študijo, ki po- vezuje dinamiko trojne vijačnice z inovacijami, ki jih poganja UI, v javnem sektorju ob upoštevanju niza kazalnikov. Izvirnost raziskave je v koncep- tualni integraciji okvira trojne vijačnice s preoblikovalnimi zmožnostmi umetne inteligence pri preoblikovanju javnega upravljanja in inovacijskih dinamik v nekaterih državah EU. Ključne besede: model trojne vijačnice, umetna inteligenca, javna uprava, inovacijski ekosistemi, Evropska unija, primerjalna analiza, digitalna preobraz- ba, digitalno upravljanje. JEL: O33, O38, R53, R58. 64 Central European Public Administration Review, Vol. 23, No. 2/2025 Triple Helix Model and Artificial Intelligence in Public Administration 1 Introduction In the era of the knowledge-based economy and intelligent artificial technol- ogies, innovation is no longer the exclusive result of university research or pri- vate investments, but of a strategic interaction between several institutional actors. In recent years, the European Union has placed a strong emphasis on the ethical and strategic adoption of Artificial Intelligence (AI) across public sectors. According to the European Commission’s Coordinated Plan on Artificial Intelligence (2021) and the EU AI Act (2024), member states are encouraged to integrate AI to improve administrative efficiency, transparency, and citizen- centred services. However, the level of AI adoption remains uneven across member states, with significant disparities in digital readiness, data govern- ance, and institutional capacities. The Triple Helix model is increasingly recognized as both an explanatory and operational framework for analyzing collaborative innovation processes (Etz- kowitz, 2003a, p. 298; Etzkowitz, 2003b, p. 305). Within the European Union, this approach has been embedded in various regional and national initiatives, supported by structural funds and programs such as Horizon Europe. Origi- nally proposed by Etzkowitz and Leydesdorff (1995a, p.29), the Triple Helix model offers a conceptual and practical foundation for fostering innovation through dynamic and systemic interactions among universities, industry, and government. This article analyzes the application of the Triple Helix model in different European Union member states, with a focus on good practices, public policies, governance structures, and economic and social results in the context of the accelerated growth of the integration of digital technologies and artificial intelligence (Nyathani, 2023, p. 3). Case studies from EU Member States illustrate different stages of maturity of innovation ecosystems and offer relevant lessons for future European policies (Grilli and Pedota, 2024, p. 242). The Triple Helix model is becoming increasingly relevant in the context of the adoption of artificial intelligence (AI) technologies in public administra- tion (Reis et al. 2019, p. 132). AI requires both academic expertise (universities and research institutes), applied technological solutions (industry, business), and institutional capacity for integration and regulation (government through central, regional, and local administrative authorities). Success stories from some European countries (Neumann et al., 2024, p. 121) are instructive in this regard. Estonia has developed and implemented the KrattAI project, in which the government collaborates with universities and the IT industry to create AI-based digital assistants for public administration. In Finland, the AI4Cities project brings together local authorities, universities, and companies to de- velop sustainable urban AI solutions. In France, the Paris-Saclay AI Hub project is an initiative where cutting-edge research, AI startups and public policies focused on digital ethics intersect. The Triple Helix model has proven effective in stimulating innovation in EU countries with mature infrastructure and coherent public policies (Etzkowitz, 2008, p. 149). To replicate its success across the Union, it is necessary to adapt models to the regional context, strengthen institutional capacity, and encour- Central European Public Administration Review, Vol. 23, No. 2/2025 65 Armenia Androniceanu, Sofia Elena Colesca age cross-sectoral collaboration. The future of European innovation depends on the ability of actors in the three spheres to act in an integrated and adap- tive manner in a competitive global context (Parent-Rocheleau and Parker, 2022, p. 14). The EU supports these directions through initiatives such as the Green Deal, Horizon Europe and the EIT (European Institute of Innovation and Technology), promoting responsible and sustainable innovation. The Triple Helix model provides the institutional and cultural infrastructure necessary for the integration of AI in public administration. It is not a technological mod- el, but it is becoming essential for the collaborative governance of emerging technologies, including artificial intelligence. This study focuses on a few EU member states, Estonia, Finland, Germany, France, and Romania, as representative cases that reflect varying levels of AI maturity and digital governance. Estonia and Finland are recognized for their advanced e-government infrastructures, while Germany and France illustrate large-scale administrative systems adapting to AI regulation and ethical governance. Romania represents a developing context, highlighting structural and institutional barriers to AI adoption. The comparative selec- tion included in this research enables a nuanced understanding of the Triple Helix dynamics across different levels of AI readiness within the EU. From this perspective, this research aims to identify, analyze, and categorize selected EU member states according to specific variables derived from the Triple He- lix model, within the broader context of developing and integrating diverse AI applications in public interest services. Although the principles of the Tri- ple Helix model are formally embedded in European innovation strategies, their practical implementation differs considerably across Member States. To standardize innovative performance and strengthen knowledge and tech- nology ecosystems across the European Union, a differentiated but coherent approach is needed at the level of public policies. While the literature on AI in the public sector has expanded rapidly, most studies focus on technological capabilities, ethics, or citizen trust (e.g., Janssen et al., 2020; Zuiderwijk et al., 2022). However, limited attention has been given to the institutional and collaborative mechanisms that enable or constrain AI innovation in public ad- ministration — particularly through the Triple Helix framework (interaction between government, academia, and industry). This paper seeks to bridge this gap by examining the functioning of the Triple Helix model in the con- text of AI adoption within selected EU public administrations, as well as the structural conditions that enable effective governance and innovation. The analysis conducted provides a coherent foundation of data and insights on the selected EU countries, categorized according to specific variables of the Triple Helix model, in the broader context of the rapid expansion of artificial intelligence across administrative and related domains. In the EU literature, the role of AI in public administrations is rapidly growing, being the subject of interesting empirical and conceptual studies, which are selectively pre- sented in the next section of the paper. 66 Central European Public Administration Review, Vol. 23, No. 2/2025 Triple Helix Model and Artificial Intelligence in Public Administration This paper contributes to the literature, offering both theoretical insights for innovation governance and practical implications for the implementation of the EU AI Act and related digital public policies. This work is organized into four interrelated sections. The first section pro- vides a comprehensive review of key concepts and scholarly studies on the Triple Helix model, emphasizing its relevance to the application of artificial intelligence in public administrations across EU member states. The second section details the research methodology, including the study’s objectives, research questions, hypotheses, and principal variables, as well as the analyti- cal framework employed to systematically investigate the topic. The third sec- tion presents the research findings alongside a correlative analysis, highlight- ing patterns and insights derived from the data. Finally, the fourth section offers the main conclusions and underscores the study’s contributions to ad- vancing knowledge in the field of public governance and AI implementation. 2 Literature Review About the Triple Helix Model in the EU Member States The Triple Helix model, developed by Henry Etzkowitz and Loet Leydesdorff (2001, p. 24), conceptualizes the interactions between university, industry, and government as pillars of innovation in a knowledge-based economy and artificial intelligence. In the EU, the Quadruple/Quintuple Helix extensions have added the sphere of civil society and the environment, strengthening a systemic framework for digitalization and AI (Androniceanu and Georgescu, 2023; Androniceanu et al., 2022). Our research aims to analyze the synergy be- tween the Triple Helix and AI in European public administration, as reflected in the specialized literature. Henry Etzkowitz and Loet Leydesdorff (2001, p. 24, 1995b, p. 115; 1999, p. 117) laid the foundations of the model in 1995, em- phasizing the hybrid role of universities, regulated by market and governance dynamics. Leydesdorff (2009, p. 381) extends the model, emphasizing the new evolution in knowledge-based economies. Elias Carayannis and Campbell (2009, p. 221) formulated the Quadruple/Quintuple Helix, including civil soci- ety and the environment in the innovation process. Research on these topics continues at an accelerated pace in the context of the large-scale penetra- tion of artificial intelligence tools in public administration in EU countries and in other areas that provide public services (Makridakis, 2017, p. 52). Thus, an intensification of interdisciplinary approaches is observed in research in the last decade. Other researchers explore AI for the public sector, emphasizing the essential role of cross-sectoral collaboration (university–industry–govern- ment), but also the managerial and technological challenges that accompany such initiatives. Straub, Morgan, Bright and Margetts (2022, p. 162) propose an integrated framework for government AI through multiple dimensions: op- erational fitness, epistemic alignment, and normative divergence. JRC (Joint Research Centre, 2024) identified and analyzed the adoption of AI in public ad- ministration through an analysis of 574 managers based on the following main dimensions: leadership, technical-ethical skills, and governance. There is a par- Central European Public Administration Review, Vol. 23, No. 2/2025 67 Armenia Androniceanu, Sofia Elena Colesca ticular interest in analyzing the synergy of the main actors in the Triple Helix model with new applications of artificial intelligence that can greatly support the cooperation between the main actors of the Triple Helix model, as univer- sities generate knowledge, companies develop AI solutions, and the govern- ment adopts/regulates everything needed in a Triple Helix structure. Michalec et al. (2024, p. 62) show that administrative centers led by mixed teams can reduce institutional barriers. Research within the JRC has highlighted the role of AI in facilitating data interoperability through ontologies and taxonomies in European public administration. AI GOV (Straub et al., 2022, p. 163) introduces procedural, structural, and relational practices at strategic and tactical levels, which can be coordinated through Triple Helix nodes. JRC (2024) recommends developing ethical and legal skills in AI governance (Rodgers et al., 2024, p. 25). In 2023, Tangi and his team at JRC produced a large study demonstrating the added value of AI in interoperability, sup- ported by government-university-industry collaboration. The European Com- mission, through the Futurium programme (European Commission, 2023) describes concrete uses such as AI assistants for employees (HR, procure- ment, reporting), highlighting investments in governance and innovation cul- ture (Etzkowitz and Carvalho de Mello, 2004, p. 162). Consequently, there is a solid body of literature exploring the interaction between AI and public administration in the context of the Triple Helix model, from theoretical per- spectives (Ethkowitz and Leydesdorff, 1999, p. 118), to applied cases and EU frameworks (JRC, 2024). This convergence provides an integrated framework for innovation, governance and skills, but the challenge of transforming this potential into real impact on public services and democratic trust remains. The literature (Votto et al., 2021, p. 14; Etzkowitz and Klofsten, 2005, p. 246) contains detailed case study examples from various EU member tates, illus- trating how the TripleHelix model is applied in public administration, in the context of artificial intelligence (Kruger and Steyn, 2025, p. 28). For example, during the pandemic, in Spain, a group of experts coordinated by Pierra Ric- cio created a multi-disciplinary center using anonymized mobility data and public surveys for epidemiological predictions and resource allocation based on the Triple Helix model and AI applications (Riccio et al., 2022, p. 7). The Triple Helix model in Spain had as main actors the regional government, the University of Alicante and the telecom companies: Telefonica and Vodafone. Another example of the application of the Triple Helix Model is identified in Denmark in the municipality of Gladsaxe. AI applications used are the internal Chatbot “GladGPT” (ChatGPT-4), launched in 2023, for employee support. In 2017, the algorithm for detecting vulnerable families was discontinued due to transparency and bias issues. The Lüneburg district and the federal states in Germany have examples of implementing a variety of chatbots to reduce direct interaction between the administration and citizens, but the results are varied (Gill et al., 2024, p. 21; Strohmeier, 2020, p. 352). Other research- ers emphasize the importance of AI strategies at the state (Bundesländer) level: competencies, regulations, and different approaches from one state to another. Other experimental examples are identified in the Czech Repub- lic between the Ministry of the Interior and universities, using various AI ap- 68 Central European Public Administration Review, Vol. 23, No. 2/2025 Triple Helix Model and Artificial Intelligence in Public Administration plications for the analysis of databases from population registers, security, and e-government. In Poland, there is a high Government AI Readiness Index (62.5%), with a progressive growth trend until 2027. The Triple Helix model consists of collaborations between the state, research institutions, and pri- vate companies specialized in ICT, focusing on chatbots, predictive analysis, and smart cities. Applied research and successful implementations of the Triple Helix model also exist in Norway in the municipality of Trondheim, where a study was conducted in approximately 200 public institutions, and 19 interviews were organized. The study analyzed the early adoption of AI, with risks of discrimination and political pressure. In Italy, the PRISMA project was carried out (2016): an interoperable cloud platform for citizen engage- ment (Catania and Siracusa municipalities) - Triple Helix models between lo- cal governments, universities, and the IT industry. AIDA is an AI system based on deep learning for crime prevention and collaboration between academia, police, and the public sector. In Belgium and Latvia, AI innovations in adminis- tration based on the Triple Helix model were carried out. In Belgium, several experimental research studies were conducted, and projects were imple- mented. One of the successful research areas was Knowledge management with generative AI (smart regulation). Another was Job matching (Jobnet). As can be seen, the Triple Helix Model in the context generated by AI in public administration in the public sector in EU countries is confirmed, but the risks of discrimination and cultural barriers represent major challenges (Ranga and Etzkowitz, 2013, p. 247). Theoretical frameworks (Nosratabadi et al., 2019, p. 18; Rodgers et al., 2024, p. 27.) and studies from different countries (Es- tonia, Italy, Germany, Spain, etc.) show that success comes from ethical poli- cies, human involvement, and adaptive organizational culture, but also from massive investments in infrastructure and in the training of human resources and citizens culture (Lorincova et al., 2024, p. 19; Michalec, 2024, p. 64). Dvor- ský (2025, p. 98) emphasizes the importance of using AI in risk management. Expert recommendations include piloted approaches, rigorous training, and transparency and accountability mechanisms (Stachová et al., 2024). AI trans- forms HR in the public sector – from recruitment, performance appraisal, to professional development and planning, emphasizing the efficiency and personalization of new models, but warns of the risks of bias, transparency, and confidentiality (Mwita and Kitole, 2025). Nosratabadi et al., 2022, p. 23) present a systematic approach (“Employee Lifecycle Management”), high- lighting the use of algorithms (Random Forest, SVM, Neural Networks) at all stages of the employee life cycle – recruitment, retention, and off-boarding. Rodgers et al. (2023) address “ethical decision-making” in HR, emphasizing the integration of responsible AI to eliminate bias. The Springer (2025) study from Tanzania shows that the success of AI implementation in HR requires technological infrastructure and organizational capital. The study draws at- tention to organizational culture and the fact that AI acceptance requires managerial involvement, cultural alignment and dedicated task forces. Through the #KrattAI initiative, Estonia is developing virtual robots to guide staff and citizens. The “job matching” system has been extended to public HR, suggesting positions in line with users’ profiles. The Jobnet system uses Central European Public Administration Review, Vol. 23, No. 2/2025 69 Armenia Androniceanu, Sofia Elena Colesca machine learning to match candidates to open positions in public administra- tion (Garg et al., 2022, p. 607). A JRC comparative study conducted in Italy and Germany (N=1411) shows that human supervision does not prevent dis- crimination in AI decisions. A “fair AI” can reduce gender bias, but remains influenced by the prejudices of the assessor. Discrimination remains a prob- lem: even algorithms designed for fairness can be influenced by the actions of human assessors (Meshram, 2023, p. 329; Androniceanu, M., 2024, p. 91; Androniceanu, M., 2025, p. 110). Rigid or bureaucratic institutional culture re- duces AI adoption. Solutions: task force, “skunk works” require training and early involvement of institutional leadership (Malin et al., 2023, p. 8). Adopting AI requires clear rules, transparency, and trained personnel who can override automated decisions, as recommended by various researchers (Alaa, 2023, p. 348; De Alwis et al., 2022, p.190; Rahman and Audin, 2020, p. 259). Relevant empirical studies to discover the implications of the Triple Helix model and AI applications are identified in the literature (Wirtz, 2018, p. 609). Some of the relevant ones are presented below. In Sweden, an empirical analysis was carried out in public administration with HR analytics. The research that was carried out was based on national, regional, and local data obtained through semi-structured interviews for 51 respondents, all middle-level managers in the Swedish public sector. As the results presented in the paper “Reasons for HR analytics adoption in public sector organisations” show, organisations cur- rently use only descriptive HR analytics (dashboards, reports), but intend to evolve towards predictive analytics. The identified determining factors were: internal pressure for efficiency, the need to quantify HR indicators, and data availability (Androniceanu, 2025, p. 82; Androniceanu, 2024, p. 110). The main challenges are: limited technological capacity, lack of skills, and con- servative organisational culture. The research showed that success depends on data infrastructure, technical skills, and strategic direction, including the qualitative involvement of HR and non-HR actors. The main advantages and challenges of the penetration of artificial intelligence in human resource man- agement in public institutions, identified by Mwita and Kitole in the work pub- lished in 2025, are presented in Table 1. The findings reported by Mwita and Kitole (2025, p. 12) highlight the poten- tial risks of decision-making errors associated with the use of automated arti- ficial intelligence systems in human resource management within public insti- tutions, as illustrated in Figure 1. 70 Central European Public Administration Review, Vol. 23, No. 2/2025 Triple Helix Model and Artificial Intelligence in Public Administration Table 1: Potential benefits and challenges of artificial intelligence in human resource management in public institutions HRM Strongly Strongly AI Benefits Agree Neutral Disagree Component Agree Disagree AI automates candidate screening to identify the 87 (40%) 65 (30%) 43 (20%) 17 (8%) 5 (2%) best fit efficiently AI enhances onboarding with personalized training 85 (39%) 67 (31%) 42 (19%) 18 (8%) 5 (2%) modules for new hires AI generates actionable insights through continuous 78 (36%) 70 (32%) 43 (20%) 19 (9%) 7 (3%) performance tracking AI improves feedback accuracy with unbiased data 80 (37%) 68 (31%) 44 (20%) 18 (8%) 7 (3%) analysis AI customizes employee training to address 81 (37%) 74 (34%) 41 (19%) 15 (7%) 6 (3%) individual skill gaps AI identifies future skill requirements for strategic 83 (38%) 70 (32%) 43 (20%) 15 (7%) 6 (3%) upskilling AI uses predictive analytics to design competitive salary 83 (38%) 72 (33%) 39 (18%) 17 (8%) 6 (3%) structures AI simplifies benefit administration by 80 (37%) 73 (34%) 41 (19%) 17 (8%) 6 (3%) automating complex processes AI monitors employee sentiment to detect early 74 (34%) 69 (32%) 50 (23%) 19 (9%) 5 (2%) signs of dissatisfaction AI recommends proactive conflict resolution 76 (35%) 67 (31%) 51 (24%) 18 (8%) 5 (2%) strategies AI ensures adherence to regulatory changes with 76 (35%) 73 (34%) 42 (19%) 20 (9%) 6 (3%) real-time alerts AI reduces human errors in compliance documentation 78 (36%) 71 (33%) 43 (20%) 19 (9%) 6 (3%) and auditing Central European Public Administration Review, Vol. 23, No. 2/2025 71 Compliance Workforce Employee Compensation and Training and Performance and Legal Planning and Relations Benefits Development Management Framework Recruitment Armenia Androniceanu, Sofia Elena Colesca HRM Strongly Strongly AI Benefits Agree Neutral Disagree Component Agree Disagree AI tracks workplace conditions to predict and 79 (36%) 68 (31%) 44 (20%) 19 (9%) 7 (3%) prevent safety risks AI facilitates wellness programs by monitoring 81 (37%) 69 (32%) 43 (20%) 17 (8%) 7 (3%) employee health metrics AI streamlines data management and 85 (39%) 71 (33%) 41 (19%) 14 (6%) 6 (3%) automates repetitive tasks in HR AI provides predictive analytics for strategic 82 (38%) 72 (33%) 42 (19%) 15 (7%) 6 (3%) workforce planning AI identifies potential leaders through 84 (39%) 69 (32%) 44 (20%) 16 (7%) 4 (2%) performance data analysis AI maps career pathways to ensure seamless succession 83 (38%) 68 (31%) 45 (21%) 17 (8%) 4 (2%) transitions AI predicts attrition risks by analysing engagement 82 (38%) 72 (33%) 43 (20%) 16 (7%) 4 (2%) trends AI designs personalized retention strategies using 83 (38%) 71 (33%) 44 (20%) 15 (7%) 4 (2%) employee data insights Source: Mwita, K. M. and Kitole, F. A. (2025). Potential benefits and challenges of artificial intelligence in human resource management in public institutions. Discover Global Society, 3(35), pp. 1–19. 72 Central European Public Administration Review, Vol. 23, No. 2/2025 Employee Workplace Succession HR Information Engagement and Health and Planning Systems (HRIS) Retention Safety Triple Helix Model and Artificial Intelligence in Public Administration Figure 1: Risks Associated with AI in Human Resource Management Source: Mwita, K. M., Kitole, F. A. (2025). Potential benefits and challenges of artificial intelligence in human resource management in public institutions. Discover Global Society, 3(35), pp. 1–19. Another example of relevant empirical research conducted in the Swedish public administration is about AI systems integrated in the Swedish Public Employment Service (PES). The study was conducted in 2024 and the main re- sults were published in the same year (Berman et al., 2024, p. 9). The theoreti- cal framework of the research was based on Institutional Theory, Resource- Based View, and Ambidexterity. Case analysis was used as the method, with an emphasis on transparency, interpretability and stakeholder involvement. The results show that AI is effective in supporting decisions (assessment of assistance applicants), but transparency and stakeholder participation are suboptimal, which requires constant audits. Another study was conducted in 2021 in Germany by Kern and his team (Kern et al., 2021). The study was con- ducted on the German employment service, and the analysis of administra- tive data for profiling the unemployed. The methodology consisted of a com- parative evaluation of predictive models with a focus on accuracy and equity. The results of the study highlighted the existence of performing models, but differentiated in the classification of policies, which can generate inequities, requiring a rigorous audit before the implementation of the system. Inter- esting experimental research was conducted in the Netherlands (Alon Barkat and Busuioc, 2021, p. 539) on the interaction between human resources and AI in public administration. Extended and diversified results were published three years later (Alon-Barkat and Busuioc, 2023, p. 157). The methods used were controlled psychological experiments with public decision-makers. The Triple Helix model provides a solid theoretical framework for understanding AI-based public innovation ecosystems in public administration. However, to translate the potential into real outcomes – such as improved decisions and citizen trust – robust research, cross-sectoral skills, and transparent and ac- countable governance are needed. The research underlying this paper con- Central European Public Administration Review, Vol. 23, No. 2/2025 73 Armenia Androniceanu, Sofia Elena Colesca tributes to a classification of the selected EU countries and to an analysis of the state of implementation of the three pillars of the Triple Helix model in EU governance processes, in the context of artificial intelligence. In summary, the existing literature demonstrates that the integration of the Triple Helix model with artificial intelligence in public administration remains an emerging yet up-and-coming field. While substantial progress has been made in conceptualizing collaborative frameworks among government, ac- ademia, and industry, empirical evidence on effective implementation and long-term outcomes is still limited. Cross-country analyses, particularly within the EU, reveal varying levels of maturity in AI governance and innovation eco- systems. Consequently, further research is needed to explore how the Triple Helix model can foster responsible, transparent, and ethically grounded AI adoption in public governance, contributing to both administrative efficiency and democratic accountability. 3 Research Methodology According to the specialized literature, the variables for the Triple Helix mod- el are specific to the three main actors: the academic environment provid- ing knowledge, research and innovation, the business environment (industry) providing smart solutions and technologies in the context of public-private partnerships and the government/public administration, which develops public policies, provides total or partial financing and is the beneficiary of re- search and innovation. This study adopts a comparative, mixed-method re- search design to explore the relationship between Artificial Intelligence (AI) adoption in public administration and the Triple Helix model of innovation across selected EU member states. The study focuses on a few EU member states. This design enables comparative insights rather than exhaustive cov- erage, aligning with the study’s aim to analyze structural and institutional de- terminants of AI adoption in public administration. This purposive sampling enables a comparative analysis of the Triple Helix dynamics and institutional factors influencing AI adoption in different administrative and policy environ- ments, rather than aiming for exhaustive coverage of all EU states. The study employs a purposive sampling approach. A few EU countries were selected to reflect a diversity of AI maturity levels, administrative capacities, and geo- graphical contexts within the European Union. The selection was based on three main criteria: (1) diversity in AI maturity and digital governance levels; (2) institutional and geographical representation of both Western/Northern and Central/Eastern Europe; and (3) availability and comparability of data from official EU and OECD databases. This balanced selection allows for cross- country comparison of institutional drivers and constraints affecting AI adop- tion in public administration. Quantitative indicators were compiled, corresponding to the implementation of the EU Coordinated Plan on Artificial Intelligence (2021 Review) and the Digi- tal Europe Programme. Data were obtained from Eurostat, the OECD, and the European Commission’s Digital Economy and Society Index (DESI) and Oxford 74 Central European Public Administration Review, Vol. 23, No. 2/2025 Triple Helix Model and Artificial Intelligence in Public Administration Insights. To ensure cross-country comparability, all variables were normalized using min–max scaling (0–1 range). Missing data (less than 5% of the total) were addressed through linear interpolation based on available time series. The empirical analysis proceeds in descriptive statistics and Pearson correla- tion coefficients were used to identify preliminary associations between AI adoption and the Triple Helix dimensions. All variables were standardized (z- scores), and multicollinearity was tested using the Variance Inflation Factor (VIF < 3). Model assumptions regarding normality, homoscedasticity, and in- dependence were verified before interpretation. This transparent methodo- logical framework ensures replicability and provides a robust foundation for interpreting the institutional mechanisms underlying AI adoption in selected EU public administrations through the lens of the Triple Helix model. Within the framework of this research, the following aspects are analyzed: (1) the degree of digital maturity of the selected EU states; (2) the intensity of the Triple Helix model; (3) the proportion of ICT graduates and the degree of in- tegration of AI in public administration; (4) collaborative framework between university, industry and government and the AI integration in public adminis- tration; (5) ITC infrastructure supporting the TH model and the integration of AI in public administration (6) the national AI and governance strategy. The objectives of the research are: (1) to analyse the degree of digital ma- turity of the states included in the pilot study; (2) to identify the impact of the Triple Helix Model (university-industry-government collaboration) on the assimilation and integration of AI in public administration; (3) to identify the main correlations between the three actors in the context of artificial intel- ligence; (4) to discover the main correlations between the TH maturity and the ICT infrastructure; (5) to find out the relations between the AI national strategies, government strategies and the degree of AI implementation in the public administration of the selected EU state. The main questions answered by the research are: (1) What is the relationship between the intensity of the Triple Helix collaboration and the degree of digi- talization and integration of AI in public administration? (2) Are there signifi- cant differences between the selected EU states in terms of implementing AI strategies in the public sector? (3) Is there a collaborative frame for supporting innovation and AI integration? How do the national AI strategies of the selected EU countries influence the success of AI implementation in administration? The main research hypotheses (H) are the following: H1. A country’s digital maturity level (DESI) mediates the relationship betwe- en the Triple Helix and the success of AI implementation in public admini- stration. H2. Countries with strong Triple Helix (TH) have a higher intensity of UIG (uni- versities, innovation, and government) collaborations. H3. Countries with higher proportions of ICT graduates tend to report grea- ter levels of AI adoption. Central European Public Administration Review, Vol. 23, No. 2/2025 75 Armenia Androniceanu, Sofia Elena Colesca H4. A well-developed collaborative framework between universities, indust- ry, and government is closely associated with increased innovation activi- ty and AI integration. H5. There is a positive correlation between TH maturity, innovation activity and infrastructure. H6. Even if states have an artificial intelligence strategy for public administra- tion, the real impact is different. The main quantitative variables used in the first stage of the research are: (1) Number of AI projects in public administration; (2) DESI index – digital public services; (3) Percentage of civil servants trained in AI; (4) Percentage of AI integration in public administration; (5) Existence of a public AI strategy; (6) Triple Helix maturity level. A special category of subsidiary research variables was added to uncover the relationships between the national AI strategies of the selected countries and their governance. This subcategory of variables includes: the level of integration of AI in the governance process; public in- vestments and partnerships with private sector organizations for the imple- mentation of AI applications in the governance process; and the degree of adoption and integration of AI in the public sector. The main research variables used for the comparative analysis are presented in Table 2. Table 2: The main research variables Research variables Type Measurement level Number of AI projects in the administration, public-private Quantitative Absolute (number) partnership Index – services publicly available digital Quantitative Index (0-100) Percent officially trained in AI Quantitative Percent Percentage of integration of AI in public Quantitative Percent administration The existence of a public AI strategy Qualitative Nominal (Yes/No) Ordinal (low/medium/ Triple Helix Maturity Level Qualitative high) The research model is represented in Figure 2. 76 Central European Public Administration Review, Vol. 23, No. 2/2025 Triple Helix Model and Artificial Intelligence in Public Administration Figure 2: The correlational research model Triple Helix (Universities- Innovation-Governments) Innovative capacity Degree of assimilation and integration of AI in administration Digital maturity (moderating variable) Source: authors. 4 Discussions of the Research Results The first parameter analyzed is the digital maturity of the selected EU states, which is measured with DESI. This index includes four relevant sub-dimen- sions: (1) human capital, which measures the digital skills of the population, including the number of IT specialists and the degree of internet use; (2) con- nectivity, which measures digital infrastructure, such as broadband network coverage and internet speed; (3) Digital technology integration, which meas- ures how companies integrate digital technologies into their activities, includ- ing e-commerce; and (4) Digital public services, which measures the degree of digitalization of public services, such as e-government. The analysis combines descriptive statistics and correlation analysis to exam- ine the relationship between AI adoption in public administration and the three dimensions of the Triple Helix model. Correlation coefficients were first used to identify bivariate relationships among the indicators. Based on the data presented in Table 3, the Pearson correlation between DESI, the global DESI indicator for the year 2024, and the Government AI Readiness Index (Ox- ford Insights, 2024) for a few EU countries was determined. Central European Public Administration Review, Vol. 23, No. 2/2025 77 Armenia Androniceanu, Sofia Elena Colesca Table 3: DESI and the AI Score of the selected EU member states Country Score DESI (%) Score AI (%) Estonia 91.0 72.0 Finland 89.0 70.0 France 86.0 68.0 Germany 85.0 65.0 Romania 65.0 50.0 Sources: European Union, 2022 and Oxford Insights, 2023 The Pearson correlation coefficient calculation between DESI (European Union, 2022) and AI scores for the five countries is 0.98, indicating a very strong and positive correlation between these indicators. The correlation coefficient of 0.98 suggests that countries with higher DESI scores also tend to have higher AI scores, indicating a strong link between overall digitaliza- tion and the use of AI technologies. Estonia stands out with high scores on both DESI and AI, being a successful example of integrating digital tech- nologies and AI. Romania has lower scores on both indicators, suggesting the need for more effective investments and public policies in the field of digitalization and AI development. The comparative analysis reinforces the fact that digital maturity (DESI) and AI in public administration are funda- mental in mediating the effects of the Triple Helix on the assimilation and integration of AI in the public sector. The results show a clear positive cor- relation: countries with a higher DESI index have a significantly higher AI adoption. These results confirm hypothesis 1. Countries with solid ecosys- tems in these areas position themselves at the forefront of the EU, and the others have major potential if they invest strategically. Countries with a low DESI (Romania) have weak AI adoption. The bar chart in Figure 3 illustrates a comparative analysis of the level of AI implementation in public administra- tion and the maturity of the Triple Helix model—representing university-in- dustry-government collaboration—across five European countries: Estonia, Finland, France, Germany, and Romania. The data reveal notable differences in how these two dimensions correlate within each national context. Estonia emerges as a frontrunner in terms of AI implementation, achieving the high- est possible score, while its Triple Helix maturity is slightly lower (4). This suggests that the country’s advanced digital governance infrastructure and strong political commitment to innovation may compensate for a moder- ately developed collaborative ecosystem. 78 Central European Public Administration Review, Vol. 23, No. 2/2025 Triple Helix Model and Artificial Intelligence in Public Administration Figure 3: The relationships between the AI implementation and the Triple Helix maturity Source: authors. In contrast, Finland and Germany display a reverse trend: both countries have achieved maximum maturity in their Triple Helix systems (5), but their AI im- plementation in administration remains at 4. This may indicate that despite robust collaboration among universities, industries, and governments, trans- lating such systemic strengths into administrative AI adoption requires ad- ditional strategic alignment or regulatory innovation. France demonstrates equilibrium, with identical scores (4) for both AI implementation and Triple Helix maturity, reflecting a balanced relationship between ecosystem collab- oration and technological integration. Romania, however, lags significantly behind, scoring only 2 in both categories. This parallel low performance high- lights systemic weaknesses in both administrative innovation and collabora- tive capacity, suggesting that foundational reforms are necessary to foster both ecosystem maturity and technological uptake. Overall, the comparison highlights a complex interplay between AI adoption and the maturity of collaborative ecosystems. While a high level of Triple Helix maturity appears conducive to technological implementation in some coun- tries, it does not guarantee rapid AI integration in public administration. Con- versely, Estonia’s performance suggests that strong political will and a digital- first strategy can accelerate AI implementation even when ecosystem maturity is relatively moderate. These findings underscore the need for nuanced policy approaches tailored to each country’s unique innovation landscape. The second parameter is the Triple Helix (TH) intensity – proxies. It is deter- mined based on ICT graduates and partnerships between public institutions and private sector organizations. At the level of the EU and according to DESI, Estonia leads in % ICT graduates (~11%) by 2022, while Italy, Belgium, and Cyprus have a process of less than 3%. The DESI–DII comparison shows that Germany, Finland, and the Netherlands have consolidated multi-sector eco- systems. We find out that countries with strong TH (e.g., Finland, the Nether- Central European Public Administration Review, Vol. 23, No. 2/2025 79 Armenia Androniceanu, Sofia Elena Colesca lands, Germany) have a higher intensity of UIG (universities, innovation, and government) collaborations. These results partially confirm Hypothesis 2. The graph in Figure 4 (% ICT graduates vs. AI adoption) confirms a moderate correlation: more ICT graduates usually mean a higher capacity to implement AI. However, there are exceptions (Spain has high AI adoption even with an average ICT percentage). Figure 4: The correlation between the ICT graduates and the AI implementation within the sampled member states Source: authors. The scatterplot illustrates the correlation between the percentage of ICT graduates and the level of AI adoption across selected European countries. A positive relationship is evident, as indicated by the upward-sloping trendline: countries with higher proportions of ICT graduates tend to report greater lev- els of AI adoption. These results confirm hypothesis 3. Finland and Denmark stand out as clear leaders. Finland, with over 10% ICT graduates, achieves an AI adoption rate of approximately 18%, while Den- mark surpasses 22% AI adoption with around 8% ICT graduates. These outli- ers suggest that while a strong ICT educational base is critical, other factors such as innovation policies, RandD investment, and digital infrastructure also play significant roles in facilitating AI integration. In contrast, Romania and Poland are positioned in the lower left quadrant of the chart, reflecting both a limited percentage of ICT graduates (below 4%) and low AI adoption rates (below 5%). This clustering suggests structural challenges in developing a skilled workforce and integrating advanced technologies. 80 Central European Public Administration Review, Vol. 23, No. 2/2025 Triple Helix Model and Artificial Intelligence in Public Administration Germany’s performance is noteworthy: with a relatively moderate proportion of ICT graduates (about 5%), it achieves a comparatively high AI adoption rate (~15%). This deviation from the trendline indicates the potential influence of non-educational factors such as industrial capacity, public-private partner- ships, and strong innovation ecosystems. Overall, while the data support the hypothesis of a positive correlation be- tween ICT education and AI uptake, the dispersion of data points around the trendline implies that ICT graduate rates alone are insufficient predictors of AI adoption. A comprehensive approach encompassing education, policy, in- frastructure, and ecosystem development is likely necessary to drive AI inte- gration at scale. The third parameter is the degree of assimilation and integration of AI in public administrations in selected EU countries. According to AIWatch data (JRC, 2022, p. 126), in most EU countries, AI is used for multi-sector collabora- tions, governance processes, and interoperability. High levels of integration and use of AI applications in the public sector are in Denmark (24%), Portugal (17%), Finland (16%), in contrast to Romania/Poland/Hungary (~3%). These results indicate a strong correlation between digital maturity, the intensity of Triple Helix collaborations, and AI integration. The scatterplot presented in Figure 5 illustrates the relationship between the number of public-private AI projects, the presence of innovation hubs, and the maturity of the innova- tion ecosystem, measured through the Triple Helix model within a few se- lected EU countries. Figure 5: The main relationships between the research variables Source: authors. Germany emerges as the most advanced ecosystem, with the highest number of AI projects (15), the strongest presence of innovation hubs (7), and the highest Triple Helix maturity (5). This suggests that a well-developed collabo- rative framework between universities, industry, and government is closely associated with increased innovation activity and AI integration. These results conform to Hypothesis 4. Central European Public Administration Review, Vol. 23, No. 2/2025 81 Armenia Androniceanu, Sofia Elena Colesca Countries with clear artificial intelligence strategies in the public sector have higher adherence to government AI projects and significant budget alloca- tions. France and Finland occupy intermediate positions, with a moderate number of AI projects (9–10) and innovation hubs (4–5), alongside relatively high ecosystem maturity (4–5). Estonia, despite having a comparable number of AI projects (12), demonstrates a lower presence of innovation hubs (3), which may limit the diffusion and scaling of innovation outcomes beyond spe- cific sectors. Romania is an outlier, characterized by the lowest values on all three dimensions: minimal public-private AI projects (3), limited presence of innovation hubs (1), and low ecosystem maturity (2). This underscores signifi- cant structural gaps that could hinder its capacity to leverage AI for socio-eco- nomic development. Overall, the data suggest a positive correlation between Triple Helix maturity and both innovation activity and infrastructure. These results conform to Hypothesis 5. The fourth parameter analyzed is national AI strategies and governance. For this purpose, in Table 4, relevant data for the 6 countries were collected based on the most recent official reports and EU sources (AI Watch, Oxford Insights, European Commission and OECD). Table 4: The key research variable for measuring the relationship between AI governmental strategy and governance Public Sector AI AI Strategy Governance Public Investment Ethical Country Adoption and (Y/N) Level (€/capita) Regulation Integration Finland 100 90 80 90 70 Denmark 100 85 75 85 65 Netherlands 100 80 85 80 75 Germany 100 95 90 85 80 Poland 80 65 50 55 45 Romania 70 60 40 50 35 Notes: Values are normalized based on recent reporting and estimates to allow for clear comparisons. Sources: European Commission, 2022a,b; Oxford Insights, 2022 and OECD, 2022 Analysis of AI Strategies and Governance in selected EU countries is presented in Figure 6 based on a representative research variable. This radar chart pro- vides a comparative overview of six EU member states—Finland, Denmark, the Netherlands, Germany, Poland, and Romania—regarding their Artificial Intelligence (AI) strategies and governance. 82 Central European Public Administration Review, Vol. 23, No. 2/2025 Triple Helix Model and Artificial Intelligence in Public Administration Figure 6: The relationship between AI Strategy and governance Source: authors. The chart visualizes five key indicators: the existence of a national AI strat- egy, governance level, public investment per capita, ethical regulation, and AI adoption within the public sector. The key findings are presented and ana- lyzed below. Finland, Denmark, the Netherlands, and Germany show a strong presence of national AI strategies (all scored 100), reflecting early and com- prehensive government commitment to AI development. These countries also score highly in governance and ethical regulation, indicating robust in- stitutional frameworks and alignment with EU ethical guidelines. Germany leads in public investment per capita, followed closely by the Netherlands and Finland, suggesting prioritization of AI research and infrastructure. Po- land and Romania exhibit considerably lower investment levels, highlighting disparities in resource allocation within the EU. While ethical regulations are generally strong in northern and western countries, Poland and Romania lag behind. This gap may affect the responsible deployment of AI systems and trust in public AI applications. Similarly, public sector adoption rates are sig- nificantly lower in Poland and Romania, potentially due to infrastructural or legislative limitations. The differences underscore the need for targeted sup- port and harmonization efforts by the EU to bridge gaps in AI governance and investment. These results prove hypothesis 6, meaning that all analysed states have AI strategies, but the impact on public administration is different. Enhanced collaboration could foster equitable AI advancements across mem- ber states, reducing digital divides. EU countries such as Germany, Finland, France, Italy, and Spain have AI strategies that include the use of AI in public services. Finland already has a working group to adapt national legislation to the AI Act. Tables 4, 5, and 6 contain comparisons between the main EU coun- tries included in the research. Central European Public Administration Review, Vol. 23, No. 2/2025 83 Armenia Androniceanu, Sofia Elena Colesca Table 5. Comparative approach of the selected EU states from the research parameters perspective ICT DESI Public sector Country graduates Observations (2022) AI strategies % high Yes (legal Finland 69.6 digital champion, robust TH (~>10%) working group) AI in e- government + Denmark 69.3 high Yes governance Advanced digital Netherlands 67.4 high Yes ecosystem medium- Germany 52.9 Yes AI standardization, active TH high reduced Average digital shelter, Poland 40.6 Yes (~3.5%) modest TH DIGITIZATION weak, fragile Romania 30.6 low (<3%) Yes TH Source: authors. Table no. 5 presents a comparative analysis of the main indicators that reflect the main components considered in this research. Based on the results of this research, 3 typologies of approaches to the Triple Helix model in the context of artificial intelligence can be identified. These are: – Leaders: Scandinavia – Finland, Denmark – TH, DESI, solid AI strategies → high AI integration. – Followers: Germany, Netherlands, France – moderate AI integration, but with infrastructure and strategies ready. – Challenged: Poland, Romania – although they have AI strategies, modest digitalization, and innovation ecosystems reduce the impact of AI in admi- nistration. For policymakers, this study highlights the importance of multi-sectoral col- laboration in implementing the EU AI Act; for scholars, it proposes a concep- tual framework linking AI governance to the Triple Helix innovation model. The adoption of artificial intelligence (AI) in public administration presents both significant opportunities and challenges for governance. From a policy perspective, AI can enhance efficiency, streamline decision-making process- es, and improve service delivery. However, successful implementation re- quires robust data governance frameworks, clear regulatory guidelines, and active collaboration between government, industry, and academia, consist- ent with the Triple Helix model. Comparative insights from Estonia, Finland, France, Germany, and Romania highlight diverse approaches: Estonia and 84 Central European Public Administration Review, Vol. 23, No. 2/2025 Triple Helix Model and Artificial Intelligence in Public Administration Finland exemplify advanced digital governance infrastructures, while Ger- many and France emphasize stringent data protection and ethical oversight. Romania, still developing its digital governance capabilities, can benefit from adopting best practices from these countries. Ultimately, responsible AI in- tegration in public governance demands a balance between technological innovation, ethical standards, and public accountability to foster trust and equitable service delivery. Table 6. The main research comparative indicators Adoption AI % ICT DESI and strategies Country graduates Observation (2022) integration in public (2022) AI (%) admin. Finland 69.6 ~11 (high) 16 Mature ecosystem Denmark 69.3 ~8 24 Government AI leader Stable, TH Netherlands 67.4 ~7 ~12 collaborations Advanced TH, AI Sweden 65.2 ~6 ~12 e-government Germany 52.9 ~5 ~10 Industrial complex Belgium 50.3 ~3 ~10 Medium TH Good digital public Spain 60.8 ~5 ~15 services Poland 40.5 ~4 ~5 Digital on the rise Romania 30.6 ~2 <5 Low digital Lithuania 52.7 ~5 ~5 Average digital maturity Note: AI adoption values in the public sector are estimated from AI-Watch data on companies. Source: authors. 4.1 Limitations and Further Research The study has several limitations that should be acknowledged. First, the sam- ple is limited to almost ten European Union countries, which, while selected to provide regional and institutional diversity, may reduce the generalizability of the findings across the broader EU or other global contexts. Second, the analysis is based on data from 2018–2023, a period that captures recent de- velopments in AI adoption and digital governance but may not reflect longer- term trends or policy shifts occurring outside this timeframe. Future research could address these limitations by expanding the sample to include additional EU member states or non-European countries, enhancing the comparative perspective and robustness of findings. Longitudinal studies covering longer timeframes could also provide insights into the evolution of Central European Public Administration Review, Vol. 23, No. 2/2025 85 Armenia Androniceanu, Sofia Elena Colesca AI adoption and the impact of governance innovations over time. Additional- ly, future work could explore more granular or sector-specific analyses, exam- ining the effects of AI adoption on particular public administration functions or policy areas. 5 Conclusions This study investigates the relationship between the Triple Helix model (uni- versity–industry–government collaboration) and the assimilation of artificial intelligence (AI) in public administration across selected European Union (EU) member states. The findings highlight distinct cluster patterns among select- ed EU countries, reflecting varying degrees of Triple Helix collaboration, digi- tal maturity, and AI integration in public administration. The study offers valu- able insights into how multi-actor ecosystems can accelerate AI-driven public sector innovation, and it proposes policy recommendations to strengthen cross-sector collaboration for digital governance. This study advances the understanding of how university–industry–government collaboration (Triple Helix) shapes the assimilation of artificial intelligence (AI) within public admin- istration across EU member states. The empirical findings confirm that coun- tries with higher levels of Triple Helix intensity exhibit significantly greater integration of AI applications in public governance processes. The analysis also highlights the mediating effect of digital maturity (measured by DESI) in amplifying the benefits of collaborative innovation ecosystems. The comparative correlation analysis reveals structural disparities across EU countries, with a clear divide between digitally mature states fostering cross- sectoral innovation and lagging countries constrained by weak institutional capacities, limited public-private partnerships, and insufficient ethical govern- ance frameworks. Theoretically, the study contributes to extending the Triple Helix model to the domain of AI-driven public sector innovation, offering a novel perspective on how collaborative ecosystems accelerate digital transformation. Practically, the findings suggest that policymakers should strengthen multi-actor govern- ance mechanisms, integrate ethical AI frameworks into digital strategies, and invest in public sector capabilities to leverage AI for citizen-centric innovation. This study underscores the transformative potential of integrating the Tri- ple Helix Model with Artificial Intelligence to advance innovation, efficiency, and responsiveness in public administration. By aligning the collaborative capacities of academia, industry, and government with data-driven decision- making and intelligent systems, public institutions can transition toward more adaptive and evidence-based governance models. The research con- tributes to the theoretical enrichment of innovation governance and pro- vides practical implications for policymakers aiming to harness AI responsi- bly within the public sector. This paper emphasizes the added value and originality of combining the Tri- ple Helix model with Artificial Intelligence as a framework for reimagining 86 Central European Public Administration Review, Vol. 23, No. 2/2025 Triple Helix Model and Artificial Intelligence in Public Administration innovation and governance in public administration. Conceptually, the study advances the field by linking collaborative innovation theory with emerging models of AI governance, providing a fresh perspective on how knowledge co-creation among academia, industry, and government can be strengthened through the use of intelligent technologies. From a practical standpoint, the findings provide actionable insights for poli- cymakers and institutional leaders seeking to foster data-driven, transparent, and citizen-oriented governance. Overall, the research enriches the academic discourse on digital transformation in the public sector and opens new di- rections for empirical investigation into the long-term societal impacts of AI- enabled collaboration. Acknowledgement: The paper has been prepared under the research project named: The impact of artificial intelligence in public administration and algorith- mic governance of human resources in the digital age: opportunities and chal- lenges, 2025, financed by the Bucharest University of Economic Studies. Central European Public Administration Review, Vol. 23, No. 2/2025 87 Armenia Androniceanu, Sofia Elena Colesca References Alaa, A. (2023). Adoption of artificial intelligence and robotics in organisations: a systematic literature review. 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International Journal of Public Administration, 42(7), pp. 596–615. https://doi.org/10.1080/01900692.2018. 1498103 Central European Public Administration Review, Vol. 23, No. 2/2025 91 DOI: 10.17573/cepar.2025.2.04 1.01 Original scientific article Country Attractiveness for Conducting Clinical Trials – A Literature Review Tomislav Geršić University of Rijeka, Faculty of Economics and Business, Croatia tomislav.gersic@uniri.hr https://orcid.org/0009-0005-0916-8189 Nenad Vretenar University of Rijeka, Faculty of Economics and Business, Croatia nenad.vretenar@efri.uniri.hr https://orcid.org/0000-0003-4689-0865 Jelena Jardas Antonić University of Rijeka, Faculty of Economics and Business, Croatia jelena.jardas.antonic@efri.uniri.hr https://orcid.org/0000-0001-6872-9293 Received: 23. 7. 2025 Revised: 1. 10. 2025 Accepted: 21. 10. 2025 Published: 11. 11. 2025 ABSTRACT Purpose: Clinical trials are a big business worldwide, bringing benefits to patients and the healthcare systems of the countries that attract them. However, despite the extremely high scientific interest in clinical research in the medical literature, there is very little economic literature on clinical research and, in particular, on the factors that influence a country’s at- tractiveness for clinical research. The purpose of this paper is to provide a review of this literature and the main approaches and findings used. Approach: For this paper, the WoS CC database was first searched and papers on clinical trials published in 2015 or later were analyzed, with a focus on papers from the research area of business economics and public administration. Subsequently, an overview of the most important published papers on the study of the attractiveness of countries is then provided, and the methodological principles and results of the analyzed papers are explained. Findings: A review of the literature shows that there are few studies in- vestigating the attractiveness of countries for clinical research. Further- more, the published papers are often small and examine individual cases or small samples of countries. However, the most important factors iden- tified are the speed, reliability and efficiency of the hospital system and Geršić, T., Vretenar, N., Jardas Antonić, J. (2025). Country Attractiveness for Conducting Clinical Trials – A Literature Review. 93 Central European Public Administration Review, 23(2), pp. 93–117 2591-2259 / This is an open access article under the CC-BY-SA license https://creativecommons.org/licenses/by-sa/4.0/ Tomislav Geršić, Nenad Vretenar, Jelena Jardas Antonić the predictability of regulations. The cost of research in each country, although not unimportant, is secondary to the key factors highlighted. Practical Implications: Clinical trials are of great importance for human health. However, they are also important for economic reasons but are underrepresented in the scientific literature dealing with them. This pa- per provides researchers with a framework for future scientific research. However, as it focuses on the study of the attractiveness of clinical trials, it is also useful for regulators and policy makers to gain a better under- standing of this field. Originality/Value: This paper offers an overview of an important but ne- glected scientific field and, by systematizing and interpreting the research and its results, enables further development and facilitates future research. Keywords: clinical trials, country attractiveness, factors, costs, regulation Privlačnost držav za izvajanje kliničnih raziskav – pregled literature POVZETEK Namen: klinične raziskave so velik posel po vsem svetu, saj prinašajo koristi pacientom in zdravstvenim sistemom držav, ki jih pritegnejo. Kljub izjemno velikemu znanstvenemu interesu za klinične raziskave v medicinski litera- turi pa je ekonomske literature o kliničnih raziskavah, zlasti o dejavnikih, ki vplivajo na privlačnost države za klinične raziskave, zelo malo. Namen tega članka je podati pregled te literature ter glavnih pristopov in ugotovitev. Pristop: najprej je bila preiskana baza podatkov WoS CC, analizirani pa so bili članki o kliničnih raziskavah, objavljeni leta 2015 ali pozneje, s po- udarkom na delih iz raziskovalnih področij poslovne ekonomije in javne uprave. Nato je podan pregled najpomembnejših objavljenih člankov o preučevanju privlačnosti držav, pojasnjena pa so tudi metodološka izho- dišča in rezultati analiziranih del. Ugotovitve: pregled literature kaže, da je malo študij, ki bi preučevale pri- vlačnost držav za klinične raziskave. Poleg tega objavljeni članki pogosto niso obsežni in obravnavajo posamezne primere ali majhne vzorce držav. Kljub temu so kot najpomembnejši dejavniki prepoznani hitrost, zaneslji- vost in učinkovitost bolnišničnega sistema ter predvidljivost predpisov. Stroški raziskav v posamezni državi – čeprav niso nepomembni – imajo sekundarno vlogo v primerjavi s poudarjenimi ključnimi dejavniki. Praktične implikacije: klinične raziskave so zelo pomembne za zdravje ljudi. Pomembne so tudi z ekonomskega vidika, vendar so v znanstveni li- teraturi, ki jih proučuje, podzastopana. Ta članek raziskovalcem nudi okvir za nadaljnje znanstveno raziskovanje. Ker se osredotoča na preučevanje privlačnosti kliničnih raziskav, je koristen tudi za regulatorje in oblikoval- ce politik pri boljšem razumevanju tega področja. Izvirnost/vrednost: članek ponuja pregled pomembnega, vendar zapostavlje- nega znanstvenega področja ter z njegovo sistematizacijo in interpretacijo raz- iskav ter rezultatov omogoča nadaljnji razvoj in olajša prihodnje raziskave. Ključne besede: klinične raziskave, privlačnost držav, dejavniki, stroški, regulativa JEL: I11, I18, M10 94 Central European Public Administration Review, Vol. 23, No. 2/2025 Country Attractiveness for Conducting Clinical Trials – A Literature Review 1 Introduction Clinical trials are scientific research trials conducted to assess and demon- strate the safety and efficacy of a new drug, treatment option or a medical device, or to demonstrate their efficacy for an indication previously not ap- proved for. Kramer and Schulman (2012) define clinical trials as a means of gathering information about medical products or services. Alvarenga and Mar- tins (2010) mention the biblical story of the king Nebuchadnezzar’s order for keeping a strict diet of meat and wine as the first document controlled clinical trial – where the prophet Daniel established the control arm by adhering to a diet of only pulse and water, and eventually showing that him and his friends became prettier and better-fed than the others. Clinical trials are conducted in four phases, different in their aims and the study sample involved - the number of patients that the drug is investigated on. Phase I and II clinical trials enroll a smaller number of patients, and their aim is to provide initial safety data and to determine the target dose ensuring therapeutic effect. Phase IV trials aren’t mandatory and aren’t always con- ducted for every drug. Apart from further demonstrating safety and efficacy, phase III trials demonstrate equivalence or superiority of the investigational medicinal product (IMP) compared to other previously available treatment options. Those trials are conducted on a larger number of patients which make a statistically significant sample – depending on the study design, this can range from several hundred to more than 20.000 patients. After the suc- cessful completion of a phase III trial, the clinical trial sponsor can request marketing authorization for the IMP from regulatory agencies. According to a report by Fortune Business Insides, the global clinical trials market is estimated to be worth USD 60.94 billion in 2024. According to the same source, phase III trials account for 46.8% of this amount, which is close to the usual estimate of nearly 50% of total clinical trial spending. Not only because of the big share of phase III trials in the market size, but also due to the fact that phase III clinical trials require the inclusion of the highest num- ber of patients among all the mandatory phases of clinical trials and are most often conducted in multiple countries, phase III clinical trials are of primary interest for this paper. Clinical trials are therefore a highly valuable and multi-beneficial activity worldwide, not only for patients, but also for healthcare systems and the scientific community. They give patients access to experimental, often more effective therapies that would otherwise not be available, improving health outcomes and quality of care. In addition, participation in industry-funded clinical trials can lead to significant cost reductions in conventional therapies, a phenomenon known as “cost avoidance” – i.e. the avoidance of costs for regular drugs and diagnostics that would otherwise be necessary. Clinical trials also bring significant economic benefits to healthcare organiza- tions. For example, according to research (Walter et al., 2020), for every euro invested in industry-supported trials in Austria, an economic multiplier of 1.95 Central European Public Administration Review, Vol. 23, No. 2/2025 95 Tomislav Geršić, Nenad Vretenar, Jelena Jardas Antonić was generated and new full-time jobs were created. In addition to these ef- fects, participation in clinical trials promotes the professional development of medical staff, improves the scientific monitoring of clinical practice and establishes high research and ethical rules, which ultimately increases the quality of healthcare and the efficiency of the healthcare system. Some fur- ther specificity of the clinical trials industry is provided by work (Amato et al., 2017) which shows that global investments in biomedical research and devel- opment increased by 18.4% between 2007 and 2012, while during the same period the investment levels in North America and Europe remained the same or decreased. They also state that the number of human trials worldwide rose from 12,018 to 234,321 between 2004 and 2016, and that the share of clini- cal trials in the European Union decreased by 15% from 2009 to 2015, i.e. that the EU is lagging. Given this, the clinical trials industry is a global industry that brings a range of advantages and economic benefits to the countries where these trials are conducted. Since the economic literature on clinical trials is very scarce, there is a need for further research. The economic and regulatory benefits and challenges of clinical research for public health systems should not be overlooked. This paper therefore provides an overview of the scientific literature on this topic, which does not originate from the field of health, but from the fields of economics and business. 2 Overview of the Economic Importance of Clinical Trials Clinical research and investment in the development of new medicines in general are not only of enormous value to human health but also generate significant costs for the companies that carry them out, while at the same time bringing considerable economic benefits to patients, hospitals and pub- lic health systems. Varmaghani et al. (2020) emphasize the economic impor- tance of developing new pharmaceutical products: the development process from molecule creation to market approval takes 10 to 15 or more years, the approval rate for drugs entering the clinical trial phase is less than 12% and conducting phase I–IV clinical trials accounts for 75% of total development costs. The total cost of clinical trials for new drugs up to their market launch is estimated at USD 266 to 802 million. Furthermore, they find that between 2006 and 2010, the Turkish state was able to save almost USD 311,096,130 through medicines that were provided free of charge to patients as part of clinical trials and that would otherwise have been paid for by the national healthcare system. D’Ambrosio et al. (2020) present the results of their study on the treatment of oncology patients over a period of four weeks, in which 126 patients were treated free of charge as part of 34 clinical trials. The cost of standard therapy for these patients in clinical practice would have amount- ed to €517,658 over this period, which corresponds to a saving of €5,487 per patient over four weeks. Walter et al. (2020) state that 116.22 million euros invested in industry-funded clinical trials in Austria in 2018 generated an added value of 144.2 million euros, and that treatments worth 100 mil- lion euros were funded by clinical trials in Austria each year. This study shows that industry-funded clinical trials not only contribute to the advancement of 96 Central European Public Administration Review, Vol. 23, No. 2/2025 Country Attractiveness for Conducting Clinical Trials – A Literature Review healthcare, medical care and science, but also have a positive effect on the economy as a whole. Kaló et al. (2014) outline the impact of clinical trials on the Hungarian economy, citing a direct effect of 0.163 contribution to Hun- garian GDP and an additional indirect contribution of 0.033% of GDP due to savings in the healthcare system resulting from not having to pay for treat- ments that would otherwise be covered. Table 1 shows the number of phase III clinical trials conducted in selected countries in the five-year period from 2015 to 2019. The data source used was the Citeline Trialtrove business intelligence system due to its more com- plete data than the US FDA’s ClinicalTrials.gov database (Stergiopoulos et al, 2019), and a filter was applied to show only the number of clinical trials funded or commissioned by the pharmaceutical industry – in other words, all trials whose sponsor or funder was a government agency, academic organiza- tion or similar entity were excluded. The reason for not including non-industry sponsors is that they do not make their decisions on the choice of country in which to conduct a trial based on commercial or economic considerations. Instead, their decisions are based on other factors, such as existing collabora- tions with academic institutions in other countries, countries that are mem- bers of the academic consortium conducting the study, etc. Table 1: Number of phase III clinical trials, commissioned by the pharmaceutical industry (2015–2019) Average no. No. of Country Number of patients clinical trials Country population of trials per site per per million (millions) month inhabitants United States 2525 5.72 339.9 7.43 Germany 1440 4.64 83.2 17.29 Spain 1339 0.34 47.6 28.18 Canada 1324 4.84 38.7 34.14 United Kingdom 1304 4.84 67.7 19.25 Italy 1221 0.45 58.9 20.74 France 1198 0.57 64.7 18.50 Poland 1170 0.53 41.0 28.52 Belgium 933 0.56 11.8 79.84 Russia 914 0.37 144.4 6.33 Australia 910 0.38 26.4 34.42 Hungary 871 0.39 10.1 85.76 Central European Public Administration Review, Vol. 23, No. 2/2025 97 Tomislav Geršić, Nenad Vretenar, Jelena Jardas Antonić Czech Republic 825 0.36 10.5 78.61 Netherlands 748 0.59 17.6 42.46 South Korea 741 0.26 51.8 14.31 Israel 664 0.25 9.8 72.37 Austria 574 0.51 8.9 64.07 Taiwan, China 572 0.35 23.9 23.91 Ukraine 538 0.37 36.7 14.64 Bulgaria 535 0.35 6.7 80.00 Romania 512 0.32 19.9 25.74 Turkey 512 0.27 85.8 5.97 Sweden 504 0.42 10.6 47.49 Denmark 492 0.50 5.9 83.24 Switzerland 397 0.38 8.8 45.13 China 387 0.21 1425.7 0.27 Greece 378 0.26 10.3 36.55 Portugal 367 0.23 10.2 35.81 Slovakia 317 0.37 5.7 54.70 Finland 315 18.63 5.54 56.80 Serbia 315 0.30 7.1 44.06 Ireland 284 0.24 5.1 56.16 Lithuania 242 0.42 2.7 89.02 Norway 233 0.30 5.5 42.56 Croatia 218 0.34 4.00 54.38 Latvia 212 0.49 1.8 115.83 Estonia 209 0.52 1.3 158.00 India 208 0.39 1428.6 0.15 Slovenia 89 0.33 2.1 41.99 Source: authors’ calculation by using Trialtrove business intelligence system, owned by Citeline, Worldometer and estimate based on the 2022 revision of UN data. 98 Central European Public Administration Review, Vol. 23, No. 2/2025 Country Attractiveness for Conducting Clinical Trials – A Literature Review The middle column shows the coefficient representing each country’s effi- ciency in participating in clinical trials based on the average number of pa- tients enrolled per trial site (i.e. a single hospital or outpatient clinic under the supervision of a principal investigator) per month. The speed of implementation and completion of a clinical trial depends pri- marily on how quickly suitable patients are enrolled at the participating trial sites in the countries involved in the study. Intuitively, one might conclude that countries with large populations contribute the most to the number of patients enrolled in clinical trials and, consequently, the most clinical trials are conducted in those countries. However, the column “Number of clinical trials per million inhabitants” in Table 1 reveals a discrepancy between coun- tries: certain countries with larger populations and higher average number of patients per trial site per month have a lower number of clinical trials per mil- lion inhabitants than other countries with smaller populations and the same patient enrollment factor (for example, Germany, with a population of 83.2 millions and a patient enrollment factor of 4.64, has fewer clinical trials per million inhabitants (17.29) than Italy, with a population of 58.8 million and a patient enrollment factor of 0.45, and 20.74 trials per million inhabitants). In addition, there are countries with approximately the same population in which the number of clinical trials per million inhabitants differs consider- ably. An example of this is Denmark and Finland: Denmark, with a population of 5.9 million and a patient recruitment factor of only 0.5, has 83.24 clinical trials per million inhabitants, while Finland, with a population of 5.5 million and a very high patient recruitment factor of 18.63, has only 56.8 clinical tri- als per million inhabitants. 3 Literature Review Due to its great economic importance – both in terms of market size and the large number of jobs in the industry – the clinical trials industry is an in- teresting and promising research topic, yet still relatively under-researched from an economic perspective. The following two figures show the number of scientific papers published since 2015 on Web of Science whose topic is clinical trials. Central European Public Administration Review, Vol. 23, No. 2/2025 99 Tomislav Geršić, Nenad Vretenar, Jelena Jardas Antonić Figure 1: The number of papers on the topic of clinical trials in Web of Science 2015–2025. Source: Web of Science Figure 2: The number of papers on the topic of clinical trials in the research areas of business economics and public administration Web of Science 2015–2025. Source: Web of Science Figure 1 shows the tree-map of published papers in the last ten years in the Web of Science Core Collection (WoS CC) in all subject areas on the specified topic. Although the total number of published papers is enormous and more than half a million (582,495), it is understandable that these are mainly on medical topics. However, when the search is narrowed down to the research areas of business economics and public administration (Figure 2), the total number of all types of research papers is only 2033, of which only 15 are in 100 Central European Public Administration Review, Vol. 23, No. 2/2025 Country Attractiveness for Conducting Clinical Trials – A Literature Review the area of public administration. This shows that clinical trials are severely neglected in public administration and even in economics, which is difficult to understand given the importance of this sector in these areas. Even though the number of published papers is very modest, the number of citations of these papers is increasing rapidly (Figure 3), which shows the importance of the topic. The analysis of keywords for clinical trial in business economics and public administration carried out with VOSviever shows (Figure 4) that country attractiveness, decision factors, etc. are underrepresented even in this research area. Figure 3: Papers on the topic of clinical trials in the area of business economics and public administration – times cited and publications over time. Source: Web of Science Due to the importance of the topic, the following part of the paper provides an overview of the relevant literature, which is limited to the very small num- ber of studies that analyze the attractiveness of countries for clinical research. The overview is neither limited to specific databases nor to the publication period analyzed above, and is divided into several research clusters based on the focus of the individual contributions. Central European Public Administration Review, Vol. 23, No. 2/2025 101 Tomislav Geršić, Nenad Vretenar, Jelena Jardas Antonić Figure 4: Keyword analysis of papers on the topic of clinical trials in the research areas of business economics and public administration Web of Science 2015–2025. Source: created by the authors based on the data from the WoS CC database and using VOSviever. 3.1 Attractiveness of Host Countries According to Lee (2016), the concept of country attractiveness is used to measure the characteristics of a particular country in relation to its markets. He explains that the concept of country attractiveness can be defined as the relative importance of individual advantages and the perceived ability of the country to provide these individual advantages. Lee notes that empirical re- search indicates that a country’s attractiveness is simultaneously influenced by several factors, including tangible factors such as market size, market growth potential, level of economic development (or per capita income), and market openness in the context of the political and institutional environment. 102 Central European Public Administration Review, Vol. 23, No. 2/2025 Country Attractiveness for Conducting Clinical Trials – A Literature Review The same author points out that a country’s attractiveness for foreign invest- ment can be positively influenced by improving socio-political stability to re- duce the risk of foreign investment, improving the level of human develop- ment (e.g., providing services that affect the quality of life, a well-educated workforce, socio-cultural conditions such as education, healthcare, culture, etc.), managing the overall investment climate, and reducing the perception of bribery and corruption by business entities. Avetisyan (2020) lists market capacity, population size, degree of economic openness, inflation, taxes, exchange rate stability, etc. as factors for attract- ing foreign direct investment, on which most authors agree. He notes that institutional instability has a negative impact on foreign investment. He ar- gues that the experience of several countries has shown that the effective functioning of political and economic regulatory institutions has a greater impact than a number of macroeconomic indicators. As negative factors iden- tified in numerous studies, he cites non-transparent regulatory policies, the dominance of state ownership and the lack of an investor protection system, a weak rule of law and violations of economic freedoms. According to Avetisy- an, when analyzing these factors, it was found that the political stability fac- tor is statistically more significant than the inflation rate. The few papers that have explored the factors that contribute to the attrac- tiveness of countries for conducting clinical trials generally support the propo- sition that investments flow to countries with greater socio-political stability, transparency, education levels and quality, etc. Murthy et al. (2015) conducted an analysis of data from the online clinical trials registry ClinicalTrials.gov and classified trials as conducted in either low-income or high-income countries based on the location of the countries in which they were conducted. In their research, they find that clinical trials (i.e. industry-funded trials, excluding aca- demic and other clinical trials funded by other sources such as public funding, etc.) are traditionally conducted in high-income countries (wealthy countries), as this is where the infrastructure for conducting such trials is developed and where most pharmaceutical companies are based. However, Murthy and colleagues point out that this trend has changed in re- cent decades and that clinical trials are increasingly being conducted outside wealthy countries, resulting in the number of countries where clinical trials are conducted doubling between 1995 and 2005. By analyzing data available on the US FDA’s online registry (ClinicalTrials.gov), they found that more than a quarter of clinical trials are conducted in non-wealthy countries, while most are conducted in both wealthy and non-wealthy countries. Glass et al. (2016) note that clinical trials are cheaper to conduct in countries such as India and South America compared to North America and Western Europe, and that pa- tient recruitment is also faster and cheaper there. The same authors believe that the search for so-called treatment-naïve patients, i.e. patients who have not previously received treatment for their diseases, is a motivation for con- ducting clinical trials in non-wealthy countries. Due to poorer healthcare pro- vision compared to wealthy countries, these countries may have larger pools Central European Public Administration Review, Vol. 23, No. 2/2025 103 Tomislav Geršić, Nenad Vretenar, Jelena Jardas Antonić of untreated patients who are more suitable for participation in clinical trials, and both patients and physicians are more motivated to participate as partici- pation in a clinical trial offers free healthcare and access to the latest thera- peutic options. Murthy et al. (2015) find that among non-wealthy geographic regions, the largest proportion of clinical trials are found in non-Western Eu- rope and Asia. They further note that investigative centers in these countries enroll more subjects than trials conducted only in wealthy countries, indicat- ing that non-wealthy countries contribute significantly to the speed and ob- jectives of trials. Although they also cite the lower costs in these countries as a likely factor, they support the thesis that the motivation for including non- wealthy countries in clinical trials and their attractiveness lies in the ease of recruitment of treatment-naïve patients with chronic diseases. Even if other studies indicate that the costs of trials do not play a (major) role in decision- making, the speed of conducting and completing clinical trials is certainly a key factor. The reason for this is the patent protection of the investigational product, which expires 20 years after the patent application and includes the period in which the clinical trials are conducted. Faster recruitment of patients to achieve the required statistical sample therefore contributes directly to a faster completion of the study and the start of commercial use of the inves- tigational product. Glickman et al. (2009) highlight that the pharmaceutical industry benefits from the cost reductions due to globalization by conducting some activities in countries with relative advantages where there is a large population for clinical trials and sales in addition to cheaper labor, mentioning in particular South America and India. Moscicka et al. (2013) present the specific characteristics of Central and Eastern European countries in their paper and highlight the reasons for the growing demand for these countries: centralized healthcare systems with a small number of specialized centers serving a large number of patients; well- trained physicians and nurses; both public and private healthcare facilities have access to treatment-naive patients (unlike in Western European coun- tries where this is becoming increasingly difficult); existing systems of verti- cal patient referral in these countries, resulting in minimal competition for patients between medical centers; and the availability of lifelong medical re- cords for patients, allowing for low rates of failed screenings and early with- drawal of patients from studies. They also point out that the migration rate in this region is much lower compared to Western Europe, which allows for bet- ter long-term follow-up of participants. Other factors that contribute to the attractiveness of the region include good technical equipment with modern diagnostic devices and the medical, pharmaceutical or scientific education of clinical trials staff. Croatia and Serbia are cited as examples of countries where approval to start a clinical trial takes longer than in other countries, namely five to six months. They conclude that the quality of clinical trial con- duct in Central and Eastern European countries does not lag behind the qual- ity in Western European countries. 104 Central European Public Administration Review, Vol. 23, No. 2/2025 Country Attractiveness for Conducting Clinical Trials – A Literature Review 3.2 Factors Influencing the Decision on the Choice of Country Silva et al. (2016) state that when selecting a country, trial sponsors should consider: the country’s capacity to provide clinical evidence, investigator qualifications, number of patients with access to advanced medical care, com- munication capacity in terms of access to computers and the internet, intel- lectual property protection and market orientation. They also emphasize that the complex relationships between pharmaceutical companies and public in- stitutions, as well as companies’ attitudes toward the rules on compensation and payments in a given country, the degree of involvement of investigators in setting these rules, and general data on the country’s market and health- care system (population, gross domestic product per capita, healthcare ex- penditure per capita) may influence the decision on the location of a clinical trial. Silva et al. (2016) also note in their review that when selecting countries, their ethnic groups, epidemiological status of the disease, medical practice and geographical proximity must be considered and emphasize that not tak- ing into account differences between countries may result in the need for a larger sample size and longer research duration. Ippoliti (2013) conducted an econometric analysis of the economic efficiency of clinical trial assessment procedures in 29 European countries and their competitiveness in the human trials market, using panel data from 2004 to 2007. Based on this research, he finds that a country’s population is statisti- cally significant for competitiveness. He concludes that this suggests that tri- als are conducted more frequently where there are more potential patients in need of treatment. The same applies to the number of doctors: a higher num- ber of doctors in a particular country has a positive effect on the decision of pharmaceutical companies to include that country. He also emphasizes that there is a positive correlation between the efficiency of the approval system for studies and investment in pharmaceuticals. Gerhring et al. (2013) conducted an anonymous online survey on attitudes towards clinical trials in Europe (SAT-EU), in which the factors influencing the selection of trial sites in Europe were assessed. They highlight the negative impact of administrative burden on the competitiveness of clinical trials. They emphasize the critical importance of the speed with which feasibility data is collected and the speed with which a clinical trial is initiated. They believe that the track record of trial sites and the ability to quickly and effectively access all relevant information for sponsors and clinical trial organizers is of great importance. An eye-opening study based on an analysis of specific clini- cal trial sites (Dilts and Sandler, 2006) has identified an unusually high number of steps involved in the decision to initiate a clinical trial. A large proportion of these steps were found to be non-value adding and had no impact on the safety of the trial or the drug. The authors suggest that, following the ex- ample of other industries, removing such administrative hurdles could signifi- cantly speed up the process and improve patient care without compromising the integrity of the trial or patient safety. Central European Public Administration Review, Vol. 23, No. 2/2025 105 Tomislav Geršić, Nenad Vretenar, Jelena Jardas Antonić Górecka and Szałucka (2013) highlight the existence of several market selec- tion models in the literature and state that international market selection is usually considered as a sequential process where less attractive markets are gradually eliminated at each stage, eventually leading to the selection of a po- tential target market. They note that a systematic approach to international market selection is crucial, as this decision-making requires processing a large amount of information from many different and complex markets. The crite- ria for evaluating countries must be defined before the screening phase, as they ultimately have a direct impact on the screening results. They also em- phasize that a number of criteria is proposed in the literature that can be used and measured, but there is no consensus on them and their selection depends on which criteria each author believes are most appropriate for a particular situation. These criteria are directly related to the objectives of a company’s international expansion and vary depending on the type of market entry and what the company specifically wants to achieve in the target market. Górecka and Szałucka (2013) further emphasize that while there are numer- ous indicators in the literature to measure the criteria for selecting foreign markets, there is no consensus on a standardized variable that would make this process less subjective. They also emphasize the lack of agreement on the relative weight or importance of individual criteria – some studies suggest assigning equal weight to all criteria, while others suggest that certain criteria may be more important than others. They note that the literature on inter- national marketing identifies two main approaches for determining target markets during the initial selection of countries: grouping and ranking. The grouping method categorizes countries into groups based on the similarity of their commercial, economic, political and cultural dimensions, which helps to identify possible synergies between these markets. This approach assumes that companies prefer to enter countries from the same group (cluster) in which they already operate successfully. The ranking method ranks countries according to their attractiveness for market entry and evaluates them based on one or more criteria. This approach provides decision-makers with an ag- gregated measure of market attractiveness. The authors emphasize that al- though both methods are recognized as important tools for analyzing a large number of countries with heterogeneous markets, they should only be used in the preliminary phase of market assessment. Bordet et al. (2015) analyzed the state of the clinical trials market in France and drew conclusions on the areas that need to be improved in order to in- crease the country’s competitiveness. They conclude that France’s productiv- ity is perceived negatively in the eyes of the clinical trials industry compared to other countries. Negative factors cited include high costs, slow patient re- cruitment and a high proportion of trial sites closing without a single patient being enrolled. After the lengthy and costly approval process to start a clinical trial and the logistical challenge of starting the trial at each individual site, the closure of a trial site without patient recruitment is a worst case scenario for any trial sponsor. In their paper, Bordet and colleagues analyzed the findings of the French Strategic Council for the Health Industries (Conseil Stratégique 106 Central European Public Administration Review, Vol. 23, No. 2/2025 Country Attractiveness for Conducting Clinical Trials – A Literature Review des Industries de Santé – CSIS), which established a public-private partnership to improve participation in clinical trials and proposed measures to reduce the time needed to sign contracts, enroll 80% or more of the planned number of patients in at least 80% of sites, and close fewer than 15% of sites without enrolled patients. They conclude that the results of the studies on the effec- tiveness of these measures show that it is possible to increase the country’s attractiveness for industry-sponsored clinical trials. Alemayehu et al. (2018) conducted a study by reviewing literature indexed in PubMed, Embase, CINAHL and Web of Science as well as the WHO Global Health Library, searching for keywords such as barriers, challenges, clinical tri- als and developing countries. The focus of their research is on the barriers to conducting clinical trials in developing countries. The most common barriers cited were lack of financial and human resources, barriers in ethical and regu- latory approval systems, an underdeveloped research environment, opera- tional barriers and competition from potential clinical trial investigators, e.g. lack of time and other priorities due to their other assignments. Based on a systematic review of the literature and internal communications from the Eu- ropean Clinical Research Infrastructure Network (ECRIN) related to the ECRIN- IA project from 2013 to 2017, Djurisic et al. (2017) cite insufficient knowledge of clinical trials and trial methodology, excessive monitoring, restrictive data protection laws and lack of transparency, complex regulatory requirements and inadequate infrastructure as barriers. They also mention lack of funding as a barrier, but this refers to academic and public clinical trials, not industry- funded ones, which are not the subject of this paper. Carvalho et al. (2021) present their view on the state of the clinical trials industry in Portugal. They highlight clinical trial organizational units as key to the success of clinical tri- als, as they believe they enable adequate feasibility studies, recruitment and retention of participants. As key factors for the success of clinical trials and also as competitive factors for strengthening clinical trials in Portugal, they mention the motivation and awareness of the trial teams, combined with a high level of reliability and good relationships between healthcare profes- sionals and trial participants. Based on eleven semi-structured interviews with employees of multina- tional pharmaceutical companies in Denmark who are involved in decisions on the awarding of clinical trials, Dombernowsky et al. (2017) describe the decision-making process for country selection. The headquarters of the trial sponsors – pharmaceutical companies – make the decision in collaboration with Contract Research Organizations (CROs – companies that organize and supervise the conduct of clinical trials for the sponsor) and their subsidiaries in individual countries. For fully outsourced trials, the decisions are made by the CROs, while in other cases the sponsor’s head office makes the decisions. The sponsor’s subsidiaries provide the head office with data on their country, the feasibility of a specific trial, the availability of human, organizational and technical resources, the track record and the availability of so-called key opin- ion leaders. For this study, the decision-makers on country allocation were interviewed. The results show that all respondents consider timely patient Central European Public Administration Review, Vol. 23, No. 2/2025 107 Tomislav Geršić, Nenad Vretenar, Jelena Jardas Antonić recruitment to be one of the most important factors by which headquarters evaluate the performance of their subsidiaries, followed by the quality of the data obtained. It has been shown that smaller countries must continu- ally demonstrate their success in patient recruitment to be included in new clinical trials, as smaller countries are not automatically selected by sponsors. In contrast, larger countries are often included in clinical trials regardless of their previous success in patient recruitment, due to other factors such as the potential for post-approval drug sales. An example of this is the United States, which, according to data from another study cited by Dombernowsky et al.(2017), recruited only two-thirds as many patients compared to other countries, but still participated in a very large number of clinical trials. The number of patients enrolled per month and per trial center is considered a measurable indicator of a country’s success. Another factor is the speed with which a trial can be operationally initiated – in other words, a shorter time to obtain approval and sign contracts with individual healthcare facilities means a faster start to patient recruitment and more time for recruitment. The same study has shown that a lack or absence of investigator experience in conducting clinical trials does not necessarily mean that such sites will be rejected for participation. The reason for this is that the trial sponsor can compensate for this lack by providing more resources for training and moni- toring the conduct of the trial. Benisheva et al. (2023) conducted a study by reviewing legal documents, EU regulations and directives, and publications and reports on local and EU re- quirements for conducting clinical trials and analyzing statistical data from the EU Clinical Trials Register for Bulgaria, Hungary, Poland, Romania, and Slovakia on the total number of clinical trials conducted in these countries, Romania and Slovakia on the total number of completed and ongoing phase I-III interventional clinical trials, the prevalence of trials in rare disease diag- noses, the distribution of completed trials by phase and the number of com- pleted and ongoing trials in the European Economic Area countries and all EU Member States from 2012 to 2022. Based on their research findings, they conclude that the number of clinical trials in a particular country does not cor- respond to the country’s population size, but that other factors play a role in the choice of country, such as the reliability and predictability of regulatory timelines, a large number of medical personnel per capita, experienced medi- cal personnel willing to conduct clinical trials, experienced CRO personnel, large potential for patient recruitment, competitive costs per patient, low pa- tient dropout rates and satisfactory results in regulatory inspections. Jeong et al. (2017) compared elements from nine representative countries with the US and used multiple linear regression to analyze factors associated with the distribution of trial sites. Through their research on characteristics and related factors in the context of globalization of clinical trials, they pre- sent a predictive model for the distribution of clinical trials that includes the following indices: EFI (Economic Freedom Index), HEC (Health Expenditure per Capita), HCI (Human Capital Index) and IPRI (Intellectual Property Rights Index). They find that the distribution of clinical trials can be satisfactorily ex- 108 Central European Public Administration Review, Vol. 23, No. 2/2025 Country Attractiveness for Conducting Clinical Trials – A Literature Review plained by factors related to healthcare system infrastructure (HEC), a free market and low bureaucracy (EFI), access to higher education (HCI) and intel- lectual property rights (IPRI). They also point out that the literature mentions that the cost of clinical trials per country also has an influence, which may partially explain the determination of trial locations, but this data was not included in their research, and further studies are needed to explain other factors that influence the allocation of clinical trials by country. 3.3 The Influence of Costs In relation to the cost of clinical trials by country and its influence on the se- lection of countries to conduct trials, research findings show contradictory results. Jeong et al. (2017) find that cost reduction is one of the main reasons why sponsors choose developing countries to conduct trials in countries such as China, India and South America. Gehring et al. (2015) found in their analysis that a favorable pool of suitable patients, speed of approval and online avail- ability of trial site information are much more important than costs and gov- ernment subsidies. Dombernowsky et al. (2017) also conclude that the costs of allocating clinical trials by country is less important. They refer to a 2009 report in which a survey of 362 clinical trial stakeholders found that 80% of respondents would prefer to meet patient recruitment targets 10% faster than reduce costs by 20%. A study conducted by Goehring et al. (2013) also found that the costs of conducting clinical trials was significantly less impor- tant compared to factors such as an appropriate patient pool, speed of the approval process and the existence of disease management networks. Dombernowsky et al. (2019) also note that cost is less important than other factors in the selection of trial sites, but that it can still play an important role in the selection of countries. However, they note that the research findings suggest that cost is more important when the sponsor’s headquarters evalu- ates the efficiency of CROs – i.e. external partners – than when it evaluates the performance of its own subsidiaries. Although research findings are not consistent regarding the importance of the cost level in a given country for enrollment in clinical trials, the inclusion of less wealthy countries can most likely be explained by their comparative advantages over wealthy countries, leading to faster recruitment of the required number of patients, as also stat- ed by Bordet et al. (2015). On the same topic, Gehring et al. (2013) state that the impact of direct costs is limited and that indirect or hidden costs, such as the loss of time due to slow bureaucracy, slow patient recruitment or poor overall efficiency of trial sites, have a significant negative impact. Although there is evidence that cost is not the decisive factor when selecting a country to conduct clinical trials, the costs of the entire process are very high and by no means negligible. Kramer and Schulman (2012) point out that regardless of the factors driving up the cost of developing new medicines, the impact of rising costs is clear: Higher research costs result in fewer new medical products coming to market, less knowledge about the products that do come to market, and less research on public health issues. Central European Public Administration Review, Vol. 23, No. 2/2025 109 Tomislav Geršić, Nenad Vretenar, Jelena Jardas Antonić 3.4 The Influence of Regulations Gerhring et al. (2013) point out that the negative impact of a suboptimal reg- ulatory environment does not necessarily have a negative impact on investi- gator selection – provided the investigator is known and visible, has proven competencies, information about their research center is easily accessible and they are able to enroll the required patients in the trial. Efficiency in terms of speed of patient recruitment takes precedence over the weight of negative factors in the regulatory and institutional environment. Bansal (2012) highlights the following difficulties in conducting clinical trials globally from a US regulatory perspective: properly obtained and truly in- formed consent from subjects, differences in medical practice and standard of care, acceptance of data from other countries due to (non)compliance with US Food and Drug Administration (FDA) regulations, and ethnic factors due to different genetic profiles. Pharmaceutical companies apply for patent protection for a newly discovered drug with the relevant regulatory authorities before starting clinical trials. In the USA (FDA, n.d.) and in the EU (Garattini and Finazzi 2022), the duration of drug patent protection is 20 years. The possibility of obtaining a patent for their discovery triggered a hunger for innovation in the pharmaceutical in- dustry (Nedelcheva, 2019). The goal of clinical trial sponsors is to complete all three phases of clinical trials as quickly as possible in order to be able to start marketing the drug and exploiting it commercially. This means that the longer clinical trials take to complete, the shorter the period for exclusive commer- cial use. Once patent protection expires, generic manufacturers are free to start producing the drug without paying royalties. Investigating the causes of these discrepancies is the basic idea of this research: to identify the factors that make some countries more attractive than others for conducting clinical trials. In the context of speed of approval, Silva et al. (2016) cite the example of China, which has succeeded in reducing the time required for the approval of clinical trials by centralizing the regulatory authority and reducing conflict- ing regulations between the central and local levels of government. In another paper, Gehring et al. (2015), based on data from the same SAT-EU study using Italy as an example, also point out that the regulatory environ- ment influences sponsors’ decisions on where to conduct their trials. Their re- search identified three areas that are critical to a country’s competitiveness: the availability of information needed for clinical trials, the predictability and speed of clinical trial approvals by ethics committees and regulatory authori- ties, and the availability of necessary equipment. The issue of equipment avail- ability highlighted in this paper is a somewhat surprising factor, as in multina- tional clinical trials sponsors generally assume that they will need to provide at least some (if not most) of the equipment for the trial sites. At first glance, this appears to be merely a logistical challenge, but it can also be interpreted as a lack of capacity to conduct clinical trials and is indeed an unfavorable fac- tor in this context – even if its importance is questionable and unproven. In re- lation to the predictability and speed of the clinical trial approval process, the 110 Central European Public Administration Review, Vol. 23, No. 2/2025 Country Attractiveness for Conducting Clinical Trials – A Literature Review authors note that the approval process and subsequent contracting with trial sites is so lengthy and demanding that by the time a clinical trial is launched in Italy, international clinical trials may have already reached their statistical sample and completed patient recruitment. As a conclusion and recommen- dations to improve Italy’s competitiveness, as possible improvement models they mention the harmonization of national approval systems (at the level of ethics committees and the healthcare institutions themselves), including the improvement of procedures for contracting with healthcare institutions to bring them in line with the clinical trial approval process, and increasing the visibility of centers of excellence, i.e. making information about trial sites available on the Internet. 3.5 Further Observations on the Criteria for Clinical Trials Strüver and Ibeneme (2021) examined the status of clinical trials in Nigeria and South Africa based on data from the ClinicalTrials.gov registry, the Pan African Clinical Trials Registry, the National Health Research Database from South Africa and the Nigeria Clinical Trials Registry and analyzed the data us- ing descriptive statistics and trend analysis. They conclude that clinical trial sponsors do not appear to prioritize diseases that are prevalent in a particular country, such as plague in Nigeria, for which there is a large pool of patients. They conclude that sponsors do not select countries according to local health needs, but according to their own business priorities. They also highlight that sponsors appear to have a greater interest in non-communicable diseases, which can be considered international diseases. By analyzing a random sam- ple of 5% of clinical trials registered in the WHO International Clinical Trials Registry Platform as interventional trials in the active patient recruitment phase, Viergever et al. (2013) came to the similar conclusions – they state that their research indicates that the correlation between disease incidence and the global distribution of clinical trials is low, and that clinical trials are much more common in higher income countries than in lower income countries. 4 Results and Discussion Locating clinical research in a particular country, region or hospital has almost no negative consequences, while the positive effects are numerous and easy to understand. The economic impact of clinical trials on national healthcare systems is multifaceted: – Patients receive free access to the most innovative therapies – Treatment in clinical trials is free for both patients and the healthcare sy- stem – Physician-investigators involved in clinical trials receive an additional sour- ce of income – Some of the money goes directly to national healthcare systems in the form of a direct contribution to clinical trial budgets Central European Public Administration Review, Vol. 23, No. 2/2025 111 Tomislav Geršić, Nenad Vretenar, Jelena Jardas Antonić – Part of the money flows indirectly into the national budget and the public healthcare system in the form of taxes, contributions and other fees Based on an overview of the clinical trials market, it is clear that the success of countries in attracting this form of foreign investment varies widely. This paper analyzes some of the key studies that attempt to highlight the reasons why some countries are more successful than others in attracting clinical re- search, i.e. the factors that influence the decision of companies to conduct clinical research. This research shows that the attractiveness of a country for conducting clini- cal trials is based on its ability to offer important economic, legal and infra- structural advantages that encourage investment in clinical research. The most important factors that make it attractive include political stability, a well-developed and accessible healthcare and research infrastructure, a high level of education, especially of medical personnel, and a transparent admin- istrative system with a low level of corruption. All of this creates a favorable environment for pharmaceutical companies looking for efficient and reliable conditions for conducting clinical trials. We found it particularly interesting that, according to some studies, Central and Eastern European countries have become competitive destinations over the last decade. Their attractiveness is enhanced by the existence of central- ized healthcare systems with several large clinical centers, which enables the rapid recruitment of large numbers of patients. In addition, the availability of so-called “treatment-naïve” patients, i.e. patients who have not yet been treated for certain diseases, makes these countries suitable for testing the efficacy of new therapies. High-quality and experienced medical staff, mod- ern diagnostic equipment and a stable population with low out-migration also increase the opportunities for long-term follow-up of test subjects, which is crucial for the success of many clinical studies. As the public healthcare sys- tems of the most successful CEE countries are similar to those of other coun- tries in this region, it is possible that other countries will become more recep- tive to such studies in the future. In developing countries, especially in Asia and South America, more and more clinical trials are being conducted. The main reasons for this are the large number of patients available and the significantly lower costs compared to developed countries, which makes this region attractive to pharmaceutical companies seeking efficiency and cost rationalization as part of their global research strategies. Previous studies have shown that pharmaceutical companies use a number of quantitative and qualitative criteria when selecting a country to conduct clini- cal trials. One of the most important is the size of the population, as a larger number of potential subjects increases the likelihood of successful and rapid recruitment. Similarly, a larger number of available physicians has a positive impact on the trial sponsor’s decision, as this is an indication of the healthcare system’s ability to support complex research activities. 112 Central European Public Administration Review, Vol. 23, No. 2/2025 Country Attractiveness for Conducting Clinical Trials – A Literature Review One of the most important criteria is the speed of patient recruitment, as time is a limited resource in the context of the duration of patent protection. In addition, the efficiency of study initiation, i.e. the speed with which regula- tory approvals are obtained and contracts are signed with research sites is often a decisive factor in the choice of a target country. Research sponsors value countries and sites that are known for fast and reliable procedures, and the existence of “key opinion leaders” – experts with international reputation who can contribute to the credibility and visibility of the study and, eventu- ally, the drug once it is placed on the market – carries additional weight in the decision-making process. Other important factors are the availability of digital infrastructures, the level of protection of intellectual property, the transparency of the regulatory sys- tem and the quality and reliability of the data collected. All of these elements combine to form the perception of the country as a professional and predict- able destination for investment in clinical trials. Interestingly, and somewhat counter-intuitively, a growing body of research suggests that cost alone is not the deciding factor in country choice. The over- all cost of clinical trials is extremely high, but research shows that factors that directly impact the speed and success of trials (such as the ability to recruit patients quickly, the efficiency of regulatory procedures and the high quality of data collected) are increasingly being prioritized. Although cost per patient may play a role, especially when assessing the ef- ficiency of external partners such as CROs, it has less weight in the context of internal decisions by pharmaceutical companies on the allocation of trials to their own subsidiaries. Considering that the total cost of developing a new drug can be as high as USD 800 million, the priority is usually on speeding- up the process rather than maximizing savings. This confirms that, although costs are not negligible, strategic and operational factors carry greater weight in decision-making in the long term. This is particularly evident from the fact that when pharmaceutical companies enter Phase III of clinical research, pat- ent protection already begins, so the speed and reliability of the trial process are of crucial importance. In this context, indirect costs – such as delays in study approval, slow administrative procedures or poor organizational infra- structure – can have a much more negative impact on the success of a trial than direct financial costs alone. For trial sponsors, time becomes a key cur- rency, as a longer trial duration shortens the time available for exclusive com- mercialization of the drug before patent protection expires. The country’s regulatory framework is one of the key elements in the decision- making process for conducting clinical trials. Although an unfavorable regula- tory environment does not automatically disqualify a country – especially if there are experienced and visible researchers – the speed and predictability of regulatory procedures still have a major impact on the attractiveness of the country. Studies show that lengthy approval processes and complex adminis- trative requirements can significantly slow the start of patient recruitment, reducing the overall effectiveness of trials and increasing time to market. Central European Public Administration Review, Vol. 23, No. 2/2025 113 Tomislav Geršić, Nenad Vretenar, Jelena Jardas Antonić In addition to the speed of approval, the availability of information about re- search sites and the existence of clear guidelines and procedures also play an important role. A lack of equipment or resources at the trial site can further delay the start of a trial, while the predictability of the approval process re- duces risk and increases sponsor confidence. Even if regulation itself is not the only decisive factor, it largely shapes the perception of the country as a reliable and efficient partner in the global clinical research chain. 5 Conclusions This research shows that the most important factors in attracting clinical tri- als in a country are economic, legal and infrastructural advantages that en- able research to be carried out quickly, efficiently and reliably. These include, above all, political stability, a well-developed and accessible healthcare and research infrastructure, a high level of training for medical staff and a trans- parent and effective regulatory system with a low level of corruption. In this context, time becomes the key factor: the speed of patient recruitment and study approval plays a decisive role, while direct costs are less important than operational efficiency and data quality. Central and Eastern European countries have proven to be particularly com- petitive due to their centralized healthcare systems, large numbers of pa- tients, including those not previously treated, and highly qualified medical staff. Although more and more trials are also being moved to Asian and South American countries due to lower costs, the location decision is increasingly based on the country’s overall ability to support the rapid and reliable con- duct of trials. The key message is that the quality of organization, speed of ad- ministration and predictability of regulations are often more important than price alone – as delays and bureaucratic obstacles can cause more harm than high financial costs. Given that clinical trials are a big business, and that countries have or should have an interest in attracting them for a number of reasons, this research is particularly useful for authorities and regulators. 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Central European Public Administration Review, Vol. 23, No. 2/2025 117 DOI: 10.17573/cepar.2025.2.05 1.01 Original scientific article Implementation of the SMART Concept within the Framework of the 2030 Agenda in the NUTS 3 Regions of the Slovak Republic Eva Ivanová Alexander Dubček University of Trenčín, Faculty of Social and Economic Relations, Slovakia eva.ivanova@tnuni.sk https://orcid.org/0000-0002-5721-4662 Katarína Štefčíková Alexander Dubček University of Trenčín, Faculty of Social and Economic Relations, Slovakia katarina.stefcikova@tnuni.sk https://orcid.org/0000-0002-8295-9666 Martina Jakubčinová Alexander Dubček University of Trenčín, Faculty of Social and Economic Relations, Slovakia martina.jakubcinova@tnuni.sk https://orcid.org/0000-0002-0590-4581 Received: 13. 7. 2025 Revised: 30. 9. 2025 Accepted: 9. 10. 2025 Published: 11. 11. 2025 ABSTRACT Purpose: The main objective of this study is to assess the level of imple- mentation of a selected element of the SMART concept within the con- text of the 2030 Agenda goals across individual NUTS 3 regions of the Slovak Republic, using various analytical methods. The study specifically focuses on the development and evaluation of the indicator “employ- ment in research, development and high-tech,” which represents a crucial component of SMART concept implementation from the labour market perspective. Methodology/Approach: To fulfil the study’s objective, in addition to analysing development trends using available statistical data, the shift- share analysis method will be applied. This method enables the identi- fication and comparison of regional employment growth or decline in the research, development and high-tech sector in relation to national Ivanová, E., Štefčíková, K., Jakubčinová, M. (2025). Implementation of the SMART Concept within the Framework of the 2030 Agenda in the NUTS 3 Regions of the 119 Slovak Republic. Central European Public Administration Review, 23(2), pp. 119–154 2591-2259 / This is an open access article under the CC-BY-SA license https://creativecommons.org/licenses/by-sa/4.0/ Eva Ivanová, Katarína Štefčíková, Martina Jakubčinová development trends in the given sector. Another method employed is the analysis of the sector through the lens of the so called “export base theory,” which examines its export potential. Through this approach, it is possible to identify the strength of representation and the influence of a given sector in the labour market on the region’s economy. Findings: The research findings indicate that job creation in the research, development and high-tech sector does indeed reflect the implementa- tion of the SMART concept, and in most regions, positive employment growth trends have been recorded. Despite support for employment in this sector in the Slovak Republic, only two regions—Bratislava and Košice—demonstrate a capacity to significantly contribute to the eco- nomic and social growth and competitiveness of the region by support- ing this sector. Practical Implications: The study concludes by offering several options for discussing how to support the creation of space for expanding this sector or other soft sectors in the regions. This would enable regions to generate greater added value than they currently do, as the prevailing dominance of manufacturing offers limited potential for sustainable de- velopment. Originality/Value: The value of the study lies in the findings derived from the application of a wider range of research methods focused on examin- ing the level of regional development (shift-share analysis and export base theory). The study identifies the results of the current level of implemen- tation of the SMART concept in regions in terms of labour market trans- formation, and offers a perspective on further possibilities for supporting regions in this transformation. The focus is on smart and sustainable sec- tors that will drive the economies of regions and the country as a whole. Keywords: research and development, employment, innovation, competitiveness, region, SMART concept Implementacija koncepta SMART v okviru Agende 2030 v regijah NUTS 3 Slovaške republike POVZETEK Namen: glavni cilj te študije je oceniti raven uresničevanja izbranega ele- menta koncepta SMART v kontekstu ciljev Agende 2030 v posameznih regijah NUTS 3 Slovaške republike z uporabo različnih analitičnih metod. Študija se posebej osredotoča na razvoj in vrednotenje kazalnika »zapo- slenost v raziskavah, razvoju in visokih tehnologijah«, ki je ključna kompo- nenta uresničevanja koncepta SMART z vidika trga dela. Metodologija/pristop: za dosego cilja študije bo poleg analize razvojnih trendov na podlagi statističnih podatkov, ki so na voljo, uporabljena tudi metoda shift-share analize. Ta metoda omogoča prepoznavanje in primer- javo regionalne rasti ali upada zaposlenosti v sektorju raziskav, razvoja in visokih tehnologij glede na nacionalne razvojne trende v navedenem sektorju. Uporabljena je tudi analiza sektorja skozi prizmo tako imenova- ne teorije izvozne baze, ki preučuje njegov izvozni potencial. Tak pristop omogoča prepoznavanje stopnje zastopanosti in vpliva danega sektorja na trg dela in gospodarstvo regije. 120 Central European Public Administration Review, Vol. 23, No. 2/2025 Implementation of the SMART Concept within the Framework of the 2030 Agenda in the NUTS 3 Regions of the Slovak Republic Ugotovitve: rezultati raziskave kažejo, da ustvarjanje delovnih mest v sektorju raziskav, razvoja in visokih tehnologij dejansko odraža uresniče- vanje koncepta SMART, pri čemer je bilo v večini regij zabeleženih pozitiv- nih trendov rasti zaposlenosti. Kljub podpori zaposlovanju v tem sektorju v Slovaški republiki pa le dve regiji – Bratislava in Košice – izkazujeta spo- sobnost, da s podporo temu sektorju bistveno prispevata k gospodarski in socialni rasti ter konkurenčnosti regije. Praktične implikacije: študija zaključuje z več možnostmi za razpravo o tem, kako podpreti ustvarjanje prostora za širitev tega sektorja ali dru- gih tako imenovanih mehkih sektorjev v regijah. To bi regijam omogočilo ustvarjanje večje dodane vrednosti, kot jo ustvarjajo trenutno, saj prevla- da predelovalnih dejavnosti ponuja omejen potencial za trajnostni razvoj. Izvirnost/vrednost: vrednost študije izhaja iz spoznanj, ki temeljijo na uporabi širšega nabora raziskovalnih metod, osredinjenih na preučeva- nje ravni regionalnega razvoja (analiza shift-share in teorija izvozne baze). Študija opredeljuje rezultate trenutne ravni uresničevanja koncepta SMART v regijah z vidika transformacije trga dela ter ponuja pogled na nadaljnje možnosti za podporo regijam v tej transformaciji. Osredotoča se na pametne in trajnostne sektorje, ki bodo poganjali gospodarstva re- gij in države kot celote. Ključne besede: raziskave in razvoj, zaposlenost, inovacije, konkurenčnost, regija, koncept SMART JEL: O32, J21, O31, F43, R11, R58 1 Introduction Approaches to implementing the SMART concept differ significantly across global regions. In Europe, the emphasis is largely on sustainability and enhanc- ing everyday quality of life. By contrast, in countries such as the United States and many parts of Asia, the focus tends to be more on building technical infra- structure and advancing the digital economy, with sustainability often viewed as a secondary concern. In regions such as Africa and Latin America, the chal- lenge remains how to apply the SMART concept in ways that meaningfully address the practical, day-to-day needs of cities and communities. Since 2015, the global 2030 Agenda framework has guided the sustainability efforts of United Nations member states, aiming to address a wide spectrum of societal challenges. In the context of accelerating digitalization and mounting social pressures, sustainability is no longer discussed solely in environmental terms. It has become increasingly linked with broader areas of public life, including the research, development, and high-tech sectors, where innovation plays a central role in shaping effective solutions to complex problems. Innovation has the potential to simplify and optimize systems across all areas of society, including public administrative processes (da Silva Martins et al., 2024; Eber- hard et al., 2017; Rasvanis, 2024). Innovation is the cornerstone of regional development. To foster genuine in- novation, state and regional authorities must do more than merely introduce Central European Public Administration Review, Vol. 23, No. 2/2025 121 Eva Ivanová, Katarína Štefčíková, Martina Jakubčinová new technologies. The key to success lies in supporting the innovators them- selves businesses and universities where job creation and increasing employ- ment help establish an environment conducive to creative work, new technol- ogies, and innovation. The role of public administration should be to ensure a future-oriented policy that continuously stimulates local employment in sec- tors with long-term potential, not only for sustainability but also for economic stability. Regions face numerous challenges in the process of smart transfor- mation. Agenda 2030 motivates countries and regions to secure a high qual- ity of life for all stakeholders in a sustainable way, with an emphasis on the adoption of new technologies. There are many successful cases where the integration of smart solutions into regional and urban life has contributed not only to sustainability but also, for example, to improvements in mobility, energy consumption, waste management, public governance, public safety, education, and culture. However, such innovations are often introduced and implemented by foreign rather than domestic companies, i.e., companies that do not significantly contribute to national GDP or employment. (Brodny and Tutak, 2023; Surana et al., 2020). Scientific development and innovation promote sustainable development (Tu, 2023), especially when effectively integrated into public policies and stra- tegic decisions of public administration. In this context, it is the natural role of government to systematically support the development of science and research and to create favorable conditions for the labour market develop- ment in these areas (Smaldone et al., 2022). Today’s knowledge-based soci- ety needs highly qualified professionals outside the academic environment (Hanatkova et al., 2022). These experts are able to link scientific knowledge with practical solutions, thereby helping to increase efficiency, transparency, and innovation in public administration, industry, healthcare, energy and digi- tal technologies. Employment in science and research thus takes on strate- gic importance not only as a tool for economic growth, but also as a pillar of sustainable development, social inclusion, and technological sovereignty. This strengthens its contribution to the innovative capacity of regions and to the achievement of the Agenda 2030 goals (European Commission, 2020; “Národná stratégia výskumu, vývoja a inovácií 2030,” 2023; Portefaix, 2025). Due to the lack of specific studies, especially in the context of the Slovak Republic and the EU, we decided to examine the issue in greater depth and chose to study a selected indicator that has significant potential in the region, not only in relation to the ongoing smart transformation, but also in achieving the social goals of Agenda 2030. This study focuses on assessing the level of implementation of selected ele- ments of the SMART concept in the context of the 2030 Agenda goals in indi- vidual NUTS 3 regions of the Slovak Republic using various analytical methods (shift-share analysis, export base theory). These methods provide a deeper understanding of structural changes in the labour market and help identify the relative competitiveness and potential of the sector for regional devel- opment. The study focuses in particular on assessing and evaluating the in- 122 Central European Public Administration Review, Vol. 23, No. 2/2025 Implementation of the SMART Concept within the Framework of the 2030 Agenda in the NUTS 3 Regions of the Slovak Republic dicator “employment in science, research, development, and high-tech,” i.e., a sector that is one of the main producers of innovation, which is a prerequi- site for the smart transformation and competitiveness of regions. Supporting employment in innovation-producing sectors is one of the most appropriate indicators for assessing the smart transformation of regions from a labour market perspective. By monitoring the development trends of this indicator, we are able to propose solutions for public administration institutions that are competent in the area of regional transformationand also supporting the creation of new jobs in regions. This indicator, its comprehensive analysis, and the subsequent proposal for improvement measures are also linked to sev- eral goals of Agenda 2030, specifically: – Goal 8 Decent work and economic growth, which includes the sub-goal of promoting employment in research, development, and high-tech sectors, creating jobs with higher added value that bring innovation and contribute to the sustainable growth of regions. – Goal 9 Industry, Innovation and Infrastructure, which includes the idea of smart transformation. The study consists of several parts, with the introductory part devoted to assessing current trends in the area under investigation through an analysis of scientific articles and professional publications, in which the authors de- fine the issue in question at both the theoretical and analytical levels. The next part of the study will consist of defining the methodological approach. The analytical part of the study will consist of obtaining and analyzing in- put statistical data and processing it using software. The analytical part of the study includes performing calculations and interpreting the results using graphs and tables. The conclusion of the study will be devoted to identifying the knowledge gained and discussing the importance of science, research, and high-tech in implementing the SMART concept and fulfilling the goals of Agenda 2030 in regions and cities, as well as the possibilities for further research on this issue. 1.1 Backround of the Study The concept of SMART was introduced within the framework of European regional policy to support sustainable development. It has since become so widely embedded in European regional policy that it appears in all major long- term regional development strategies (Rauhut and Humer, 2020). Since its foundation, the EU’s regional policy has primarily aimed at fostering solidarity, reducing regional disparities, achieving sustainability, and continu- ously improving the quality of life in the regions through technological pro- gress. Accordingly, the EU has long anchored its key development strategies in supporting research, development, innovation, and smart specialization. (Foray, 2025). Interest in supporting education, science, research, and development stems primarily from the fact that European countries recognize their responsibil- Central European Public Administration Review, Vol. 23, No. 2/2025 123 Eva Ivanová, Katarína Štefčíková, Martina Jakubčinová ity for climate change and its impact on various spheres of social life. They are aware of the extent to which the activities of sectors essential to human existence—such as agriculture, mining, energy, and manufacturing—contrib- ute to land and environmental degradation. Therefore, the EU consistently strives to enhance the efficiency of these sectors to ensure their sustainability and their capacity to serve future generations (“Horizon Europe strategic plan 2025-2027,” 2024). To achieve its objectives, the EU has long based its key strategies on the concept of “smart.” Within the Europe 2020 development strategy for the 2014–2020 programming period, the aim was to foster “smart, sustainable, and inclusive growth.” In pursuing smart growth, the strategy emphasized in- creasing investment in science, research and development, knowledge, inno- vation, and digital technologies, as well as raising overall employment across the population (Figueiredo and Figueiredo, 2024). In the 2021–2027 programming period, the EU’s main priority is to make Eu- rope “smarter, greener and low-carbon, more connected, more social, and closer to its citizens.” The aim is to build on the achievements of the previ- ous period and to continue supporting digital transformation, strengthening business competitiveness, increasing employment in future-oriented sectors, promoting green and smart transformation, advancing climate and environ- mental initiatives, fostering more ecological agriculture, facilitating the tran- sition to renewable energy sources, and ultimately achieving carbon neutral- ity (“COMMUNICATION FROM THE COMMISSION EUROPE 2020 A strategy for smart, sustainable and inclusive growth,” 2020). However, it is not only European countries that are placing emphasis on pro- tecting the environment and improving the overall quality of life. UN member states are also addressing these issues. The Agenda 2030 strategy, adopted at the UN summit in 2015, has significantly contributed to the effort to ad- dress global challenges such as climate change, poverty, hunger, quality of education, and unequal opportunities in the labour market. It sets ambitious goals for development in the field of societal sustainability. The scope of the program is defined by 17 Sustainable Development Goals (SDGs), which are to be achieved by 2030.The UN’s objectives within the program are as follows: 1. No Poverty 2. Zero Hunger 3. Good Health and Well-being 4. Quality Education 5. Gender Equality 6. Clean Water and Sanitation 7. Affordable and Clean Energy 8. Decent Work and Economic Growth 9. Industry, Innovation and Infrastructure 10. Reduced Inequalities 11. Sustainable Cities and Communities 124 Central European Public Administration Review, Vol. 23, No. 2/2025 Implementation of the SMART Concept within the Framework of the 2030 Agenda in the NUTS 3 Regions of the Slovak Republic 12. Responsible Consumption and Production 13. Clime Action 14. Life Below Water 15. Life on Land 16. Peace, Justice and Strong Institutions 17. Partnerships for the Goals (GUIDE TO SDG INTERACTIONS: FROM SCIEN- CE TO IMPLEMENTATION,” 2020; “The 2030 AGENDA FOR SUSTAINABLE DEVELOPMENT,” 2015; Sachs et al., 2021). Similar to the EU’s objectives, the goals of Agenda 2030 are grounded in the transformation of countries, regions, and cities, fostering the adoption of state-of-the-art technologies designed to simplify and improve the quality of life. However, innovations in rapidly evolving technologies necessitate adap- tation to the current needs of society, particularly in the labour market. These innovations are contributing to a reduced demand for human labor in many sectors of the economy, as technological solutions increasingly replace tradi- tional work (Filippi et al., 2023). Continuous technological development generates demand for labor in high- tech, science, research, and development, while simultaneously reducing em- ployment in commerce, services, and manufacturing and processing indus- tries, where workers can often be effectively replaced by technology (Hötte et al., 2023). An important part of both Agenda 2030 and EU strategies—such as Cohe- sion Policy, Horizon Europe, and the EIT Strategic Innovation Agenda—is the support of job creation in science, research and development, and high-tech sectors. These sectors are particularly significant due to their capacity to drive innovation and sustainability. They also generate high incomes, thereby con- tributing to healthy economic development at the national and regional level, as well as to a higher standard of living (Ferraro et al., 2023; Filippi et al., 2023). The term SMART is inextricably linked with innovation and advanced tech- nologies. As such, this framework serves as a global roadmap for the imple- mentation of a broad spectrum of technologies and innovations aimed at streamlining processes in areas such as public safety, administration, commu- nication, transportation, the economy and labour market, environmental pro- tection, and the overall quality of life. In recent years, the SMART concept has garnered significant scholarly attention. This rising interest is largely driven by the rapid evolution of digital technologies, including novel software appli- cations, multimedia tools, and other innovations that address contemporary challenges across various fields of science and research (Kumar Das, 2024). Among the most transformative innovations of the past decade is artificial in- telligence (AI). Within the context of SMART implementation in regional and local development, AI has proven to be a breakthrough technology, enabling municipalities and regions to: – analyse traffic data to improve the regulation of traffic flow, parking, and public transport scheduling; Central European Public Administration Review, Vol. 23, No. 2/2025 125 Eva Ivanová, Katarína Štefčíková, Martina Jakubčinová – identify opportunities for reducing energy consumption and achieving cost savings; – optimise waste management strategies, including sorting and collection schedules; – detect local infrastructure issues and predict risks such as floods, fires, and other hazards (Dias et al., 2023). The SMART concept, along with related technological innovations, is increas- ingly recognised as a strategic instrument for enhancing regional competitive- ness from both economic and social development perspectives. It represents a transformative approach to addressing territorial challenges and fostering balanced, sustainable growth (Kalsoom et al., 2025; Kruse, 2024). While the integration of SMART principles in public administration, health- care, manufacturing, logistics, and resource management presents new op- portunities, it also introduces certain risks. It profoundly influences regional life by reshaping needs and preferences, which may lead to both positive and negative externalities such as shifts in labour market dynamics, workforce shortages in certain sectors, and subsequent disruptions in the supply of spe- cific goods and services (Sutriadi, 2017). Nevertheless, numerous studies suggest that the adoption of SMART solu- tions in less developed regions is critical to reducing regional disparities and promoting competitiveness (Billones et al., 2021). The term SMART region has thus evolved as an extension of the SMART city concept, promoting a more holistic and sustainable planning approach at the regional level. The overarching goal is to integrate advanced technologies into daily life to streamline operations not only in mobility, environmental management, and social services, but also in public finance, education, health- care, and the labour market (Billones et al., 2021; Peráček and Kaššaj, 2025). A territorial unit that strategically implements smart solutions has the potential to achieve significant economic growth and enhance its regional competitive- ness (Sutriadi, 2017). The concept of the SMART region must also be linked to the pursuit of sus- tainable development, rooted in the continuous development of human capital and regional potential. This approach fosters territorial cohesion by promoting the effective utilisation of endogenous resources. Implementing innovative strategies facilitates the development of economic sectors, rein- forces regional identity, safeguards cultural and historical assets, supports urban planning, and ultimately increases the region’s attractiveness (Rach- mawati et al., 2024). The fundamental objective of every SMART region is to achieve smart spe- cialisation a strategy aimed at stimulating socio-economic transformation by focusing on areas of competitive advantage. Smart regional transformation entails the formulation and execution of tailored solutions adapted to the specific needs of regions, cities, or municipalities. These efforts are support- 126 Central European Public Administration Review, Vol. 23, No. 2/2025 Implementation of the SMART Concept within the Framework of the 2030 Agenda in the NUTS 3 Regions of the Slovak Republic ed by national and European level policies through financial, institutional, and legislative instruments. The strategic use of such support in conjunction with the SMART concept offers significant opportunities for improving effi- ciency and sustainability. However, it is essential to align this approach with other key development strategies to ensure coherence and long-term suc- cess (Zlámal, 2019). 1.2 Implementation of the SMART Concept within the Framework of the 2030 Agenda Several studies have addressed the implementation of smart transformation with the aim of achieving sustainability and improving residents’ quality of life. For example, Destefanis and Ur Rehman (2023) examine the impact of sup- port measures for science, research, and development on employment in in- dividual NUTS 2 regions of the EU. The results of the panel regression analysis clearly confirm that investment in science, research, and high-tech not only increases employment but also generates positive externalities in the form of high innovation activity and a strong, competitive economy. Wirkierman et al., (2021) also assessed the level of support for employment in science, research, and high-tech in individual regions. They concluded that regions with the most significant support for science, research, and high-tech had the best labour market outcomes, high employment rates (not only in science, research, and high-tech, but also in related service industries), and a positive impact on the economy. Moretti and Thulin (2013; 2022), using calculations based on export base the- ory in the US and Sweden, found that support for highly skilled jobs and high value-added industries has significant export potential. In addition to gener- ating high incomes and stimulating regional economies, such support also creates jobs in sectors linked to the satisfaction of human needs, particularly in trade and services. Not only this study but also other research clearly points to the importance of locating high-tech companies in regions, as they have strong potential to become the driving force of the entire region or city—es- pecially when the goal is to build a smart and sustainable territory. The role of the state and regional governments should therefore be to support these companies (Runlin and Feng, 2024; Hechi et al., 2024; Lawrance et al., 2023). Significant findings were presented in the study by Rigby et al., (2022), which assesses the impact of smart specialisation principles on the economic devel- opment of cities and regions within the European Union. The authors ana- lysed the evolution of the technological capabilities of European cities from 1980 to 2015, focusing on how cities and regions have developed technology and infrastructure over time. The research identified those cities and regions that experienced the most significant technological advancements, which ul- timately translated into improved economic performance. According to the study, the German regions showing the most notable technological progress and economic improvement during the analysed period were Bavaria and Central European Public Administration Review, Vol. 23, No. 2/2025 127 Eva Ivanová, Katarína Štefčíková, Martina Jakubčinová Baden-Württemberg. Other regions that demonstrated strong technologi- cal advancement with a positive impact on economic development include the Finnish region of Uusimaa, the Swedish region of Stockholm län, and the French region of Île-de-France. The Italian region of Lombardy, and the Span- ish region of Catalonia, were also highlighted. The authors conclude that these regions significantly diversified their technological focus toward more complex domains and achieved above-average growth in both innovation and economic productivity. This rapid transformation was largely driven by the ef- ficient use of existing potential and the promotion of employment in sectors that integrate innovation and new technologies into everyday life. The 2017 study Smart Specialization in the US Context, similar to the work by Rigby et al. (2022), identified economically successful regions in the United States that achieved growth through the adoption of the smart specializa- tion concept in the labour market. The study focuses on how regions lever- age their potential and capabilities to develop and implement innovations for economic growth. The authors confirm that high-tech enterprises and re- search institutions are among the key drivers of innovation and new technolo- gies. Therefore, creating new job opportunities and harnessing the potential of human capital in this area is essential. According to the study, the most successful SMART regions and cities include Albany in New York State, Austin in Texas, and Silicon Valley in California (Wessner and Howell, 2017). These findings are supported by the study Smart City Implementation in Indo- nesian Regions: A Legal and Empirical Review, whose authors emphasize the importance of innovation and the need for cooperation between national, regional, and local governments. Using secondary analysis methods, the study critically evaluates key documents and activities implemented to date. It con- cludes with a recommendation to promote employment in innovation-related sectors and to enhance support for SMART concept implementation through legislative measures, financial incentives, and strengthened collaboration be- tween stakeholders at the city, regional, and national levels (Syah et al., 2024). Evidence from the study by (Adenle et al., 2023), shows that the richest coun- tries, which dominate global research and development, have strengthened their economies. In contrast, low- and middle-income countries accounted for about 70 researchers per million inhabitants, compared to more than 3,500 per million in high-income countries. According to the authors, the global community should therefore encourage partnerships and transformative ca- pacity development in science, research, and training. Specifically, national governments should support the creation of opportunities for industrial sec- tors by promoting scientific research and development for innovative econo- mies and by building their capacities through education and training policies. In addition to promoting employment in education and high-tech industries, and emphasizing the need for cooperation across different levels of territori- al governance, a 2023 study by experts from the University of Wisconsin Park- side highlights the importance of civic community participation in introducing innovation into the development of cities and regions. Within their method- 128 Central European Public Administration Review, Vol. 23, No. 2/2025 Implementation of the SMART Concept within the Framework of the 2030 Agenda in the NUTS 3 Regions of the Slovak Republic ology, the authors expand the traditional “triple helix” model collaboration between academia, business, and the public sector into a “quadruple helix” model, which also includes the citizen community. This broader approach rec- ognizes civic participation as a crucial element in implementing innovation at the regional and urban levels (Banerjee et al., 2023). Hunady et al., (2018) in their paper “The Link Between Human Resources in Science and Technology and Regional Economic Development in the EU”, in- vestigate the relationship between employment in science and technology and the regional economic development of NUTS 2 regions in the EU using regression and correlation analysis. The results clearly demonstrate a positive impact of increasing the number of employees in science and high-tech sec- tors on economic growth. European Union countries are showing common progress in reducing unem- ployment (SDG 8: Decent Work and Economic Growth). One area of employ- ment that is developing positively is research and development. Growth in the number of workers in this sector was recorded in all ten European re- gions studied by Pop and Stamos, (2023), (SDG 9: Industry, Innovation and Infrastructure). This points to the growing importance of innovation and the knowledge economy. However, as the varying degrees of change among countries indicate, success in addressing this issue differs significantly. Baculakova and Harakalova (2017), confirmed a positive relationship between the level of public investment in research and development and employment growth. They concluded that a 1% increase in spending leads to a measurable increase in jobs. This effect is evident not only in the academic and technolog- ical sectors but also in related areas such as the creative industries, where av- erage wages are also rising. The effect is particularly pronounced in high-tech sectors, which serve as key drivers of innovation and technological progress. Mao (2024), examined the mechanisms of tax incentives and investment in research and development for employment absorption in this context. His results show that investment in research and development, operating profit margin, and remuneration have a significantly positive impact on employ- ment absorption. According to Halaskova et al., (2024), this is most evident in countries classified as moderate innovators and emerging innovators. In these groups, they confirmed the positive impact of research and development ex- penditure on GDP per capita and employment in knowledge-intensive service sectors. Employment in science and research is also indirectly influenced by investment in these fields, as confirmed by Díaz et al., (2024), who demon- strated a positive impact on employment. In addition, a higher proportion of scientists and engineers in the population correlates positively with the creation of new companies, especially in high- tech sectors. However, employment in high-tech sectors has a negative im- pact on entrepreneurial activity. This is mainly attributed to the concentration of talent and resources in large companies, which reduces the motivation to establish new businesses Skica, et al., (2025). Halaskova, et al., (2024), also Central European Public Administration Review, Vol. 23, No. 2/2025 129 Eva Ivanová, Katarína Štefčíková, Martina Jakubčinová point out that youth unemployment can be reduced by employing young peo- ple in research and development at universities. These findings highlight the complex and multi-layered effects of investment in research and development on employment, economic growth, and the de- velopment of individual sectors. They are particularly relevant in high-tech sectors in countries with developing innovation potential. It is therefore im- portant to consider the regional dimension of innovation. Samara et al, (2022), address the impact of high-tech on regional develop- ment by modelling innovation systems. The study employs regression and correlation analysis along with selected mathematical models based on the system dynamics approach to simulate various scenarios of digital technology development in regions. The model was applied to two Greek regions West- ern Macedonia and Central Macedonia which differ in their levels of develop- ment. The results indicate a positive impact of smart technologies on regional development in the studied areas. The authors also provide several recom- mendations, including the further promotion and development of digital skills and infrastructure, support for employment in key innovation and tech- nology sectors, and enhanced education across diverse population groups. They strongly emphasize the importance of considering regional specificities and using forecasting and planning tools tailored to regional development. This scientific portfolio includes scientific studies focused on the SMART con- cept within the context of the 2030 Agenda. These studies aim to analyse labour market indicators and regional economic growth. A valuable contri- bution to this field is the study by Keungoui et al., (2024), which applies a method for measuring regional specialisation and development potential. This helps identify the key factors contributing to the successful implementa- tion of innovations, which are undoubtedly a driving force behind regional economic growth. Corrocher et al. (2024) explore the complex relationship between innovation and the labour market. Their study examines the impacts of technological advances on employment, skills, and wages. Using export base theory, they identify regions where innovation-intensive industries have the greatest im- pact on economic growth and competitiveness. Even smaller regions can be innovation leaders if they focus on specializa- tion. Employment in the research and development sector is often supported through international research networks and projects (Cristani, 2024). Cross- border cooperation initiatives create favorable conditions for the develop- ment of an innovative environment and the sharing of expertise (Dušek, 2024). Mutambik et al., (2024), further argue that smart cities are more efficient and have more opportunities to ensure their growth. Pessina (2025) takes a simi- lar approach, emphasizing that employment in science and research is a key factor in the ecological and technological transformation of regions. Research on the SMART concept’s implementation in relation to the 2030 Agenda is also addressed in the study “Smart cities and attracting knowledge 130 Central European Public Administration Review, Vol. 23, No. 2/2025 Implementation of the SMART Concept within the Framework of the 2030 Agenda in the NUTS 3 Regions of the Slovak Republic workers: Which cities attract highly educated workers in the 21st century?” This study investigates how smart cities attract skilled professionals. Using shift- share analysis to assess structural changes in the labour market, the authors identified trends in sectors employing highly skilled workers and pinpointed factors influencing regional employment growth in the knowledge econo- my. The results show that implementing technological innovations signifi- cantly attracts skilled workers. Furthermore, the study concludes that the steady increase in knowledge economy employment contributes to regional economic growth, development, and the creation of new job opportunities (Betz et al., 2016). Based on a comprehensive analysis of scientific studies, we have concluded that many experts are paying attention to the issue of smart transformation of regions and cities in the context of achieving the goals of Agenda 2030. Several experts are deeply involved in the implementation of the SMART con- cept in practice and in examining how it contributes to the competitiveness and sustainability of regions and cities. A large number of studies focus on specific solutions and the implementation of specific activities to build smart regions and cities. However, it can be said that there is a lack of studies that examine the issue in greater depth, i.e., by examining the impact of specific indicators of smart transformation on the development and sustainability of regions. Given the importance of employment in regional development, we have decided to fo- cus on examining development trends and the strength of employment in the sector of the future, namely employment in science, research, and high-tech. This is a sector with strong economic and innovation potential, as well as po- tential for building smart infrastructure and sustainability. Very few experts are paying attention to researching the impact of employ- ment support in such a future-oriented sector as science, research, and high- tech. Most of these studies come from the American continent, such as those by Betz et al., (2016); Moretti and Thulin, (2022). 2 Methods The main objective of this study is to assess the level of implementation of a selected element of the SMART concept within the context of the 2030 Agen- da goals across individual NUTS 3 regions of the Slovak Republic using various analytical methods. The study specifically focuses on the development and evaluation of the indicator “employment in research, development and high- tech,” which represents a key driver of innovation and a crucial component of SMART concept implementation from the labour market perspective. The indicator “employment in research, development, and high-tech” is one of the key elements aimed at achieving the objective of supporting innovative ecosystems within the SMART concept. Monitoring the development trends of this indicator is also essential for assessing the fulfilment of one of the 2030 Agenda goals: Central European Public Administration Review, Vol. 23, No. 2/2025 131 Eva Ivanová, Katarína Štefčíková, Martina Jakubčinová – Goal 8 Decent work and economic growth, which includes the sub-goal of promoting employment in research, development, and high-tech sectors, creating jobs with higher added value that bring innovation and contribute to the sustainable growth of regions. – Goal 9 Industry, Innovation and Infrastructure, which includes the idea of smart transformation. After a thorough review of the available literature, we identified a lack of relevant research outputs not only within the EU but also in Slovakia, where no study of this type currently exists. This gap motivated us to examine the issue in greater depth by focusing on a specific indicator whose regional position has significant potential, both in relation to the ongoing trend of smart transformation and to the achievement of the social goals outlined in Agenda 2030. As the Slovak Republic has recently begun to make progress in promoting employment in science, research, and high-tech primarily due to EU financial support we consider it important to highlight this develop- ment and, at the same time, emphasize the potential of such support for the future of regions, particularly in terms of innovation, competitiveness, and socio-economic development. Therefore, employment in science, research, and innovation should be supported more intensively by both state and re- gional governments. The methods of this research are inspired by those employed in the studies of Betz et al. (2016); Keungoui et al. (2024); Moretti and Thulin (2022). These methods appear to be appropriate for the stated objective, particularly given their ability to identify the position of a sector within a region in relation to both national and regional employment. Using them, it is possible to iden- tify regions where the sector has the potential to generate additional jobs. In this study, we also apply these methods for our own analytical purposes. This research is based on secondary data obtained from the Slovak Republic’s statistical database, DataCube. Our research was based on data available for the period 2015–2023, as Agenda 2030 was adopted in 2015. To fulfill the main objective of this study, it is essential to formulate the fol- lowing research question: “Does the development of employment in research, development and high-tech sectors significantly affect the competitiveness of NUTS 3 regions in the Slovak Republic?” To answer this research question, it is necessary to establish several addition- al research sub-questions: 1. “Is there a statistically significant difference in the development of emplo- yment in the research, development and high-tech sectors between the NUTS 3 regions in the Slovak Republic?” 2. “Does the research, development, and high-tech sector significantly contri- bute to regional competitiveness and economic growth only in the Bratisla- va region?” 132 Central European Public Administration Review, Vol. 23, No. 2/2025 Implementation of the SMART Concept within the Framework of the 2030 Agenda in the NUTS 3 Regions of the Slovak Republic To assess the level of implementation of the SMART concept in the NUTS 3 re- gions of the Slovak Republic, the following analytical methods will be applied: analysis of development trends based on available statistical data on employ- ment in the research, development, and high-tech sectors; comparison and synthesis of the data; shift-share analysis of structural changes in the labour market; and labour market analysis using export base theory. 1. The general methods of scientific research applied include analysis (used for the in-depth examination of theoretical and empirical data by breaking them down into smaller and more transparent units), comparison (used to identify common features across data), and synthesis (applied to integrate partial data into final units for subsequent evaluation, interpretation, and the formulation of conclusions) (Markechová, 2011). 2. Shift-share analysis is a method of spatial analysis of structural changes in the labour market. It allows the competitive position of regions to be extracted from the national economic context, thereby revealing either the development dynamics or, conversely, the lagging of a selected sec- tor of the national economy in a given region compared to the national average over a specific time period. In our case, the analysed sector will be employment in the research, development and innovation sector, over the time period from 2015 to 2023. This method is based on data on sectoral employment in the regions and the gross value added of the sector. Gi = eio ((Et/Eo) - 1) + eio ((Eit/Eio) - (Et/Eo)) + eio ((eit/eio) - (Eit/Eio)) ( 1 ) (1) Where: Gi= regional employment growth in sector i eio= regional employment in sector i at the beginning of the reference period eit= regional employment in sector i at the end of the reference period Eio= national employment in sector i at the beginning of the reference period Eit= national employment in sector i at the end of the reference period Eo= national employment at the beginning of the reference period Et= national employment at the end of the reference period The application of this method will make it possible to assess the level of competitiveness of individual regions in a given sector, as well as the ex- tent to which one of the objectives of the SMART concept has been im- plemented namely, supporting employment in the field of research, de- velopment and high-tech in the NUTS 3 regions of the Slovak Republic. In conducting the analysis of structural changes in the labour market, we rely on statistical data on employment in the research, development and high- tech sector, which represents innovation, as well as on regional and na- tional employment data for the period 2015–2023. 3. Export base theory is a method used to identify the potential of a given sector to contribute to regional value creation through stronger economic Central European Public Administration Review, Vol. 23, No. 2/2025 133 Eva Ivanová, Katarína Štefčíková, Martina Jakubčinová growth. One of the tools used in this context is Izard’s location quotient (Lq), which reflects the competitiveness of given sector in a region. 𝑥𝑥𝑖𝑖𝑖𝑖 𝑥𝑥 𝐿𝐿𝑞𝑞 = 𝑖𝑖 𝑥𝑥 𝑖𝑖 𝑥𝑥 (2) Where: Xij = number of people employed in industry i in region j X = number of people employed in the country Xj = number of people employed in the region Xi = number of employees in industry i Local employment (Xij) refers to the difference between actual employ- ment in the sector in the region and basic (local) employment, also known as employment surplus. It is represented by workers who produce “ex- portable” outputs beyond the borders of the region. This indicator is cal- culated only in regions where the value of the Izard location quotient is greater than or equal to 1. Xijl= Xij/ L(q) (3) Where: Xij= number of employees in industry i in region j Lq = Izard‘s localization quotient The employment multiplier (Mz) explains how much an industry contributes to job creation in a region. 𝑋𝑋𝑋𝑋𝑋𝑋− 𝑋𝑋𝑋𝑋𝑋𝑋 Mz = 1 +∑𝑛𝑛 𝐿𝐿𝐿𝐿 𝑋𝑋=1 𝑋𝑋𝑋𝑋𝑋𝑋 (4) Where: Xij= number of employees in industry i in region j Lq = Izard‘s localization quotient (Belajová and Fáziková, 2005). 4. Testing hypotheses to answer the research question: Wilcoxon matched pairs test is a nonparametric statistical method designed to compare two paired samples. W = min (W+ , W-) (5) Where: W+ = sum of the orders of positive differences W-= sum of the orders of negative differences (Markechová, 2011). 134 Central European Public Administration Review, Vol. 23, No. 2/2025 Implementation of the SMART Concept within the Framework of the 2030 Agenda in the NUTS 3 Regions of the Slovak Republic 3 Results Given the broad scope of the Agenda 2030 goals, we analyze the level of smart transformation in NUTS 3 regions, that is, the extent of SMART concept implementation, through the indicator “employment in science, research, and high-tech.”This indicator is not only a prerequisite for enhancing the economic and innovation potential of regions, but also a necessary condition for regions to become smart and thereby improve the quality of life for all stakeholders. As noted earlier, studies of this kind absent not only in the Slovak Republic but also across the EU. This gap provides potential for future research, par- ticularly through expanding the analysis to other European regions that lag in smart transformation or exhibit low employment in science, research, and high-tech sectors. The present study is based on data from the period 2015–2023, corresponding to the post-adoption phase of the Agenda 2030 program launched in 2015. In the 2014–2020 programming period, EUR 2.67 billion was allocated from EU funds to support science, research, and innovation (HORIZON 2020, Op- erational Programme Research and Innovation, Slovak Investment Holding). However, given that the Slovak Republic has long been among the countries with a low absorption capacity for EU financial support, only about EUR 1.1 billion — roughly 80% of the total — was successfully utilized (“Horizon Eu- rope strategic plan 2025-2027,” 2024; “Operational Programme Research and Innovation 2014 - 2020,” n.d.; “Slovak Investment Holding,” 2023). Our focus on employment in this sector stems primarily from the relatively weak support for the smart transformation of regions and the limited imple- mentation of the SMART concept. Compared to other European regions, sup- port for this sector has long been insufficient. The Slovak Republic, along with most of its regions, lags significantly behind in fostering science, research, and innovation, as well as in adopting specific elements that contribute to smart regions serving all stakeholders. According to the innovation score, Slovakia ranks 24th among the 27 EU member states (“European Innovation Scoreboard 2025 Country profile Slovakia,” 2025). Figure 1 demonstrates the development of employment in the research, de- velopment and high-tech sector in the Slovak Republic over the period 2015– 2023. During the analysed timeframe, employment in this sector exhibited a consistently increasing trend. Between 2015 and 2023, the number of indi- viduals employed in the research, development and high-tech sector grew by approximately 12,300. This increase suggests that either new enterprises have been established in various regions of the Slovak Republic or existing ones have expanded their workforce in this sector. Such a trend is not only significant for the country’s future economic growth and development but is also of crucial importance in the context of implementing the SMART concept and achieving the objec- tives of the 2030 Agenda. Central European Public Administration Review, Vol. 23, No. 2/2025 135 Eva Ivanová, Katarína Štefčíková, Martina Jakubčinová Figure 1: Number of employees in R&D and high-tech Source: (“Zamestnanosť v odvetví vedy, výskumu high-tech,” 2025) Figure 2 offers a comparative view of the development of employment in the research, development and high-tech sector in individual NUTS 3 regions in the Slovak Republic. Over the 2015 to 2023 reference period, the highest number of employees was recorded in the Bratislava region. It is essential to note that there is a significant gap in the number of workers in the research, development and high-tech sector between the Bratislava Region and other regions. Regional differences not only in employment in science, research, and high-tech, but also in the level of smart transformation and overall regional development are particularly pronounced between the Bratislava region and the other NUTS 3 regions. This is mainly because the Bratislava region is classi- fied as an OECD metropolitan region, concentrating most innovative compa- nies as well as the majority of research and educational institutions. In the comparison of 2015 and 2023, it can be stated that the most significant increase in the number of employees in the given sector, with the exception of the Bratislava Region, occurred in the Trenčín Region and the Prešov Region during the period under review. However, there was also a small decrease in the number of the workforce in the research, development and high-tech sec- tor during the period under review, namely in the Nitra region and the Žilina region. This phenomenon may have been caused by organizational changes within companies, as the decline is only marginal. Nevertheless, an analysis of the available statistical data allows us to conclude that, during the period under review, employment in the science, research, and high-tech sector de- veloped favorably. This trend is a positive signal for smart transformation, as well as for the economy and competitiveness of the region. When examining labour market sector dynamics in terms of growth intensity, particular attention should be given to structural change analyses (shift-share analysis). These analyses provide a comprehensive perspective not only on 136 Central European Public Administration Review, Vol. 23, No. 2/2025 Implementation of the SMART Concept within the Framework of the 2030 Agenda in the NUTS 3 Regions of the Slovak Republic sectoral employment trends but also on the pace of development and region- al competitiveness. Consequently, they allow for the identification of both development trajectories in selected labour market sectors and potential la- bour shortages or demand in specific sectors and regions. Figure 2: (a) Number of employees in R&D and high-tech 2015; (b) Number of employees in R&D and high-tech 2023 Source: (“Zamestnanosť v odvetví vedy, výskumu high-tech,” 2025 www.datacube.statistics.sk) Table 1 provides an overview of the results of the shift-share analysis of struc- tural changes in the labour market across individual NUTS 3 regions of the Slovak Republic, specifically in the research, development, and high-tech sec- tor. The shift-share analysis enables the identification of whether the aver- age change in employment in a given sector within a region exceeded the Central European Public Administration Review, Vol. 23, No. 2/2025 137 Eva Ivanová, Katarína Štefčíková, Martina Jakubčinová average national change in that sector. In this context, the highest regional employment growth rates in the research, development, and high-tech sec- tor between 2015 and 2023 were recorded in the Bratislava Region (0.008) and the Trenčín Region (0.008), outperforming both the national average and other regions. This indicates that these two regions experienced faster em- ployment growth in the sector compared to the national level. Conversely, negative values were observed in the Nitra Region (-0.007), the Žilina Region (-0.005), the Banská Bystrica Region (-0.003), and the Prešov Re- gion (-0.002). Even in regions where employment increased in absolute terms, the growth rate lagged behind the national average. Moreover, the negative shift-share values were considerably more pronounced in regions that experi- enced an actual decline in employment within the sector. The overall conclusion of the shift-share analysis is that the Bratislava and Trenčín Regions have most effectively leveraged their conditions to advance one of the key objectives of the SMART concept promoting and creating jobs in research, development, and high-tech. However, the situation in several other regions remains concerning. If the Slovak NUTS 3 regions were com- pared with those in other EU Member States, the results would likely be even more unfavourable. These findings highlight an urgent need to strengthen support for employ- ment in this sector, which is among the most promising for fostering future economic growth and competitiveness particularly in light of the expected decline in labour demand within Slovakia’s traditionally dominant industrial sector due to ongoing digitisation and automation. Table 1: Values of the Shift-share analysis Region Values of the Shift-share analysis Bratislava Region 0.008 Trnava Region 0.001 Trenčín Region 0.008 Nitra Region - 0.007 Žilina Region - 0.005 Banská Bystrica Region - 0.003 Prešov Region - 0.002 Košice Region 0.001 Source: Author’s own calculation based on statistical data (www.datacube.statistics.sk) 138 Central European Public Administration Review, Vol. 23, No. 2/2025 Implementation of the SMART Concept within the Framework of the 2030 Agenda in the NUTS 3 Regions of the Slovak Republic Table 2 presents the results of calculations based on Izard’s location quotient, the values of which indicate whether the research, development and high- tech sector is competitive in terms of the region’s economic development. The period under review spans from 2015 to 2023. Table 2: Values Izard’s location quotient Region Lq2015 Lq2023 Bratislava Region 3.94 3.43 Trnava Region 0.51 0.57 Trenčín Region 0.32 0.58 Nitra Region 0.73 0.53 Žilina Region 0.68 0.45 Banská Bystrica Region 0.61 0.63 Prešov Region 0.28 0.24 Košice Region 0.89 1.00 Source: Author’s own calculation based on statistical data (www.datacube.statistics.sk) If the value of Izard’s location quotient is less than 1, the sector in the re- gion cannot be considered competitive for economic growth. This indicates that the sector’s output does not exceed regional boundaries (i.e. it is a non- exporting sector), or that the sector’s share of employment in the region is lower than the national average. Conversely, if the value of the quotient is greater than 1, the sector can be considered competitive, meaning it gen- erates output beyond the region’s borders (export-oriented sector) or has a higher employment share compared to the national level. The results of the Izard location quotient calculations show that, at the beginning of the ana- lysed period, the research, development and high-tech sector was competi- tive and contributed significantly to regional economic growth only in the Bra- tislava Region. By 2023, this sector had also become competitive and a driver of economic growth in the Košice Region. A comparison of the Izard location quotient values for the Bratislava and Košice Regions reveals that, despite an increase in the number of workers in the research, development and high- tech sector in the Bratislava Region, the overall competitiveness of the sector declined. The fact that only two regions in Slovakia have been identified as having potential in science, research, and high-tech is primarily attributable to the concentration of businesses and universities in the country’s two largest cities. A decrease in quotient values was also recorded in the Nitra and Žilina Regions, where there was an actual decline in the workforce employed in the research, development and high-tech sector during the monitored period. Central European Public Administration Review, Vol. 23, No. 2/2025 139 Eva Ivanová, Katarína Štefčíková, Martina Jakubčinová Table 3 presents the results of local employment calculations for regions in which the research, development and high-tech sector was competitive in the reference years 2015 and 2023, based on the Izard location quotient. Table 3: Values of local employment Region LE 2015 LE 2023 Bratislava Region 4541 7023 Košice Region - 5975 Source: Author’s own calculation based on statistical data (www.datacube.statistics.sk) In 2015, the Bratislava Region was the only region where the research, devel- opment and high-tech sector was classified as an exporting, i.e., competitive sector. The total number of workers in this sector in the Bratislava Region that year was 17,890. Of these, 4,541 were employed in export-oriented activities, contributing directly to the region’s economic growth. By 2023, two Slovak regions had a competitive research, development and high-tech sector: the Bratislava Region and the Košice Region. In Bratislava, the total number of workers in the sector had increased to 24,089, with 7,023 employed in export oriented roles supporting regional economic growth. In the Košice Region, lo- cal employment in the sector was recorded at 5,975 workers the same as the total number of employees in the sector in that region. Since the value of the Izard location quotient for Košice in 2023 was exactly 1, this indicates that, although the sector does not yet generate export value, it is still considered competitive and holds potential for future economic growth. The increase in employment in this sector is primarily attributable to the con- centration of scientific and research institutions, high-tech companies, and universities in Slovakia’s two largest cities, Bratislava and Košice. In the re- gional capitals of other NUTS 3 regions, such institutions and companies are less prevalent. However, if Slovakia’s current industry is transformed into a smart and inclusive one in line with Agenda 2030, it is likely that other re- gions will also become more competitive. Such a transformation could help mitigate demographic challenges, particularly the outmigration of young and educated people to central cities. Table 4 shows the extent to which competitive export industries contribute to the creation of additional jobs in the region. 140 Central European Public Administration Review, Vol. 23, No. 2/2025 Implementation of the SMART Concept within the Framework of the 2030 Agenda in the NUTS 3 Regions of the Slovak Republic Table 4: Values of local employment Region LE 2015 LE 2023 Bratislava Region 17 890. 93 24 089. 71 Košice Region - 5 975. 02 Source: Author’s own calculation based on statistical data (www.datacube.statistics.sk) In 2015, the research, development and high-tech sector in the Bratislava Region contributed to the creation of 17,890.93 jobs. By 2023, the number of people employed in this sector had increased to 24,089.71. In 2023, sig- nificantly higher employment in the sector was also recorded in the Košice Region, where more than 5,975 jobs were created in the regional labour mar- ket. This contributed not only to strengthening the regional economy, but also to enhancing competitiveness in the implementation of the SMART con- cept and selected objectives of the 2030 Agenda. The results of the above calculations clearly highlight the need to focus on supporting job creation in the research, development and high-tech sector, as innovation is one of the key prerequisites for future regional development. Making a region or city “SMART” cannot rely solely on imported innovations. Rapid technological advancement compels us to consider the inevitable transformation in labour market demands. To achieve sustainable economic development, we must also respond to the already significant changes in labour needs within the manufacturing and pro- cessing industries. A decline in demand for industrial labour could pose seri- ous economic challenges in many regions. Therefore, achieving sustainable economic and social development requires not only external innovations but also those generated within the region itself, which can ensure greater adapt- ability in the labour market. However, for regional innovation to thrive, a supportive environment must be established, along with systemic support from the state across all spheres of social life. Innovations can emerge from any sector from foundational areas such as education, public administration, and healthcare, to fields like tour- ism, which hold versatile future development potential for the labour market in the Slovak Republic. However, it is essential that individual actors includ- ing the state, regional governments, universities, research institutions, and innovative companies join forces and form consortia aimed at creating new jobs and generating innovative technologies. These should not only simplify public administration and improve the daily lives of citizens but also enhance economic competitiveness and sustainability. Central European Public Administration Review, Vol. 23, No. 2/2025 141 Eva Ivanová, Katarína Štefčíková, Martina Jakubčinová 4 Discussion Several problems arise in the process of smart transformation, or the gradual implementation of the SMART concept through support for employment in science, research, and high-tech in the NUTS 3 regions of the Slovak Republic: – There is low state support and a lack of cooperation between institutions responsible for science, research, and education at both national and regi- onal levels and other entities such as universities and high-tech companies. Moreover, Slovakia lacks innovation clusters and consortia. Targeted policy instruments such as research grants, innovation vouchers, tax incentives for high-tech enterprises, and start-up incubation programs could significantly stimulate regional employment in knowledge-based in- dustries. Evidence from EU innovation leaders demonstrates that well-de- signed support schemes encourage the growth of spin-offs from universiti- es and research institutions, which are key drivers of regional employment. – Most of the funding for the development of science, research, and innova- tion in Slovakia comes from EU resources, complemented by the mandato- ry national co-financing set for EU member states. – Links between regional and local authorities and key businesses and univer- sities in science, research, and innovation remain weak. – The Bratislava region, as an OECD metropolitan region and the country’s capital area with the highest concentration of science, research, and high- -tech institutions, employs incomparably more workers in this sector than other regions. – Despite the presence of several car manufacturers in the Žilina (Kia), Nitra (Jaguar Land Rover), Trnava (STELLANTIS – Citroën, Opel), and Bratislava (Volkswagen) regions, the vast majority of employees in these companies are not part of the high-tech sector but belong to the manufacturing and processing industries, which were not included in our study. Our focus is on highly qualified professionals such as developers, analysts, specialists in various fields of cybernetics, and scientists. Industry in its current form is not regarded by Agenda 2030 or several recognized studies as a sector with higher added value, nor as one sustainable in line with Agenda 2030 goals (“European Innovation Scoreboard 2025 Country Profile Slovakia,” 2025; Hickel et al., 2020; Pavlínek, 2012). The Agenda 2030 program aims to make industry inclusive, sustainable, and innovative, but under Slovakia’s current conditions, this cannot be regarded as such. However, if smart transformation of regions is achieved including the transformation of indu- stry it will be possible to foster economic competitiveness and sustainable growth even in economically less developed regions in Slovakia (“Europe- an Innovation Scoreboard 2025 Country profile Slovakia,” 2025; Pavlínek, 2012; Vokoun, 2024). The results of our analyses confirm that employment in the research, devel- opment and high-tech sector holds significant potential for sustainable eco- 142 Central European Public Administration Review, Vol. 23, No. 2/2025 Implementation of the SMART Concept within the Framework of the 2030 Agenda in the NUTS 3 Regions of the Slovak Republic nomic growth and development. However, in the NUTS 3 regions of the Slo- vak Republic, employment growth in this sector remains highly uneven even after nearly a decade. This persistent disparity ultimately threatens both the competitiveness and the long-term sustainability of regional development. The shortage of qualified professionals in high-tech fields, digital skills, and applied research continues to be one of the main constraints. In particular, regions outside Bratislava often lack sufficient numbers of doctoral gradu- ates, ICT specialists, and R&D project managers, which reduces their ability to absorb investment and expand employment in high-tech sectors. The differences in employment levels and the pace of employment develop- ment in the research, development and high-tech sector clearly indicate that fostering a strong innovation-driven economy and promoting sustainable growth are not yet priorities across all regions of Slovakia. Currently, the ma- jority of the Slovak workforce is employed in the service and industrial sectors. With rapid technological advancement and shifts in labour market demand, a significant portion of jobs in these sectors is expected to disappear. There- fore, labour market and employment policies should focus on designing ob- jectives and measures aimed at promoting employment in knowledge-based sectors, including tourism, as these are closely interconnected with various soft segments of the national economy. The results of the analysis of structural changes in the labour market indi- cate a positive and more pronounced growth in the number of workers in this key sector for the future in only two of the monitored regions Bratislava and Trenčín. However, despite the relatively rapid employment growth in the research, development and high-tech sector, the Trenčín Region still does not reach a competitive level. Other regions show only negligible growth or even a slight decline in employment in the sector during the observed period, which presents a considerable challenge to efforts aimed at introducing innovation and implementing the SMART concept through the labour market. This situa- tion requires targeted approaches and support measures. Given the low level of regional specialisation in the research, development and high-tech sector, the lack of alignment in regional development strategies also becomes ap- parent. Despite the risks associated with automation and digitalisation, many strategies still focus the future structure of the labour market on the auto- motive industry. Instead, regional development policies should prioritise di- versification towards sectors such as biotechnology, renewable energy, crea- tive industries, and digital services, all of which offer higher added value and greater employment resilience in line with Agenda 2030 goals. At the same time, it is necessary to acknowledge that current political, fi- nancial, legislative, and other instruments do not sufficiently or effectively support smart regional specialisation. With the exception of the Bratislava Region, Slovak regions have not succeeded in creating adequate conditions for the development of the knowledge economy, despite a generally positive national trend in the number of workers employed in research, development and high-tech sectors. Central European Public Administration Review, Vol. 23, No. 2/2025 143 Eva Ivanová, Katarína Štefčíková, Martina Jakubčinová Nevertheless, the issues addressed in this study are broad in scope and offer potential for further research. Such research, however, requires the continu- ous updating of statistical data, as this study is based on data covering the 2015–2023 period. We also see potential for further research in expanding the study to include other sectors that represent the future of the labor mar- ket, not only in terms of sustainability but also competitiveness. However, at present, the main limitation lies in the insufficient comprehensiveness of the available statistical data. For a deeper elaboration and contribution to the subject, it will be important: – Undertake repeated, in-depth, and multi-faceted analyses of regional dif- ferences in the labour market, especially in knowledge economy sectors, as it is necessary to investigate the factors hindering the implementation of SMART concept elements in the labour market space. These analyses should be linked to other regional data, particularly in the areas of educa- tion, infrastructure development, migration, and investment development (Hechi et al., 2024). – Compare the conducted analyses and obtained results with those from other EU regions. This involves reflecting on the knowledge gained through foreign studies and examples of good practices from countries with the hi- ghest share of the workforce in knowledge economy sectors, as well as stu- dying the development strategies and mechanisms that advanced regions have adopted to support the knowledge economy. Relevant examples of good practice may be drawn from regions such as Uusimaa (Finland), Baden- -Württemberg (Germany), Stockholm län (Sweden), Île-de-France (France), as well as Emilia-Romagna (Italy) and Catalonia (Spain) (Rigby et al., 2022). – Create a space for communication and discussion among regional deve- lopment and labour market experts, representatives of the knowledge eco- nomy sector (including high-tech enterprises and research institutions), and policy decision-makers at both national and local levels. The goal is to esta- blish a supportive financial and legislative environment for promoting kno- wledge economy sectors within regional labour markets (Rigby et al., 2022). – Emphasise participatory models in line with the quadruple helix principle in the development of employment strategies. In addition to the public, private, and education/research sectors, it is desirable to involve citizens in planning and implementing the SMART concept, as well as in expanding employment capacities in the knowledge economy sectors. This requires systematic investment in life-long learning, reskilling programmes for wor- kers displaced by automation, and the creation of attractive career path- ways for young graduates to remain in their home regions rather than migrating abroad. Targeted scholarships, mentorship programmes, and regional talent retention schemes could help address these gaps. These individuals must be motivated and educated to fill future jobs in these sec- tors. Since knowledge economy industries place a high premium on a skil- 144 Central European Public Administration Review, Vol. 23, No. 2/2025 Implementation of the SMART Concept within the Framework of the 2030 Agenda in the NUTS 3 Regions of the Slovak Republic led workforce, it is essential to incorporate these requirements effectively into key education strategy documents (Banerjee et al., 2023). – Beyond the national-level concept of labour market support for kno- wledge-based industries, it is recommended to develop tailored politi- cal-economic strategies for individual regions, as each possesses distinct development potential. These strategies must be adapted to the existing infrastructure, human capital, and other regional conditions to ensure eco- nomic competitiveness and sustainability. The involvement of all actors lo- calised within the regions will be crucial, as effective outcomes can only be achieved through collaborative dialogue (Zlámal, 2019). Other commonly recognised measures to support employment in the re- search, development and high-tech sector or the knowledge economy sector more broadly include: – Strengthening financial, legislative, and consultative state support for existing innovation centres and clusters in the regions, as well as creating appropriate conditions for the establishment of new clusters. – By 2030, increase public and private investment in research and deve- lopment to at least 2% of total GDP, in line with the EU average expenditu- re on science and research, which currently stands at 2.22%. Achieving this threshold would not only align Slovakia with the EU average but also create thousands of new jobs in research, development, and knowledge-intensi- ve services, particularly in regions currently lagging behind. A consistent increase in R&D expenditure has been shown to correlate with long-term growth in high-skilled employment across OECD countries (OECD, 2025). – Establishing bilateral agreements to connect Slovak innovation centres and enterprises with foreign counterparts, particularly for the purpose of exchanging experience and fostering cooperation in the development and implementation of innovations. – Enhancing the attractiveness of ongoing activities mainly those supported by EU project funding such as cooperation between universities, the priva- te sector, and public administration; SMART mobility and energy projects; or initiatives aimed at attracting talent to the regions – is essential. In the context of Slovakia’s managing authorities, it is crucial to create a favoura- ble environment that reduces administrative and bureaucratic burdens, fo- cuses on results achieved, and adheres to the principle of value for money to ensure high quality, efficiency, and long-term sustainability. Furthermore, Slovakia should increase its participation in calls that facilitate cooperation on knowledge economy, science, research, and innovation pro- jects with institutions from other EU Member States, going beyond those lim- ited to the national context. In order for individual regions of the Slovak Republic to move closer to achiev- ing sustainable economic and social development by 2030, and to success- fully deliver and implement innovation, it will be essential to intensively de- Central European Public Administration Review, Vol. 23, No. 2/2025 145 Eva Ivanová, Katarína Štefčíková, Martina Jakubčinová velop their own innovation capacities. Such capacity building typically begins within smaller communities, which can subsequently expand their influence to a broader area. In this context, it is crucial that Slovak regions create an environment that enables them to leverage their strengths and potential to establish sustainable and smart local governments that utilise technology to address everyday challenges and improve the quality of life for residents and entrepreneurs, who represent the driving force of each regional economy. Such an environment enhances the capacity of regions to attract investors, retain highly skilled professionals, and stimulate the creation of knowledge- intensive jobs. In practice, this means not only strengthening the high-tech sector itself, but also expanding employment opportunities in related areas such as digital infrastructure management, smart mobility, renewable energy solutions, and data-driven public services. Overall, the findings highlight the urgent need for Slovakia to strengthen its knowledge economy capacities across all regions, as this remains the cornerstone for achieving both regional competitiveness and sustainable development in line with Agenda 2030. 5 Conclusion The main objective of this study is to assess the level of implementation of a selected element of the SMART concept within the context of the 2030 Agenda goals across individual NUTS 3 regions of the Slovak Republic using various analytical methods. In order to fulfil this objective, the following research question was formu- lated: “Does the development of employment in the research, development and high- tech sector significantly affect the competitiveness of NUTS 3 regions in the Slo- vak Republic?” To address this research question, the following hypotheses were formulated and tested: 146 Central European Public Administration Review, Vol. 23, No. 2/2025 Implementation of the SMART Concept within the Framework of the 2030 Agenda in the NUTS 3 Regions of the Slovak Republic Table 5. Wilcoxon Signed-Rank test Q: Is there a statistically significant difference in the development of employment in the research, development and high-tech sector between the NUTS 3 regions in the Slovak Republic? H0: There is no statistically significant difference in the development of employment in the research, development and high-tech sector between NUTS 3 regions in the Slovak Republic. H1: There is a statistically significant difference in the development of employment in the research, development and high-tech sector between NUTS 3 regions in the Slovak Republic. Parameter Value p-value 0.07813 W test (W-, W+) 5, (5, 31) Effect size (r) 0.6228 Significance level (α) 0.05 Source: Author’s own calculation The test results do not provide sufficient evidence to reject the null hypothe- sis (H0) at the 5% significance level (p > α), indicating a substantial but statisti- cally non-significant difference in employment in the research, development and high-tech sector between 2015 and 2023. It can be concluded that, al- though the number of people employed in this sector increased considerably, the change was not statistically significant. At the national level, the increase appears relatively substantial, but regional development trends remained largely unchanged, with the exception of the Trenčín Region. Most NUTS 3 regions, except Nitra and Žilina, recorded positive trends in employment in the research, development and high-tech sector, suggesting a regional effort to foster conditions for new jobs in the knowledge economy and innovation sectors. A striking disparity persists between the Bratislava Region and the rest of the Slovak Republic, which may intensify in the future and challenge the country’s ability to effectively implement the SMART concept in line with the 2030 Agenda labour market objectives. Central European Public Administration Review, Vol. 23, No. 2/2025 147 Eva Ivanová, Katarína Štefčíková, Martina Jakubčinová Table 6: Wilcoxon Signed-Rank test Q: Does the research, development, and high-tech sector significantly contribute to regional competitiveness and economic growth only in the Bratislava region? H0: There is no statistically significant difference in the share of the research, development and high-tech sector in economic growth between the Bratislava Region and other regions. H1: There is a statistically significant difference in the share of the research, development and high-tech sector in economic growth between the Bratislava Region and other regions. Parameter Value p-value 0.485 W test (W-, W+) 0.500316 Effect size (r) 0.13 Significance level (α) 0.05 Source: Author’s own calculation The test results do not provide sufficient evidence to reject the null hypoth- esis (H0) at the 5% significance level (p > α), indicating that the difference in the share of the research, development and high-tech sector in economic growth between the Bratislava Region and other Slovak regions is not sta- tistically significant. Nevertheless, the analysed data suggest that only in the Bratislava Region is this sector represented by a workforce that generates ex- portable outputs and contributes substantially to regional economic growth and job creation. The multi-faceted analyses conducted for the 2015–2023 period also indicate that the research, development and high-tech sector shows signs of competitiveness in the Košice Region. However, in terms of workforce growth or decline, the sector remains relatively stagnant, pointing to a lack of systemic support. These findings underline the urgent need to foster job creation in the re- search, development and high-tech sector, as it holds significant potential for the labour market of the future, sustainable economic development, and overall quality of life. The study concludes that employment development in this sector influences both regional and national competitiveness, particularly in the context of SMART concept implementation in line with the 2030 Agen- da. Given the rapid digitalisation of the labour market and changing work- force skill requirements, it is crucial to strengthen support mechanisms and strategies aimed at generating new employment opportunities in cities and regions, especially in science, research, and innovation. In order to create new job opportunities in science, research, and high-tech, we consider the following to be important: 148 Central European Public Administration Review, Vol. 23, No. 2/2025 Implementation of the SMART Concept within the Framework of the 2030 Agenda in the NUTS 3 Regions of the Slovak Republic – On the part of the state – establishing a long-term framework for financing science, research, and innovation, modernizing tax incentives for innovati- ve companies, and providing systematic support for talent through educa- tion and retraining. – On the part of regional governments – updating the smart specialization strategies of RIS3 regions, building clusters, innovation hubs (or laborato- ries), and consortia in cooperation with other regions, with support from the state, universities, innovative enterprises, and industrial actors. These initiatives should create space for programs aimed at retaining talent and graduates in the region. During the course of the study, we encountered a number of limitations, particularly those relating to the regional delimitation of territories when ex- amining indicators such as employment in science, research, and high-tech sectors, as overlaps between functional urban areas can significantly distort the results. We also identified limitations in the form of inconsistent statisti- cal data, since in the industrial sector—especially the automotive industry— there are workers who may be considered highly skilled high-tech employees. Another limitation of the study lies in the narrow selection of indicators ap- plied in the chosen methods (focused mainly on employment in the science, research, and high-tech sectors). On the other hand, this limitation opens op- portunities for expanding the research in the future. 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Tatyana Tomova Sofia University “St. Kliment Ohridski”, Bulgaria t.tomova@phls.uni-sofia.bg https://orcid.org/0000-0003-0680-3480 Elena Kalfova Sofia University “St. Kliment Ohridski”, Bulgaria elena_kalfova@phls.uni-sofia.bg https://orcid.org/0000-0002-9427-7451 Simeon Petrov Sofia University “St. Kliment Ohridski”, Bulgaria sapetrov@phls.uni-sofia.bg https://orcid.org/0000-0001-9652-5562 Kaloyan Haralampiev Sofia University “St. Kliment Ohridski”, Bulgaria k_haralampiev@phls.uni-sofia.bg https://orcid.org/0000-0001-7430-1867 Received: 14. 7. 2025 Revised: 29. 9. 2025 Accepted: 3. 10. 2025 Published: 11. 11. 2025 ABSTRACT Purpose: To demonstrate the necessity of reverse mapping in the imple- mentation process of environmental policy. Design/Methodology/Approach: A representative survey (of the adult population of Bulgaria) on pro-environmental behaviour and public atti- tudes towards relevant policies; data analysis conducted through ANOVA and factor analysis. Findings: There is a gap between public approval of ecological goals and support for concrete measures. Preferences regarding policy tools de- pend on their perceived beneficial or harmful impact on the material situ- ation of individuals. No more than 30% of citizens are willing to pay for ecological improvements. Tomova, T., Kalfova, E., Petrov, S., Haralampiev, K. (2025). Environmental Policy Implementation: Can We Reduce Failures Without Changing Objectives? 155 Central European Public Administration Review, 23(2), pp. 155–189 2591-2259 / This is an open access article under the CC-BY-SA license https://creativecommons.org/licenses/by-sa/4.0/ Tatyana Tomova, Elena Kalfova, Simeon Petrov, Kaloyan Haralampiev Practical Implications: Individual preferences should be monitored throughout the process of environmental policy implementation and used as evidence to inform changes in policy development. Originality/Value: The notion that individual preferences regarding pol- icy tools are significant in the implementation of environmental policy; the composite indicator of pro-environmental behaviour. Keywords: policy tools, environmental policy implementation, implementation models, individual preferences regarding environmental policy tools, backward mapping implementation. Izvajanje okoljske politike: ali lahko zmanjšamo neuspehe, ne da bi spremenili cilje? POVZETEK Namen: prikazati nujnost vzvratnega mapiranja v procesu izvajanja okolj- ske politike. Načrt/metodologija/pristop: reprezentativna anketa (med odraslim pre- bivalstvom Bolgarije) o prookoljskem vedenju in javnih stališčih do ustre- znih politik; analiza podatkov z ANOVA in faktorsko analizo. Ugotovitve: obstaja razkorak med javnim odobravanjem okoljskih ciljev in podporo konkretnim ukrepom. Preference glede političnih orodij so odvisne od tega, ali se zaznava, da pozitivno ali negativno vplivajo na ma- terialni položaj posameznikov. Plačevati za okoljske izboljšave je pripra- vljenih največ 30 odstotkov državljanov. Praktične implikacije: posameznikove preference je treba spremljati sko- zi celoten proces izvajanja okoljske politike in jih uporabiti kot dokazila za usmerjanje sprememb v oblikovanju politik. Izvirnost/vrednost: opozorilo, da so preference posameznikov glede po- litičnih orodij pomembne pri izvajanju okoljske politike; sestavljeni kazal- nik prookoljskega vedenja. Ključne besede: orodja politike; implementacija okoljske politike; modeli implemen- tacije; preference posameznikov glede orodij okoljske politike; im- plementacija z vzvratnim mapiranjem. JEL: D78, Q56, H83 1 Introduction Environmental policy is probably the only area in which the administration and experts are more important than politicians, not because they have more powers, but because implementation is more important for achieving the desired results compared to policy formulation. The tools that can effec- tively stimulate people‘s pro-environmental behavior can be found within the framework of the implementation process. The likelihood of this happening at the macro-political level of governance is small for at least two reasons. On the one hand, this probability is limited due to the specificity of ecosys- 156 Central European Public Administration Review, Vol. 23, No. 2/2025 Environmental Policy Implementation: Can We Reduce Failures Without Changing Objectives? tems, local environmental problems, and public relations regarding their so- lution. On the other hand, the volatility of human behavior, which is difficult to predict due to the influence of unconscious and irrational factors, leads to unpredictability of reactions to the measures taken and to the need for these measures to be constantly adjusted and even supplemented. This turns the administration from a „politicians‘ headquarters“ into an active initiator of specific tools for achieving policy goals. Moreover, due to the horizontal nature of sustainability goals, seeking compliance with them is part of the administration‘s commitments, regardless of the sector in which it operates. There are at least two reasons the implementation of environmental policy is more important than goal setting. One is related to the policy essence, and the other relates to the development process. The long-dominant traditional model assumes a rational and coherent link between problems and policy in which optimal tools are prescribed to solve policy issues, regardless of the individual preferences to policy tools. The in- creasingly current behavior perspective, however, focuses on the effects of individual-level perceptions of policy tools. However, research on citizens’ potential preferences for policy tools is limited. This deficit encourages the perception of instrument choice as an expert-technical endeavor, especially with regard to policies where there is no clear political dividing line. In such an approach, the question of why the outcomes of certain policies is very limited, despite relative clarity and/or agreement on key objectives, remains open. In this context, the present study considers environmental policy as particularly relevant for the study of preferences for policy tools. Almost 60 years after the Club of Rome Report, which gave the first impetus to the environmental policy, the results of its implementation remain ques- tionable. Even after the 2015 Paris Agreement on climate change, which in some way changes the traditional approach by recognizing the need to limit certain human activities, skepticism that policies will actually deliver results still exists (Laitos and Okulski, 2017). Despite some individual improvements in selected indicators and specific locations, the overall decline in environmen- tal quality continues with unwavering strength, and no country has achieved environmental sustainability (Howes et al., 2017). It seems that environmental goals are, in general, commonly shared. Proof of this is the process outlined after 1992 by the successive Rio Earth Summits. This process led to the adoption in 2015 of the 17 Sustainable Development Goals (United Nations, 2015), adopted by the Governments of all Member States of the international organization (193 in total). Of course, a particular- ity of these goals is their weak specification, and it is difficult to dispute the statement that if we describe people’s goals at a high level of abstraction – “to have a good life” – then almost everything is a means to achieve these goals (Alemanno and Sibony, 2015). Environmental policy follows two alternative approaches to solving identi- fied problems: technological innovation and consumption change. In some Central European Public Administration Review, Vol. 23, No. 2/2025 157 Tatyana Tomova, Elena Kalfova, Simeon Petrov, Kaloyan Haralampiev ways, the two approaches are interconnected. It is expected, and even seems logical, that technological change will increase the sustainability of produc- tion consumption, so that the economy will not only pollute and/or deplete natural resources. This approach clearly has its limitations. Electric motors, for instance, pollute less, but their production involves the use of many more resources. In addition, the issue of their disposal seems, at least for now, in- soluble and extremely harmful to the natural environment. In general, the his- tory of technology shows that many discoveries that are the basis of modern life have caused and continue to cause intractable environmental problems. The second approach, which is consumer-oriented, seems even more contra- dictory. Even when not explicitly identified, changing behavior has long been at the heart of environmental programs (Bujold et al., 2020). However, the shift of pollution sources from production processes to consumption pro- cesses makes pro-environmental behavior of citizens essential for reducing pollution (Carducci et al., 2021). Modern consumer culture, which is strongly influenced by marketing rather than actual needs, has a beneficial impact on economic growth, but at the same time, a detrimental impact on the environ- ment. The paradox here is that this also applies to products that meet certain environmental standards – they are more on the trajectory of consumerism than of environmental consumption. Environmental policy can hardly achieve a significant effect without elimi- nating the reasons for the problems for which it is undertaken. When hu- man activities are oriented primarily towards maximizing individual benefit, consideration for nature remains in the background. A society in which the benefit pursuit is the main factor of individual behavior can probably protect natural resources through policies if there is no contradiction between these two goals, and they are naturally achieved simultaneously. For the moment, however, this seems impossible - ecology is either expensive, or leads to a reduction in jobs, or makes it difficult for individuals. This, in most cases, leads to a refusal of either production, consumption, or ecology. Despite the logical contradictions in the approaches to environmental policy, there is no reason to believe that it has become an occasion for new politi- cal cleavage. The thesis that achieving real results related to sustainability requires limiting economic growth (Asara et al., 2015) remains, at least for now, marginal in the policy debate. On the contrary, the big question is how to maintain the pace of economic growth and restore the ecological balance at the same time. Within a simplistic vision of policy objectives, there is a focus on the efficient use of resources to achieve ecological goals, without much attention to the demand or behavioral characteristics of audiences (Shafir, 2012). Thus, poli- cymaking is typically seen as an activity focused on the calibration of policy tools – such as the size of sanctions or incentives – rather than on considera- tions of the nature of the instruments and mechanisms themselves (Capano et al., 2019). 158 Central European Public Administration Review, Vol. 23, No. 2/2025 Environmental Policy Implementation: Can We Reduce Failures Without Changing Objectives? Beyond the contradictory approaches of the environmental policy, the pro- cess of its formation and implementation contains additional pitfalls. Envi- ronmental policy flows from top to bottom – from institutions to citizens and from the supranational through the State to the local level of govern- ance. Although citizens are directly affected by environmental pollution, they, except in isolated cases, do not feel it directly. The individual’s commit- ment to the environment is more of a cultural and informational origin than a material one, related to immediate needs. Not only at the beginning of the global process to sustainability but also now, the initiators of environmental policies are international expert circles and networks. In most cases, specif- ic policies arise from global or international agreements, turn into national strategies and environmental laws, and then into regional programs and lo- cal plans. This largely seems logical. In the conditions of free trade, which turns countries into “race to the bottom” of regulations and active policies, нindependent environmental policy at the state level of governance would be a factor with adverse consequences for competitiveness. Therefore, in- ternational agreements on environmental policy, which in a sense set limits to the global “race to the bottom,” are the incentives for measures taken at other levels of governance. This article develops only one aspect of environmental policy implementa- tion – the adaptation of policy to the preferences of affected individuals and the specific tools for their implementation. It seems to us that in such a task, there is a significant potential for improving the results of measures related to sustainability. At the same time, this issue cannot be solved in advance and in principle because of the strong dependence of human behavior on random factors. The first part of the article justifies the idea of implementation as a process that can improve performance, including by reformulating the tools. In the second part, based on the Bulgarian case, one of the main challenges facing the implementation of environmental policy is examined – the prefer- ences of affected citizens regarding policy tools. On this basis, conclusions are drawn on how the administration can improve the relevant ecosystem through its own behavior. 2 Implementations as a Choice of Tools In the theory, the issue of policy implementation is not new. As early as the 1970s, Jeffrey Pressman and Aaron Wildavsky opened this research field, proving that this stage of the policy process can significantly worsen the pol- icy effect (Pressman and Wildavsky, 1984). The two authors study the policy process in a federal state, focusing on the transition from decisions at the central level to the actions of local authorities. They prove that a policy deci- sion can be rendered ineffective by passing through the so-called implemen- tation chain. The main claim is that the more agents are involved in the chain, the greater the probability of unsuccessful implementation. The subject of Pressman and Wildavsky’s study is the implementation of a federal job creation program in Auckland. Although the program is designed Central European Public Administration Review, Vol. 23, No. 2/2025 159 Tatyana Tomova, Elena Kalfova, Simeon Petrov, Kaloyan Haralampiev and funded at the federal level, its implementation passes through several different agents: administrative agents or structures that allocate resources, local authorities that adapt the program to the local context, implementing organizations or institutions that directly implement the program and pro- vide services, and finally – the final beneficiaries. The eventual failure of oth- erwise well-designed policies, according to Pressman and Wildavsky, can be caused by the presence of a series of approval points, the complexity of the actions, the relationships between the individual agents, etc. The implementation chain of Pressman and Wildavsky is vertical. They study the transition and development of policies from the federal to the state level of governance. This fact is a reason to believe that their statements are not applicable in the conditions of unitary countries, where implementation is pri- marily horizontal coordination between various governmental and non-gov- ernmental agencies and organizations. The difference between the vertical implementation chain and the process of horizontal coordination is signifi- cant. In the first process, the relative freedom of each governmental level, the so-called discretion, is much more pronounced due to the presence of em- powered, self-governing, independent, politically constituted communities. The vertical implementation chain does not replace horizontal coordination – they occur simultaneously. In the case of federal states, as well as in the case of more cultural than economic phenomena, such as environmental policy, the vertical implementation chain has a leading importance due to the lack of hierarchy between the main participants in it. Pressman and Wildavsky’s idea of implementation, however, contains sev- eral starting points for the present study. On the one hand, they prove that this stage does not imply only the implementation of the decision taken at the higher level, but is a creative process oriented towards maximizing the result. Accordingly, the result is a consequence of many factors, which, among other things, also relate to the relative freedom of each individual agent to make choices and solve problems. On the other hand, Pressman and Wildavsky defend the thesis that implementation is not technical, but, like formulation and decision-making, is a political process, during which the choice of policies or specific measures to achieve collective goals is exposed to the pressure of political or private interests. On the other hand, the failure of policies is also possible due to the last link in the implementation chain – the end-users of public services. To determine the relative importance of the so-called implementation pitfalls, Howes et al. (Howes et al., 2017) use a categorization from other studies (Al- thaus et al., 2017; Kamieniecki and Kraft, 2012). According to the authors, these can be categorized as structural reasons, implementation traps, or problems with knowledge of the problem. The emphasis in our study is on the second group, which House et al. categorize as “implementation-related”. We check the possibility of improving the effect of policies by controlling their quality. We accept that the implementation is a process by which policy is converted into action (Barrett, 2004). The first question that this definition raises is who 160 Central European Public Administration Review, Vol. 23, No. 2/2025 Environmental Policy Implementation: Can We Reduce Failures Without Changing Objectives? is the main agent of the transformation of goals into actions. The second - given that the goal does not predetermine the action, what are the possible actions and what determines their choice. There is no agreement on both questions in the literature. According to Pülzl and Treib (2007), research on implementation develops in three successive stages. The first, which began in the 1970s, raises the ques- tion of the potential gap between the common goal and the concrete actions for its implementation, the temporal and substantive difference between the law and the results of its application (Bardach, 1977). According to the same authors, this stage is rather pessimistic because it proves that policy intentions are not fully realized or are modified due to the complexity and sometimes unpredictability of the implementation process. The second and third stages are related to the analysis of implementation models. Research from this stage contrasts the top-down approach, in which a policy decision is implemented through the actions of a series of agencies, with the bottom-up approach, in which street level bureaucrats solve problems in a highly decen- tralized environment. Top-down theorists see policy designers as the central actors and concentrate their attention on factors that can be manipulated at the central level. Bottom-up theorists emphasize target groups and service deliverers, arguing policy really is made at the local level (Matland, 1995). The attempt to reconcile the two models leads to the identification of four paradigms that relate to the political-administrative relation and the degree of conflict within the implementation process. These four paradigms include low conflict-low ambiguity (administrative implementation), high conflict- low ambiguity (political implementation), high conflict-high ambiguity (sym- bolic implementation), and low conflict-high ambiguity (experimental imple- mentation) (ibid.) Our approach rejects the top-down approach without fully coinciding with the bottom-up approach. The reason is that our reasoning provides a differ- ent perspective on the understanding of implementation than the traditional one. The latter can improve the policy process by adapting specific measures to local specificities and, above all, to the attitudes and behavior of those af- fected. Such reasoning abstracts from the possible political-administrative conflict and considers the relative freedom of the administration to further develop political decisions. Such a perspective on the reasoning about imple- mentation is related to the search for flexible forms of public governance that would allow for maximum consideration of the specificities of the place and time in which the policy is implemented. Matland (1995) summarizes the existence of three main criticisms of the top-downists: the interruption of the cyclical relationship and the failure to consider the lessons learned from pre- vious implementations; the understanding of implementation as a purely ad- ministrative, technical process of implementation and the bias towards legal policy regulations. These three features of top-down approaches reject any possibility of policy being tailored to end-users. Accordingly, in this approach, outcome orientation, even if it exists, is sought solely based on theoretical considerations about what is “right” and “necessary.” Central European Public Administration Review, Vol. 23, No. 2/2025 161 Tatyana Tomova, Elena Kalfova, Simeon Petrov, Kaloyan Haralampiev The criticism of bottom-up approaches relates to the limited possibilities for political control and the overestimation of local autonomy and its resource provision to achieve public goals (ibid.). We claim that policy cannot be suc- cessful if the final links in the implementation chain cannot, for one reason or another, influence the policy design. This is not about their inclusion in the policy development, but about their active presence in the implementation process, when the policy needs to be adapted or even reformulated. One of the first attempts to reconcile the two extreme models - Elmore’s concept of forward and backward mapping, was developed back in the 1980s (Elmore, 1979). The idea of the model is that public authorities and target groups should jointly create the policy design. Forward mapping consists of specifying precise political goals, developing detailed “means-ends” schemes and specifying clear outcome criteria by which the policy is to be evaluated at each stage. Backward mapping consists of precisely specifying the behavior that needs to be changed at the lowest level, describing a set of operations that can ensure the change, and repeating the procedure upwards in steps until the central level is reached (ibid.). At first glance, this model contradicts efficiency, due to the slowness of the process. Therefore, its application in practice is most often limited to its first part - forward mapping with the par- ticipation of representatives of target groups. In the absence of reverse map- ping, however, many issues become challenging – the changing attitudes of the affected parties over time and the emergence of new stakeholders; the possible lack of a clear and constant relationship between attitudes and be- havior, as well as a mandatory connection between social group affiliation on the one hand and attitudes and behavior on the other. The lack of reverse mapping is a possible answer to the question of why “in many countries, ef- fective shaping of public policies, programs, and projects let alone their im- plementation and monitoring, institutionalization, and evaluation, is one of the weakest points of public governance (Mencinger et al., 2017). In fact the implementation is not a one-way process at all (Sager et al., 2024). It is rather a process of interaction between independent agents incl. those affected by the policies – the end users of policy results. The failure of policies should be sought not only in the institutions but also in the preconceptions and behav- ioral stereotype of the end-users. For instance, when citizens are engaged, motivated, and willing to change their behavior, it is much easier for Govern- ments to achieve their policy goals, in part because all citizens are joint par- ticipants in actions that have collective benefits. When citizens are excluded, antagonistic to Governments, and focused on their short-term interests, pub- lic policy becomes much more difficult to implement and the outcomes are poor (John, 2018). The analysis of implementation, as well as of the policy process as a whole, con- cerns not only the question of “who is involved and what kind of interaction is there between the diferent agents”, but also “what for does this interaction take place”. In this sense, regardless of the implementation model (top-down, bottom-up or hybrid), this process is related to the choice of policy tools. And if the goal is abstract and can (at least in theory) be achieved in many ways, 162 Central European Public Administration Review, Vol. 23, No. 2/2025 Environmental Policy Implementation: Can We Reduce Failures Without Changing Objectives? the instrument is a concrete technique that changes individual behavior so that the overall goal is achieved. The choice of instrument is no less important than the choice of the goal, because the instrument must make people do something that they would not otherwise do (Schneider and Ingram, 1990). This article focuses on the last part of the implementation chain. The question of how the end-user of public services can influence the success of policies is rarely a subject of research. In principle, both implementation and the en- tire chain are foreseen as a one-way process: from formulation at the political level, through implementation, where multiple state and/or territorial agen- cies participate, to the end-users. Each subsequent link in the implementa- tion chain applies the decisions of the previous one, considering the specific context of its activity, and then makes decisions for its own activity, seeking efficiency. Since each link in the chain is relatively free in making decisions for its own activity, as well as because of the time distance between the formula- tion and the achievement of results, the risks of policy failure appear. A solu- tion has been consistently sought in recent years within a logic of collabora- tive governance (Ansell et al., 2017), as well as shaping policy design through the participation of all stakeholders. The question that remains unanswered, however, is who represents the end-users and to what extent this represen- tation is credible in terms of the future behavior of the affected individuals towards the instruments. The issue is further complicated because even if there is support in principle, the affected individual, whether a person or an organization, may not respond adequately to the instruments used, and thus create a risk to the achievement of the objectives. Overcoming or limiting this risk is usually sought in effective communication to present the measures to the affected individuals, especially in cases where they are unpopular or have a high social cost (Wenzelburger and Hörisch, 2016). Institutions responsible for achieving common goals can change the behav- ior of individuals in the community through “stick, carrot, or sermon” (Be- melmans-Videc et al., 2011). This metaphor corresponds to the three ways in which the collective will, embodied in political power, can change individual behavior: coercion, incentives, and persuasion. It corresponds to the differ- ent resources that legitimate institutions use to influence individuals - power, public finances and information, as well as to the different techniques that public authorities in modern societies (and not only) use to achieve common goals - regulations, economic incentives, incl. taxes and fees, communication and exhortation. Despite the existence of multiple categorizations of tools (see e.g., Howlett, 2023), the above-mentioned study has had a significant impact on research in recent years, not only in the field of evaluation but in the theory of public policies in general (Olejniczak et al., 2025). Knowledge on policy instruments and implementation patterns is brought to- gether against the backdrop of current debates on behavioural science find- ings (Loer, Neher, 2024). In the last few decades, with the introduction of behavioral science into policy research, a new tool has emerged – nudges, which unconsciously change the architecture of individual behavioral choices Central European Public Administration Review, Vol. 23, No. 2/2025 163 Tatyana Tomova, Elena Kalfova, Simeon Petrov, Kaloyan Haralampiev (Thaler and Sunstein, 2008; Klunin et al., 2024). Despite many criticisms of this approach, not coincidentally defined as libertarian paternalism (Sunstein, 2014) due to its “hidden” intervention, these tools are widely used and highly effective in certain areas of public management (Naru, 2024). Based on these criticisms, some similar categories, also inspired by behavioral science, have emerged, such as “Nudge plus” (Banerjee, 2021) or “Boosts” (Grune-Yanoff, and Hertwig, 2016). The goal of Nudge plus is not to use behavioral insights to create a one-time change, but to foster a state or environment where these interventions help establish a new equilibrium of self-reinforcing and ben- eficial behaviors that embed reflection as part of the nudge. With greater transparency, the agent becomes aware of his or her biases, which are sys- tematically repeated with heuristics, i.e., they undergo perspective transfor- mation (Banerjee, 2021). The common denominator behind Boosts policies is the idea of empowering people by expanding their competencies. Boosts are rationally based regulatory strategies designed to improve people’s ability to manage emotional reactions by overcoming biased thinking and undeliberate choices (Jolls and Sunstein, 2005). Thus, while classical nudges are considered bias-preserving, Boosts are considered bias-eliminating techniques (Di Porto and Rangone, 2015) aimed at improving people’s competence to exercise their freedom of choice. In the broadest sense and based on whether policy tools guide or encourage appropriate behavior, they can be divided into “hard” and “soft” policy tools (Hood, 2007; Banerjee et al., 2021). Hard tools are those that guide people’s behavior through formulated rules and directives, and financial incentives such as fines, taxes, and subsidies. On the other hand, soft tools are those that seek to guide people’s behavior by providing additional information or by changing the information environment in which they make choices. Sev- eral studies have already examined public support specifically for these soft policy tools (Aghion et al., 2010; Banerjee et al., 2021). Although implementation – the choice of a policy instrument – is a process in which multiple agents interact, exchanging expertise, influence, and often in- terests, the instrument must be able to achieve the goal in a specific situation. At this stage, we are not discussing the question of what the implementation model should be to choose the optimal instrument. The question is, rather, what the instrument should be to be determined as optimal. In this case, the question is not about the choice but about the evaluation. Policies, and therefore instruments, achieve several goals simultaneously, and this is precisely the great challenge in their formulation. However, their main purpose is to change people’s behavior and to reconcile or replace their indi- vidualistic goals with common ones. Without this, no instrument can achieve results and therefore, its use becomes meaningless. Instruments and goals are linked in the sense that the use of policy tools in- volves implicit or explicit assumptions and expectations about the effect that the implementation of the tools has on those affected by them. It is crucial for policy development that the behavior resulting from the use of instruments 164 Central European Public Administration Review, Vol. 23, No. 2/2025 Environmental Policy Implementation: Can We Reduce Failures Without Changing Objectives? in practice is what is expected. Whether these goals are purely social con- structs with few empirical referents or reflect a more objective assessment of the actual behavior of the relevant groups of actors, this actual behavior is critical to the relationship between goals and instruments (Howlett, 2019). The point is that no social technique acts directly. It is refracted through the attitudes, motivations and behavioral stereotypes of the affected individuals. In recent years, the application of behavioral science in public management has been mainly associated with the tools of nudge. However, it allows us not only to nudge, but also to establish and consider in advance that regulations work because people are interested in them, or because they inertially comply with the community and the authorities in it, or because the repressive or con- trolling apparatus in the community works well, etc. The reasons can be many. In any case, however, the effectiveness of the tools depends on the reactions of the individuals whose behavior is a prerequisite for achieving the goals. Eco- logical goals can be achieved and the tools chosen in connection with them can work if people are ready to reduce their consumption, or if they consume environmentally friendly products, or if they contribute to recycling, etc. Simi- larly, achieving sustainability goals depends on how economic agents organize the production process, what technologies they use, etc. Therefore, attitudes towards tools matter. Specific instruments may work where public attitudes are favorable and have no or minimal effect where this is not the case. Existing research does not deny the relationship between policies and public attitudes. In most cases, however, the solution to the possible contradiction between policies and public attitudes is sought in the inclusion of stakehold- ers in the process of policy development and in collaborative governance (Em- erson et al., 2012). The expectations are that the eventual contradictions will be overcome by finding a common point of view between the participants or by informing them. However, it is logical that citizens and their organizations can support the goals, and yet, in the process of implementing the instru- ments, adjust their behavior in such a way that the goals cannot be achieved. Studies that prove the existence of certain preferences for policy tools are not often conducted. This is probably because the instrument is seen as a technique, the development of which is more a matter of expertise than of interests and attitudes. However, some significant connections between pub- lic attitudes and policy tools are already empirically proven. For instance, Haselswerdt et al. (Haselswerdt et al., 2015) demonstrate that the way public policies are implemented has significant consequences for public attitudes towards them. The authors conducted a series of research experiments to test how citizens react to alternative instruments such as tax breaks and spending programs. Their study shows that citizens prefer tax breaks to direct subsidies, not in principle, but only because this is the current state of the measures taken. In cases where direct subsidies are applied or when no measures are taken at all, preferences for tax breaks decrease. The study also shows that ideology and political preferences also matter – con- servatives prefer tax breaks to a much greater extent, but the same prefer- Central European Public Administration Review, Vol. 23, No. 2/2025 165 Tatyana Tomova, Elena Kalfova, Simeon Petrov, Kaloyan Haralampiev ence prevails among liberals and is similarly influenced by the status quo. The authors conclude that the status quo of policy structures citizens’ perceptions of the instruments. Anna Wielicka-Regulska (Wielicka-Regulska, 2020) studies food consumption to establish the relationship between public attitudes and policy tools. Her preliminary hypothesis is that pro-environmental behavior (specifically con- sumption of local and/or seasonal products, consideration of the carbon foot- print of food) is associated with favorable attitudes towards the implemented policy tools (green public procurement, higher VAT on unhealthy food, regu- lation allowing retailers to provide short-term food with a shelf life to chari- ties as a tax-free donation, a levy on the amount discarded for distributors, a deposit for plastic bottles). The results of the study prove that the attitude towards the different instruments is not the same, and that while the accept- ance of green public procurement and increased VAT is strongly expressed, this is not the case for the deposit for plastic bottles, as well as the penalty fee on discarded food. The author concludes that “we can also expect that after introducing a solution to the market, the degree of acceptance could significantly change, but it is still very important to know the factors which are most responsible for shaping attitudes and acceptance towards interventions stimulating sustainable food consumption” (Wielicka-Regulska, p. 447). A recent study by Andersson and Almqvist (2022) aims to establish public preferences for nudges compared to traditional policy tools. The study is rep- resentative of the Swedish adult population and establishes public attitudes towards instruments from different policy areas. Based on the data obtained, the authors argue that, in general, information and subsidies are perceived more positively than other types of instruments – taxes, regulations, and nudges. According to them, the explanation is partly related to individualis- tic ideological views, support for political goals, as well as certain socio-de- mographic variables. The authors assume that the explanation can also be sought in the fact that the preferred instruments – information and subsidies – restrict individual freedom less and, to a limited extent, lead to direct mate- rial losses for individuals (Andersson and Almqvist, p. 22). It would not be an exaggeration to note that current research on public preferences for policy tools is related to “nudges”. Accordingly, they serve to support and affirm or, conversely, to reject an unconventional type of in- strument. Regardless of their direct implications, these studies are of utmost importance because of the principal thesis that public preferences for policy tools matter. The study by Dominic H. Enste and Jennifer Potthoff (Enste and Potthoff, 2021) makes a significant contribution to the further development and argumentation of the above thesis. According to the cited authors, the development and communication of effective environmental policies require dividing the population into smaller units and identifying the full range of their environmental attitudes, behavioral patterns, requirements, and ex- pectations. They use the concept of social milieu, which describe groups of people who are similar in terms of life, values, mentality, and lifestyle (Schip- 166 Central European Public Administration Review, Vol. 23, No. 2/2025 Environmental Policy Implementation: Can We Reduce Failures Without Changing Objectives? perges, 2019). Social milieu is simultaneously defined by attitudes and value orientations, social status, and generational affiliation. The authors conclude that changing human behavior to combat the climate change crisis requires an intervention that is different from traditional economic theory or a purely legal approach. Individual characteristics, cognitive boundaries, social factors, and group affiliation significantly influence the actions and decisions of in- dividuals (Enste and Potthoff, 2021, p. 86). Therefore, the choice of policies must be accompanied by specific studies of public preferences, and the tools must be tailored to the characteristics of those they will affect. 3 Bulgarian Case: “Environmental Policy If We Don’t Pay For It And If It Is Not a Burden For Us” The present study aims to establish the public preferences of citizens towards environmental policy tools. The traditional categorization of tools was used, according to which the behavior of individuals is influenced by prohibitions (regulations), incentives, or the dissemination of information. Due to the un- conventional nature of the classic “Nudge” (Thaler and Sunstein, 2008), public attitudes towards it are established primarily through experiments and are difficult to include in standard questionnaires. However, some modified cat- egories, also inspired by behavioral sciences, such as “Nudge plus” (Banerjee, 2021) or “Boosts” (Grune-Yanoff and Hertwig, 2016), can be classified as in- centives or information dissemination techniques. The research model was developed based on the following assumptions: 1. The environmental policy outcomes’ achievement depends on the pro-en- vironmental characteristics of individual behavior. 2. The policy tools that transform goals into action aim to change the beha- vior of individuals so that they become possible. In a policy-driven society the prerequisite for the effectiveness of the process are individuals who respond relevantly to specific measures, changing their behavior in accor- dance with the common goals. 3. The behavior of individuals (whether person or organization) is multifacto- rial. There are connections and dependencies between the factors of be- havior themselves. The reactions of individuals to policies depend on their preferences towards them, their attitudes, beliefs and convictions, as well as their socio-demographic characteristics. 4. Even in the presence of favorable attitudes towards policy tools, enviro- nmental behavior may remain unchanged due to the existence of more im- portant incentives for individuals’ actions. 5. The relative strength of policy tools as a driver of behavior depends on trust in the institutions involved in policymaking, but not only. In many ca- ses political affiliation can be much less important than others factors. The present survey was conducted in the period 4-14 April 2024 among 1008 Bulgarian citizens aged 18 and over. The study is representative of the adult Central European Public Administration Review, Vol. 23, No. 2/2025 167 Tatyana Tomova, Elena Kalfova, Simeon Petrov, Kaloyan Haralampiev population of Bulgaria. It is based on a nationally representative two-stage nested sample, implemented after preliminary stratification of the universe by administrative region (NUTS-3), settlements and size of the settlement, a random route of movement across the territory of the nest and selection of respondents starting with a starting address plus a step. The maximum per- missible stochastic error is ± 3.1%. The registration method is a direct stand- ardized interview. One of the main hypotheses drafting the questionnaire is that environmental policy in Bulgaria has not led – at least so far – to a significant spread of pro- environmental individual behavior. Taking steps towards the development of behavioral models, a number of researchers are striving for a comprehensive review of the models and variables of behavior – Hines et al. (Hines et al., 1987), Stern (Stern, 2000), Kollmuss and Agyeman (Kollmuss and Agyeman, 2002), etc. Two dominant approaches have been used to study environmental behavior, one focused on impact and the second on intention. Intention refers to behaviors that contribute to environmental sustainability and emphasizes the outcome of the behavior. Impact-oriented makes assumptions based on motivations, rather than focusing on the outcome of the behaviors. The New Environmental Paradigm is considered the “gold standard” for measuring at- titudes (Dunlap et al., 2000) and is a widely used and well-validated measure designed to assess an individual’s belief system about nature. Stern (Stern, 2000) adopts an intention-oriented approach to understanding pro-environ- mental behavior as actor-defined behavior with the intention of changing the environment. Stern distinguishes three types of behavior: environmental citi- zenship, political support, and personal behavior. Environmental citizenship behavior includes actions such as joining environmental groups and environ- mental activism. Political support includes accepting government decisions that aim to protect the environment, including raising taxes and prices. The final category of behavior is personal behavior, which includes “the purchase, use, and disposal of personal and household products that have an impact on the environment” (Stern, 2000). One of the most important classifications of consumer actions, also used in this study, is that of Kaiser et al. They identified 65 self-reported environmen- tal indicators in six groups: energy conservation, mobility and transportation, waste reduction, consumerism, recycling, and social behaviors towards envi- ronmental protection (Kaiser et al. 2003). Based on numerous meta-analyses, Kurisu (2015) makes several useful classi- fications of various pro-environmental actions (behaviors). Subgroups of envi- ronmental behavior are energy efficiency at home; waste and recycling; water consumption; energy saving; personal transportation; purchasing green prod- ucts; environmental activism. Possible reasons for environmental/non-envi- ronmental behavior are summarized as knowledge; norms; environment (in- frastructure); perceived impact (utility); cost/benefit balance; abilities; habits; real opportunity. Some of them are defined as intrapersonal, and others as contextual. The leading variables in many studies can be divided into psycho- 168 Central European Public Administration Review, Vol. 23, No. 2/2025 Environmental Policy Implementation: Can We Reduce Failures Without Changing Objectives? logical (control, responsibility); cognitive (knowledge); demographic (gender, age, education, income, place of residence) (Kurisu, 2015). For the study purpose, a composite indicator of pro-environmental behavior was created that covers a large part of the known pro-environmental prac- tices. Similar to the measurement of environmental perception, there is no scientific consensus on which instrument to use to measure pro-environmen- tal behavior. The number of behaviors used to measure pro-environmental behavior varies greatly across studies (from 3 to over 50 different behaviors), leading to a wide heterogeneity in the results. Behaviors can be attributed to different behavioral clusters (e.g., water/energy saving, political action, etc.). Going a step further, some studies group behaviors into composite coeffi- cients (Binder and Blankenberg, 2017; Schmitt et al., 2018) to capture the rel- evant behavior more adequately. Although Kaiser (1998) notes that the use of composite scores to measure pro-environmental behavior is controversial because it assumes that aggregation across different types of behavior will capture relevant aspects of a particular type of environmental behavior and involves different ways of aggregating behavior into a composite variable, the goals of the present study suggest precisely such an approach. In many studies, authors combine different developed scales or create completely new ones (Mónus, 2020). Based on the detailed review of the available data and empirical studies, three aggregate indicators were created for this study. The aggregate indi- cator for pro-environmental behavior is composed of 21 specific behavioral actions, which we believe cover the groups of behaviors identified in the lit- erature - preference for seasonal, locally grown food; reading product labels given their potential harm to health; striving to reduce waste; participating in environmental campaigns; recycling; efforts for energy efficiency; using a car, etc. The aggregate indicator for awareness of environmental problems is composed of 8 specific perceptions of real problems – air pollution; water pollution; soil pollution; climate change; the extinction of some animal and plant species; depletion of natural resources; natural disasters; epidemics. The aggregate indicator for knowledge includes the declared level of 2 ac- tions - the purposeful pursuit of self-education about environmental prob- lems; and reading articles and watching shows; and 6 self-reported levels of familiarity with specific categories and groups of practices - the zero-waste concept; green energy sources; environmental standards; eco-labels for appli- ances; the harms of the production of most goods that are purchased. The design of the questions focused on closed-answer questions with both 2 and 5 degrees of answers. The main assumption behind such a design is that we need to quantify as much as possible the differences regarding en- vironmental policy among respondents. Choosing among different degrees in the answers scale allows us to identify significant differences in the at- titude between different groups of responders. Quantification helps us to draw clear conclusions by splitting significant from insignificant differences in the attitude. It was already mentioned that the number of participants and Central European Public Administration Review, Vol. 23, No. 2/2025 169 Tatyana Tomova, Elena Kalfova, Simeon Petrov, Kaloyan Haralampiev the sample selection approach make the survey nationally representative. It means that the number of responses and the design of the questions allow us to use quantitative statistics like Cronbach’s Alpha, Factor analysis, ANOVA, and Chi-square. These classic statistics are used because of their robustness and high accuracy. In terms of results interpretation, it is a bit of a conserva- tive approach since there are different statistical methods available to be used but the main idea is to identify essential trends in data by using classical and highly reliable statistics. In other words, the classical design of the data analysis puts us on the safe side. With that respect, we use Cronbach’s Alpha, Factor analysis, ANOVA, and Chi-square as methods for analyzing data from the nationally representative survey. The statistical analysis of the procedure follows six steps: 1. When we had preliminary clarity about which primary indicators form a composite indicator, then we only checked their internal consistency with Cronbach’s Alpha. 2. When we did not have prior clarity on which primary indicators formed a composite indicator, we applied factor analysis. After the extraction of the factors, we checked the internal consistency of the primary indicators they consist of with Cronbach’s Alpha. 3. After we established the composition of the composite indicators, we cal- culated average scores for each composite indicator. 4. We have grouped the average scores of composite indicators into five gro- ups based on the mean plus/minus one standard deviation and plus/minus two standard deviations: a. Very week – below mean minus two standard deviations. b. Week – between mean minus two standard deviations and mean minus one standard deviation. c. Moderate – between mean minus one standard deviation and mean plus one standard deviation. d. Strong – between mean plus one standard deviation and mean plus two standard deviations. e. Very strong – above mean plus two standard deviations. 5. We compared the average scores of different groups of respondents using ANOVA. 6. We examined relationships between grouped composite indicators using Chi-square. 7. ANOVA compares the means of three or more groups to determine whe- ther there are any statistically significant differences between them. Analysis of variance is used to test the hypothesis that several means are equal. It tests the hypothesis that all group means are equal by analyzing the variance within groups and between groups. ANOVA helps determine whether observed differences in sample means are likely due to real effec- ts or just random variation. If the p-value from ANOVA is below a certain 170 Central European Public Administration Review, Vol. 23, No. 2/2025 Environmental Policy Implementation: Can We Reduce Failures Without Changing Objectives? threshold (e.g., 0.05), it suggests that at least one group mean is significan- tly different from the others. Factor analysis is a statistical method that attempts to identify underlying variables, or factors, that explain the pattern of correlations within a set of observed variables. Factor analysis is often used in data reduction to identify a small number of factors that explain most of the variance that is observed in a much larger number of manifest variables. Factor analysis is used to iden- tify underlying relationships between observed variables. It reduces a large set of variables into fewer latent factors, which represent common patterns in the data. Each factor captures the shared variance among multiple vari- ables, helping to explain correlations between them. Researchers often use it in psychology, marketing, and social sciences to uncover hidden dimensions like intelligence, customer preferences, or attitudes. The technique assumes that observed variables are influenced by both common factors and unique error components. Cronbach’s Alpha is a measure of internal consistency. It is a score indicating the probability of two or more variables to measure a single underlying trait. In this survey, it is essential for estimating consistency between similar questions and is a benchmark for including them in the same composite indicator. 4 Results: Lack of Clustering in Preferences to Policy Tools The results show a huge clustering of respondents’ answers around the aver- age values of the composite indicator for pro-environmental behavior. 67,4% of respondents have “moderate” pro-environmental behavior. The high levels on the scale – “strong” and “very strong” pro-environmental be- havior, slightly exceed the corresponding low levels on the five-point scale of the composite indicator. Cronbach’s alpha is 0.913, indicating excellent in- ternal consistency. The percentages of the empirical distribution are close to the expected percentages of the normal (Gaussian) distribution, which are 2.3:13.6:68.3:13.6:2.3. Figure 1. Pro-environmental behavior Source: Own. Central European Public Administration Review, Vol. 23, No. 2/2025 171 Tatyana Tomova, Elena Kalfova, Simeon Petrov, Kaloyan Haralampiev There is a statistically significant relationship between pro-environmental be- havior and time spent abroad. ANOVA statistics show a significant difference (p=0,048) between pro-environmental attitudes among respondents with short stay abroad and those without experience abroad. Figure 2. Mobility ANOVA Pro-environmental behavior Sum of Squares df Mean Square F Sig. Between Groups 2,405 2 1,203 3,051 ,048 Within Groups 318,492 808 ,394 Total 320,897 810 Source: Own. There are many reasons for the relatively unfavorable picture of pro-environ- mental behavior. What interests us in this case is the influence of policies on environmental behavior. Our assumption is that if attitudes towards policies are unfavorable, then their influence on environmental behavior will be limited. Figure 3. Research model policy approval of the pro- objectives and objectives environmental tools preferences to behavior tools Source: Own. 172 Central European Public Administration Review, Vol. 23, No. 2/2025 policies attitude to policies Environmental Policy Implementation: Can We Reduce Failures Without Changing Objectives? The survey recorded an extremely high level of awareness of environmental problems. Between 55 and 65% of respondents believe that water, soil, air pollution, climate change, natural disasters, and epidemics are real problems. Slightly smaller are the share of respondents who believe that the disappear- ance of natural resources is a completely real problem (48.6%), as well as the disappearance of some animal and plant species (51.8%). Cronbach’s alpha is 0.913, indicating excellent internal consistency. Figure 4. Awareness of the ecological problems Source: Own. The composite indicator, which includes awareness of all the above-mentioned types of environmental problems, shows a huge concentration at the highest level of the scale - the share of those who believe that environmental prob- lems are not real is insignificant. The distribution is heavily skewed towards the right end of the scale. Very often, but not always, such extreme skewness indicates the presence of so-called social desirability bias. It is possible that re- spondents are indeed very aware of the ecological problems, but it is also pos- sible that they have responded in a way that they know is expected of them. Environmental awareness has both a cognitive component, based on knowl- edge, and an emotional component, based on perception. The study found a statistically significant relationship between environmental behavior and the degree of awareness of environmental problems - the higher the awareness, the higher the degree of pro-environmental behavior. The problem is that despite this, moderate adherence to pro-environmental practices in everyday life prevails. In contrast to the high level of awareness of environmental problems, the level of knowledge about ecology is rather mod- erate. In this sense, the latter indicator corresponds to a much greater extent to the insufficient presence of environmental practices in everyday life. Central European Public Administration Review, Vol. 23, No. 2/2025 173 Tatyana Tomova, Elena Kalfova, Simeon Petrov, Kaloyan Haralampiev Figure 5. Knowledge about ecology Source: Own. Cronbach’s alpha is 0.912, indicating excellent internal consistency. Accord- ing to the overall knowledge indicator used in the study, 65% of citizens have a moderate level of knowledge about ecology, 16% have a strong level of knowledge, and 3% have a very strong level of knowledge. Since this is a self- assessment of knowledge, it is possible that this distribution simply reflects the high level of awareness of the problems. Figure 6. Strive to expand knowledge Source: Own. In any case, the interest in environmental issues is present - 35% of the sur- veyed individuals express the opinion that they purposefully strive to expand their knowledge in the field of the environment. Environmental knowledge is generally considered a prerequisite for voluntary action (Frick et al., 2004). Although theoretically, knowledge seems to play a significant role in pro-en- vironmental behavior, empirical evidence is inconclusive, as shown by some meta-analyses (Bamberg and Möser, 2007). Therefore, environmental knowl- 174 Central European Public Administration Review, Vol. 23, No. 2/2025 Environmental Policy Implementation: Can We Reduce Failures Without Changing Objectives? edge is considered a necessary but not sufficient condition for an individual’s pro-environmental behavior (Kollmuss and Agyeman, 2002). With a high awareness of environmental problems and moderate interest in knowledge about them, the insufficient environmental orientation of the daily behavior of individuals is more related to policies and attitudes towards them. Of course, the preferences for policy tools stated in the study reflect intuitive, unthinking, preliminary attitudes. A significant part of adult Bulgarian citizens does not recognize their own re- sponsibility for achieving environmental goals. Only slightly over 50% of them believe that environmental protection also depends on their own behavior. In practice, Bulgarian society is divided into two, almost equal parts: one be- lieves that it should contribute to environmental protection, the other – does not see the connection between its own behavior and the achievement of green goals. Almost half of the Bulgarian population supports the statement that environmental protection is the duty of institutions, and it is not right to put emphasis on what individuals do. Perceived control refers to individuals’ perception of whether they can change or achieve a desired outcome through their actions or not. External focus attributes outcomes to external forces, while internal focus suggests that outcomes can be achieved through people’s behavior. People with in- ternal perceived control are more likely to take action (Johnson et al., 2004). Individuals with external perceived control cannot imagine environmental problems being solved without general government prescriptions and pro- hibitions (Kauder et al. 2018) – people tend to externalize responsibility and demand collective action. Denial of personal responsibility appears to be a major obstacle to pro-environmental behavior (Lorenzoni et al., 2007). The transfer of responsibility “outside” and the exoneration of one’s behavior is also confirmed by the feeling that nothing depends on the individual citizen - 7 out of 10 people share the opinion that decisions on important issues in the country do not depend on them, but on a narrow circle of individuals, and 5 out of 10 respondents are convinced that the individual consumer cannot influence production and pollution. The data show a significant tendency to shift responsibility for the state of the environment to institutions. At the same time, however, there is a huge distrust of politicians and environmental policies. Almost 80% of respondents believe that “politicians are not doing what they should”, approximately the same share is of the opinion that certain people are getting rich from environ- mental protection measures. The current environmental policy also provokes distrust. According to the ma- jority, it is necessary, but it is not effective and is not implemented properly, and it is “just another way for some people to get rich”. There is a high level of skepticism towards the display of environmental concerns behind which other interests are hidden. Central European Public Administration Review, Vol. 23, No. 2/2025 175 Tatyana Tomova, Elena Kalfova, Simeon Petrov, Kaloyan Haralampiev Figure 7. Evaluation of the activities of politicians Source: Own. Figure 8. Integrity assessment Source: Own. Figure 9. Evaluation of control effectiveness Source: Own. 176 Central European Public Administration Review, Vol. 23, No. 2/2025 Environmental Policy Implementation: Can We Reduce Failures Without Changing Objectives? Given this mindset, the likelihood that citizens will not comply with measures stemming from unpopular politicians whose decisions fuel corrupt practices is enormous. The results of previous studies demonstrate that people with a high level of political support tend to comply with policies and accept insti- tutional directives. An insufficient level of support, on the other hand, is an obstacle to the smooth implementation of environmental policy and it may end in failure (Wan et al., 2015). Figure 10. Individual action versus collective action Source: Own. Chi-square = 69.95, p = 0.000, indicating the presence of a statistically signifi- cant relationship. The level of environmental knowledge is statistically signifi- cantly related to attitudes towards intervention types (Chi-square = 49.76, p = 0.000). The higher the knowledge, the more aware one is of the importance of own behavior in solving environmental problems. Similarly, the higher the environmental knowledge, the more support for soft approaches in environ- mental policy increases. Environmental knowledge can be described as the amount of information that people have regarding environmental problems and their ability to un- derstand and assess their impact on their surroundings (Blankenberg and Harm, 2019). According to older research, the possession of such environ- mental knowledge increases the likelihood of pro-environmental behavior (Hines et al., 1987). The study does not register a significant difference between public prefer- ences for different types of intervention: regulations and administrative con- trol, negative and positive incentives, and dissemination of information about policies. Favorable public attitudes prevail in all four cases. At this level of pol- icy instruments specification, citizens tend to express their support for envi- ronmental policies in general. The majority of respondents even believe that Central European Public Administration Review, Vol. 23, No. 2/2025 177 Tatyana Tomova, Elena Kalfova, Simeon Petrov, Kaloyan Haralampiev control over the implementation of environmental measures is not sufficient, which, however, should not be perceived as a desire to strengthen coercive instruments, but only as a desire to comply with environmental measures. Figure 11. Environmental knowledge Source: Own. Although public preferences are favorable for all approaches to achieving envi- ronmental goals, the deviation from the meaning in the aggregate indicator of instrument preferences shows relatively greater support for soft tools related to information. Although the difference is small, support for soft tools is still higher among respondents with a higher level of environmental knowledge. Figure 12. Attitude towards intervention types Source: Own. 178 Central European Public Administration Review, Vol. 23, No. 2/2025 Environmental Policy Implementation: Can We Reduce Failures Without Changing Objectives? Cronbach’s alpha is 0.659, indicating questionable internal consistency. At a more concrete level of policy tools specification the preferences of citizens become more specific. In this study, respondents stated their preferences for 15 different tools that are widespread in environmental policies in EU coun- tries. Among the tested environmental protection alternatives, the propos- als to introduce monetary incentives for citizens who return glass packaging receive the greatest support (approximately 8 out of 10 people completely or somewhat agree), followed by lower prices for lower electricity consump- tion, incentives for stores that allow you to return unwanted products, incen- tives for manufacturers that use recycling, and lower prices for lower water consumption. The proposals that are associated with paying a price/fine by citizens are the least approved, such as: paying more taxes and fees that go to environmental measures; higher taxes for citizens who do not recycle; paying a higher price for an environmentally friendly product; and fines for citizens who do not recycle Through factor analysis, based on the combination of preferences declared by respondents, 5 subscales have been identified. The latter cannot be me- chanically reduced to the “stick, carrot, and sermon”. They differ in two more criteria: who they affect (an individual citizen or a specific economic organiza- tion) and whether the instrument is incentive or punitive. The first subscale brings together four tools that, in the most general sense, can be defined as financial incentives that increase the income before taxes or disposable income of the affected individuals (both people and organi- zations). In this 1st factor includes both direct subsidies and tax reduction. These are positive financial incentives. Additional testing with Cronbach’s Al- pha showed a value of 0.806, indicating good internal consistency. The second subscale includes taxes, prices or fines that punish citizens’ be- havior in case it is inconsistent with environmental goals. All four instruments in this 2nd factor included in are negative financial measures that “punish” citizens by reducing disposable income or increasing their expenses. Ad- ditional testing with Cronbach’s Alpha showed a value of 0.879, indicating good internal consistency. The third subscale combines negative financial tool aimed at organizations with behavior that is irrelevant to the environment. These instruments increase the costs or reduce the profits of economic entities. Additional testing with Cron- bach’s Alpha showed a value of 0.896, indicating good internal consistency. The fourth subscale includes two tools. They reduce the costs of consumers with pro-environmental behavior. These are more of positive incentive tools for pro-environmental consumption. Additional testing with Cronbach’s Al- pha showed a value of 0.912, indicating excellent internal consistency. The fifth subscale again includes two tools, which are united based on their punitive and/or prohibitive nature. These are sanctions, that can be direct prohibitions or fixed high prices of harmful products. Additional testing with Central European Public Administration Review, Vol. 23, No. 2/2025 179 Tatyana Tomova, Elena Kalfova, Simeon Petrov, Kaloyan Haralampiev Cronbach’s Alpha showed a value of 0.622, indicating questionable internal consistency. The subscales are presented in order of respondents’ preferences. The great- est support is for positive financial incentives (subscale 1), and the least - for sanctions (subscale 5). This result shows support for measures that are ben- eficial for the material state of individuals. If the policy tools harm it the sup- port for them decrease. Table 1. Main results of the study: public preferences towards policy tools Tools Subscales (factors) In a statistically significant relationship with: Introduce incentives for manufacturers who use recycled products Introduce incentives for stores that allow to return unwanted products – 1st 1. Education (F = 4.17, p = 0.016) clothing, batteries, etc. Positive financial 2. Socio-professional group (F = 3.37, p = 0.005) incentives for Introduce monetary incentives 3. Place of residence (F = 7.90, p = 0.000) citizens for citizens who buy second-hand electrical appliances To introduce monetary incentives for citizens who return glass packaging I’m willing to pay more taxes and fees that go specifically to environmental measures 1. Gender (F = 14.06, p = 0.000) I’m willing to pay a higher price for 2. Age group (F = 4.41, p = 0.001) 2nd Negative a more environmentally friendly 3. Education (F = 26.08, p = 0.000) financial incentives product. 4. Socio-professional group (F = 4.28, p = 0.001) for citizens 5. Income group (F = 4.83, p = 0.000) Taxes should be higher for citizens 6. Place of residence(F = 8.18, p = 0.000) who don't recycle Fine citizens who don't recycle Fine companies that don't recycle Taxes should be higher for 3rd Negative 1. Education (F = 5.26, p = 0.005) companies that don't recycle financial incentives 2. Place of residence (F = 4.56, p = 0.004) for enterprises Fine stores that don't have separate collection containers Introduce lower prices for lower 4th Positive water consumption incentive for pro- 1. Gender (F = 9.36, p = 0.002) Introduce lower prices for lower environmental 2. Place of residence (F = 6.27, p = 0.000) electricity consumption consumption Cars should be banned from entering downtown 1. Gender (F = 18.21, p = 0.000) 5th Sanctions 2. Socio-professional group (F = 2.83, p = 0.015) Prices of plastic goods should be 3. Place of residence (F = 4.09, p = 0.007) higher Source: Own. 180 Central European Public Administration Review, Vol. 23, No. 2/2025 Environmental Policy Implementation: Can We Reduce Failures Without Changing Objectives? The study does not establish a significant relationship between citizens’ pref- erences and indicators of their socio-demographic situation: income group, age group, educational group, place of residence, gender, marital status, type of employment, international mobility. The preliminary hypothesis is that higher income groups, more educated, younger people and those groups that have lived abroad for a long time in the last three years have a different attitude towards environmental policy tools. This hypothesis is not confirmed by the data obtained. They show that the socio-demographic characteristics of the respondents do not structure attitudes towards environmental policy tools, except in isolated cases. Men and women differ significantly in pro-environmental behavior (Eisler et al., 2003). Women show higher pro-environmental behavior than men (Long- hi, 2013), report stronger pro-environmental attitudes (Zelezny et al., 2000) and are more willing to take pro-environmental actions (Stern et al., 1993). However, some studies find no or very small effects of gender (Blocker and Eckberg, 1997), which can be explained by the chosen behavior. In the pre- sent study, gender was statistically significantly associated with attitudes on three of the subscales: 5, 4 and 2. In the latter two subscales, the deviations from the mean in women were much larger. Age is generally considered a key predictor of pro-environmental behavior, but the results of empirical studies are contradictory. On the one hand, young people are considered to behave less environmentally friendly than older people (Casaló and Escario, 2018), partly because the latter are more moti- vated by improving the quality of the environment for the next generation (Shen and Saijo, 2008). At the same time, younger people generally consider it less necessary to behave pro-environmentally, because they believe that technological progress will deal with future environmental problems (Benn, 2004). From the perspective of the present study, belonging to an age group only matters for the acceptance of financial tool that “punish” citizens for en- vironmentally unfriendly behavior (2nd subscale). The group between 30-39 years old is more likely to accept this category of tools. Higher levels of education and employment have been identified as positive predictors of pro-environmental behavior (Casaló and Escario, 2018). Educa- tion is generally expected to affect environmental concerns by increasing knowledge about environmental issues, but the analysis of concerns about global warming shows that education (treated as endogenous) has no effect on this type of concern (Chankrajang and Muttarak, 2017). In the field study, education is statistically significantly associated with three of the categories studied – positive incentives (1st subscale); negative financial incentive (2nd subscale) and financial sanctions for companies (3rd subscale). In all three cat- egories, higher education is associated with a higher level of acceptance of the above categories. Social group membership is statistically significantly associated with three of the identified subscales – 1st, 2nd and 5th. Managers and freelancers are most supportive of financial “penalties” on citizens. At the same time, the unem- Central European Public Administration Review, Vol. 23, No. 2/2025 181 Tatyana Tomova, Elena Kalfova, Simeon Petrov, Kaloyan Haralampiev ployed group most strongly supports both types of incentives – for pro-en- vironmental behavior (1st subscale) and for low consumption (5th subscales). The amount of personal income is statistically significantly related to pref- erences for 2nd subscale – negative financial tools over citizens. The higher the income, the higher the support for these tools. Income in general has a controversial effect on pro-environmental behavior (Whitmarsh and O’Neill, 2010). Higher incomes are correlated with low individual pro-environmental behavior, and poorer people declare increased use of public transport and reduced heating costs (Longhi, 2013). However, most people are likely to en- gage in pro-environmental behavior if it is not costly (money, time, efforts and convenience) (Diekmann and Preisendorfer, 2003). The place of residence is the only indicator that is in a statistically significant relationship with all five subscales. Support for positive incentives (1st sub- scale) is highest in the capital, for negative financial incentives for citizens (2nd) – in small towns; for negative financial stimuli on companies (3rd) – again in the capital; for stimuli for reduced consumption (4th) – in regional and small towns; for prohibitive and punitive measures (5th) – in the capital. Around 30% of respondents hesitate to believe that they themselves should be fined if they do not implement individual sustainable practices. Around 35% of the respondents believe that the prices of plastic products could be higher. Approximately the same share of respondents declares their willing- ness to pay more for an ecological product. The remaining almost 70% op- pose this perspective – to pay for an ecological policy. The study establishes a very strong, statistically significant relationship be- tween the composite indicator of ecological behavior and preferences for the tools. The higher the level of pro-environmental behavior, the stronger the preferences for sanctions (subscale 5th), negative financial incentives for companies (subscale 3rd) and negative financial tools or citizens (subscale 2nd). Pro-environmental behavior is related to all groups of tools, but its high levels are associated with preferences for sanctions. The latter correlation can be interpreted as meaning that restrictive measures have a greater effect than incentives. This puts us in the difficult situation of interpreting a seemingly contradictory situation. People prefer incentives and would change their behavior to a greater extent because of them – as we have already shown, incentives are the most preferred approach among the tools studied. At the same time, people with pro-environmental behavior declare preferences for sanctions – perhaps this hides an unfavorable assess- ment of the policies followed, or distrust, even dissatisfaction with “other” citizens... Obviously, these are questions for other studies, but the contradic- tion between “incentives for me” and “sanctions for others” must be taken into account when formulating environmental (and not only) policy. 182 Central European Public Administration Review, Vol. 23, No. 2/2025 Environmental Policy Implementation: Can We Reduce Failures Without Changing Objectives? Figure 13. Correlation with pro-environmental behavior Source: Own. 5 Conclusion Since Pressman and Wildavski, hardly anyone doubts that implementation matters. This is especially true for environmental policy, where for many rea- sons the achievement of results seems difficult to achieve, despite the exist- ing agreement on the goals. The question, however, is what in the implementation needs to be changed to improve the process as a whole, so as to accelerate the achievement of the desired results. The theoretical review has led us, to use Elmer’s term, to reverse mapping, i.e. to identify the necessary changes in the behavior of the individuals affected and to take concrete measures to accelerate this change. This reverse mapping presupposes a certain degree of discretion on the part of the administration engaged in the policy implementation, as well as suf- ficient capacity of this same administration to participate actively in shaping the policy design. Research on citizens’ preferences for environmental policy tools largely proves the above thesis. 1. They are contradictory and poorly structured, as a result of which, based on their establishment at a certain point in time, their future state cannot be predicted. This makes it necessary to monitor them in the process of implementation and to adapt the initial policy plan. 2. They are specific, which is why transferring knowledge about preferences for policy tools established in another political and cultural context is not a reliable basis for policy development. 3. Social group affiliation does not predict attitudes towards environmental policy tools. 4. Age group is not a predictor of preferences for environmental policy tools. Central European Public Administration Review, Vol. 23, No. 2/2025 183 Tatyana Tomova, Elena Kalfova, Simeon Petrov, Kaloyan Haralampiev Only the expansion of the share of people for whom pro-environmental be- havior is a commitment can make reverse mapping unnecessary. In Bulgaria, these people are about 30% and are willing to pay for ecology. There are not many, but it is a good start. 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Central European Public Administration Review, Vol. 23, No. 2/2025 189 DOI: 10.17573/cepar.2025.2.07 1.01 Original scientific paper Analysis of the Cost Efficiency of Public General Hospitals in Croatia Romario Marijanović University of Rijeka, Faculty of Economics and Business, Croatia Institute of Public Finance, Croatia romario.marijanovic@ijf.hr https://orcid.org/0009-0001-8622-5563 Mihaela Bronić Institute of Public Finance, Croatia mihaela.bronic@ijf.hr https://orcid.org/0000-0002-0863-2040 Simona Prijaković Institute of Public Finance, Croatia simona.prijakovic@ijf.hr https://orcid.org/0000-0001-7835-582X Received: 10. 4. 2025 Revised: 2. 9. 2025 Accepted: 8. 9. 2025 Published: 11. 11. 2025 ABSTRACT Purpose: The Croatian population is rapidly ageing, and if current de- mographic trends continue, by 2050 one in three Croatians will be over the age of 65. This demographic shift implies that a smaller working-age population will need to support a growing number of elderly individuals, placing considerable strain on economic performance. Simultaneously, increasing demand for public health services has driven up public health- care expenditures, with general hospitals bearing the majority of accu- mulating unpaid obligations. In this context, assessing the cost efficiency of general hospitals becomes crucial in minimising resource wastage. Design/Methodology/Approach: Cost efficiency is assessed by analys- ing how monetary inputs are converted into intermediate outputs. The cost efficiency of 19 Croatian general hospitals is analysed using the most common method—input-oriented Data Envelopment Analysis (DEA)— during the pre-pandemic years of 2015 and 2016, and the pandemic years of 2021 and 2022. One input is used (total expenditures and outlays of general hospitals, excluding investments in facilities) and three outputs (number of inpatient treatment days, beds/chairs occupancy rate in day hospitals, and number of outpatient services in polyclinic-consultative healthcare). Marijanović, R., Bronić, M., Prijaković, S. (2025). Analysis of the Cost Efficiency of Public General Hospitals in Croatia. 191 Central European Public Administration Review, 23(2), pp. 191–220 2591-2259 / This is an open access article under the CC-BY-SA license https://creativecommons.org/licenses/by-sa/4.0/ Romario Marijanović, Mihaela Bronić, Simona Prijaković Findings: Cost efficiency scores range from 48% to 100%. On average, hos- pitals could have reduced expenditures by 7% in 2015, 14% in 2016 and 2021, and by 16% in 2022 while maintaining current output levels. During the COVID-19 pandemic, the overall cost efficiency of general hospitals declined. Pula-Pola and Varaždin consistently emerged as benchmark (most efficient) hospitals across all four years. In contrast, Vukovar under- performed, with cost efficiency scores below 70% throughout. For most hospitals, relative efficiency rankings remained stable over time—high performers before the pandemic continued to perform well afterward; low performers remained low. The data also indicate that larger hospitals, in terms of expenditures, generally demonstrate better cost efficiency. Academic contribution to the field: This study contributes to the litera- ture by measuring cost inefficiencies in general hospitals, which are of- ten overlooked in international health economics research, particularly in Central and Eastern European countries. It identifies persistent bench- marks and inefficiencies, offering a data-driven foundation for policy reforms aimed at enhancing financial sustainability and operational ef- ficiency in Croatia’s healthcare system. Research limitations: The model incorporates a limited set of variables due to data constraints. Including additional indicators, such as pharma- ceutical expenditures or case-weighted inpatient discharges, could pro- vide a more nuanced cost efficiency assessment. This limitation highlights the need for more comprehensive and standardised healthcare data col- lection in Croatia, especially from the Ministries of Health and Finance. Practical implications: These findings may assist policymakers, as cost- efficient general hospitals are vital to economic and social prosperity. Benchmark general hospitals can serve as models, sharing best practices in cost management and resource use that could help improve cost effi- ciency across general hospitals. Less efficient general hospitals should be targeted for audits, managerial training, or support with budgeting and resource allocation. Furthermore, the study provides a foundation for enhancing national hospital performance monitoring systems and data reporting standards. Originality/Value: This is the first study to calculate the cost efficiency of 19 Croatian general hospitals. Keywords: cost efficiency, Croatia, Data Envelopment Analysis, health, public general hospitals Analiza stroškovne učinkovitosti javnih splošnih bolnišnic na Hrvaškem POVZETEK Namen: Hrvaško prebivalstvo se hitro stara, in če se bodo sedanji demo- grafski trendi nadaljevali, bo do leta 2050 vsak tretji Hrvat starejši od 65 let. Ta demografski premik pomeni, da bo moralo manjše delovno aktiv- no prebivalstvo podpirati čedalje več starejših, kar bo močno obremenilo gospodarsko uspešnost. Hkrati naraščajoče povpraševanje po javnih zdra- vstvenih storitvah povečuje javne izdatke za zdravstvo, pri čemer največji delež nakopičenih neporavnanih obveznosti nosijo splošne bolnišnice. V tem kontekstu postane ocenjevanje stroškovne učinkovitosti splošnih bolnišnic ključno za zmanjševanje razsipavanja virov. 192 Central European Public Administration Review, Vol. 23, No. 2/2025 Analysis of the Cost Efficiency of Public General Hospitals in Croatia Zasnova/metodologija/pristop: stroškovna učinkovitost je ocenjena z analizo, kako se denarni vložki pretvorijo v vmesne rezultate. Stroškovna učinkovitost 19 hrvaških splošnih bolnišnic je analizirana z najpogoste- je uporabljeno metodo – vhodno usmerjeno analizo ovojnice podatkov (DEA) – v predpandemičnih letih 2015 in 2016 ter v pandemičnih letih 2021 in 2022. Uporabljen je en vhod (skupni izdatki in odhodki splošnih bolnišnic, brez naložb v objekte) in trije izhodi (število bolnišničnih oskrb- nih dni, zasedenost postelj oziroma stolov v dnevnih bolnišnicah ter števi- lo ambulantnih storitev v poliklinično-konzultativni dejavnosti). Ugotovitve: ocene stroškovne učinkovitosti segajo od 48 % do 100 %. Povprečno bi bolnišnice lahko znižale izdatke za 7 % v letu 2015, za 14 % v letih 2016 in 2021 ter za 16 % v letu 2022, ne da bi zmanjšale obstoječe ravni izhodov. Med pandemijo covida-19 se je skupna stroškovna učinko- vitost splošnih bolnišnic poslabšala. Bolnišnici Pula-Pola in Varaždin sta v vseh štirih letih dosledno izstopali kot referenčni (najučinkovitejši) enoti. Nasprotno pa je Vukovar dosegal slabše rezultate, s stroškovno učinkovi- tostjo pod 70 % v celotnem obdobju. Pri večini bolnišnic so relativne uvr- stitve po učinkovitosti ostale stabilne skozi čas – visoko učinkovite pred pandemijo so ostale učinkovite tudi po njej; manj učinkovite so ostale niz- ko uvrščene. Podatki kažejo tudi, da večje bolnišnice, merjeno po izdatkih, praviloma dosegajo boljšo stroškovno učinkovitost. Akademski prispevek k področju: študija prispeva k literaturi z merje- njem stroškovnih neučinkovitosti v splošnih bolnišnicah, ki jih mednaro- dne raziskave zdravstvene ekonomike pogosto spregledajo, zlasti v drža- vah Srednje in Vzhodne Evrope. Identificira vztrajne referenčne primere in neučinkovitosti ter ponuja podatkovno podlago za politične reforme, usmerjene v izboljšanje finančne vzdržnosti in operativne učinkovitosti hrvaškega zdravstvenega sistema. Omejitve raziskave: model vključuje omejen nabor spremenljivk zaradi po- datkovnih omejitev. Vključitev dodatnih kazalnikov, kot so izdatki za zdra- vila ali po primerih uteženi akutni bolnišnični odpusti, bi lahko omogočila bolj niansirano oceno stroškovne učinkovitosti. Ta omejitev poudarja po- trebo po celovitejšem in standardiziranem zbiranju zdravstvenih podatkov na Hrvaškem, zlasti s strani ministrstev za zdravstvo in finance. Praktične implikacije: ugotovitve lahko pomagajo oblikovalcem politik, saj so stroškovno učinkovite splošne bolnišnice ključne za gospodarsko in socialno blaginjo. Referenčne bolnišnice so lahko vzor, delijo dobre prakse upravljanja stroškov in uporabe virov ter s tem pomagajo izbolj- šati stroškovno učinkovitost v celotnem sklopu splošnih bolnišnic. Manj učinkovite bolnišnice naj bodo cilj revizij, managerskega usposabljanja ali podpore pri proračunskem načrtovanju in načrtovanju virov. Poleg tega je študija podlaga za izboljšanje nacionalnih sistemov spremljanja uspešno- sti bolnišnic in standardov poročanja podatkov. Izvirnost/vrednost: gre za prvo študijo, ki je izračunala stroškovno učin- kovitost 19 hrvaških splošnih bolnišnic. Ključne besede: stroškovna učinkovitost, Hrvaška, analiza ovojnice podatkov (DEA), zdravje, javne splošne bolnišnice JEL: H75, I18 Central European Public Administration Review, Vol. 23, No. 2/2025 193 Romario Marijanović, Mihaela Bronić, Simona Prijaković 1 Introduction The Croatian public health system is struggling with financial stability due to two main factors. On the one hand, there is a growing demand for medical services driven by an aging population and the increasing need for expensive treatments and medications. On the other hand, limited public resources are available to support the healthcare system. As a result, the health system con- sistently faces budget deficits. Hospitals (especially general hospitals) are ma- jor contributors to these deficits. For instance, in 2022, 19 general hospitals ac- counted for around 45% of the deficit (total revenues and receipts minus total expenditures and outlays) of all healthcare institutions (MoF, 2025). Further, it must be emphasised that in 2021, 2022, and 2023, all general hospitals faced cumulative deficits, incurred during these years and/or in the periods before 2021 (MoF, 2025). A fiscal sustainability study by Šimović et al. (2021) found that hospitals account for the majority of healthcare debt, with 73% of debt older than 60 days, further indicating deep-rooted financial instability. In 2022, Croatia’s public health expenditure was in line with the EU average, with the EU and Croatia spending 7.7% of their GDP on health (Eurostat, 2025a). The major difference is that, on average, the EU spends (3.2% of GDP) on hospital services and (2.3% of GDP) on outpatient services, while Croatia spends more on hospital services (4.3% of GDP) and less on outpatient ser- vices (1.2% of GDP). In terms of health outcomes, Croatia lags behind most EU countries. In 2023, life expectancy at birth in Croatia was 78.6 years, below the EU average of 81.5 years (Eurostat, 2025b). Additionally, Croatia’s infant mortality rate was 4.1 deaths per 1,000 live births in 2022, which is higher than the EU average of 3.3 (Eurostat, 2025c). Improving health outcomes in Croatia while containing costs requires greater efficiency. That is why one of the main goals of the Croatian National Health Development Plan for 2021 to 2027 is to improve the financial sustainability of the healthcare system. It is stipulated that there is a need to analyse the revenue and expenditure side of healthcare thoroughly and to define specific short-term and long-term steps to bring health financing into balance. The existing system of financing is sustainable neither in the short nor in the long term (Ministry of Health, 2021). There is inevitably a need to find new financ- ing sources and improve cost efficiency of healthcare system. We analysed the cost efficiency of 19 general hospitals in Croatia using an input-oriented DEA model with variable returns to scale. General hospital Si- sak was excluded from the analysis due to the unavailability data for 2021 and 2022 because of the consequences of the earthquake. Also, general hospitals Nova Gradiška and Pakrac were excluded from the analysis due to the unavail- ability of data for 2015 and 2016. In this way, we want to find out which gen- eral hospitals could spend less on expenditures and outlays, maintaining the existing level of output. We calculate the cost efficiency, that is, the efficiency of the transformation of monetary input (total expenditures and outlays of 194 Central European Public Administration Review, Vol. 23, No. 2/2025 Analysis of the Cost Efficiency of Public General Hospitals in Croatia hospitals without investments in building facilities in euro) into intermediate outputs (number of days in hospital treatment for hospital (inpatient) health- care, beds/chairs occupancy rate in the day hospital, and number of services in polyclinic-consultative (outpatient) healthcare). To increase the robustness of the analysis and allow for a better understanding of the impact of the pandem- ic, the analysis includes two years before the pandemic (2015 and 2016), as well as two years during the pandemic (2021 and 2022). Including pre-pandem- ic years allows for a comparison of the performance of hospitals under normal and emergency circumstances and a more precise identification of changes and challenges in resource management during the COVID-19 pandemic, when hospitals were operating under special restrictions and reorganisation. The paper is organised as follows. After the introduction, the literature re- view first defines cost efficiency; and then identifies the results and gaps in existing research on the efficiency of healthcare expenditures in Croatia and abroad. The third section discusses the data and methodology. The fourth section presents the results while the fifth presents the discussion. The paper ends with conclusions and recommendations for future research. 2 Literature Review Public health efficiency is a key concept in evaluating health systems, focusing on how effectively governments utilise resources to achieve optimal health outcomes for their citizens. The goal is to ensure that resources are allocated rationally to achieve the best possible health outcomes within available finan- cial constraints (Yi et al., 2020). Health outcomes reflect the core objectives that policymakers aim to achieve (in terms of mortality rates, standardised death rates from all causes per 1,000 people, life expectancy, etc.). The overall efficiency of public healthcare expenditures measures the ratio of total health expenditures to the health outcomes achieved (Figure 1). Ver- hoeven et al. (2007) argue that overall efficiency can be divided into cost efficiency and system efficiency. Cost efficiency represents the efficiency of converting monetary inputs (total health expenditures) into intermediate outputs (e.g., the number of physicians, pharmacists, healthcare workers, hospital beds, and immunisation vaccines). System efficiency represents how well the intermediate outputs are used to achieve health outcomes (such as life expectancy). Asbu et al. (2020), in their literature review on determinants of hospital ef- ficiency, conclude that hospital efficiency is influenced by internal factors – elements that hospitals can directly manage and change – and external fac- tors, which are outside a hospital’s immediate control and require broader interventions at the health system or cross-sectoral level. Internal factors include size, specialisation, teaching status, case-mix index, bed occupancy rate, outpatient-to-inpatient ratio, etc. External factors include geographic location (related to demand for hospital services), competition, reimburse- ment system, provider incentives, etc. Linna et al. (2010) focused on how Central European Public Administration Review, Vol. 23, No. 2/2025 195 Romario Marijanović, Mihaela Bronić, Simona Prijaković well hospitals manage to achieve desired outcomes within a given budget, analysing hospital care in four Nordic countries on a sample of 184 hospitals. The study confirms that hospitals cannot directly influence the level of de- mand for health services, as they depend on patient referrals, and concludes that deviations in efficiency result from a combination of objective factors (e.g., patient structure) and subjective factors (e.g., management practices). The key takeaway from the literature review is that since hospital efficiency is affected by internal and external factors, there is no universal policy or magic formula that can broadly enhance performance across all hospitals (Asbu et al., 2020). However, we would also argue that the first step involves analysing the efficiency of hospitals to identify which ones are less efficient according to various criteria, followed by further analysis to pinpoint internal factors they could change – such as adjusting outpatient-to-inpatient ratios, staffing issues, or medication procurement practices – to improve the effi- ciency of less efficient hospitals. In that manner, Sheikhzadeh et al. (2012) studied the efficiency of hospitals in Iran, also using DEA, with a particular focus on input variables such as staffing and number of beds, and output variables such as patient discharges and outpatient visits. They concluded that there are significant inefficiencies in resource use and recommended targeted management interventions. Figure 1. The efficiency relationship between health expenditure, resources/ outputs, and outcomes Source: Adapted by authors from Verhoeven et al. (2007). In this paper, we focus on the cost efficiency of 19 general hospitals, as de- fined by Verhoeven et al. (2007), which refers to the efficiency of converting monetary inputs into intermediate outputs. We decided not to investigate the overall efficiency of general hospitals since health outcomes data (e.g., 196 Central European Public Administration Review, Vol. 23, No. 2/2025 Analysis of the Cost Efficiency of Public General Hospitals in Croatia life expectancy) are available only at the county level, where general hospi- tals operate. However, these health outcomes (e.g., life expectancy in one county) are influenced not only by the operations of general hospitals but also by other healthcare facilities in that county (such as healthcare centres, private and public hospitals, and health institutes) as well as behavioural and environmental factors beyond the control of the health system (such as diet, alcohol and tobacco consumption, the proportion of the population over 65 years of age). We have focused exclusively on an analysis of general hospitals; Rabar (2010) focused on the efficiency of all hospitals in Croatia together, but the results of her research make it obvious that different types of hospitals should be di- vided into separate categories. She emphasised the importance of a categori- cal approach in calculating efficiency based on similarities between different types of hospitals. Accordingly, clinical, general and special hospitals should be analysed separately. Linna et al. (2010) also analysed the efficiency of hos- pitals in Finland using DEA, with a focus on cost effectiveness and resource allocation, highlighting the importance of distinguishing hospital types and the impact of patient structure on efficiency results. Seven papers in Croatia analysed the efficiency of the whole healthcare sys- tem or the efficiency of hospitals using DEA methodology. However, cost ef- ficiency, as defined by Verhoeven et al. (2007), was analysed only in two DEA studies regarding the efficiency of the whole Croatian health system (Buljan and Šimović, 2022; Jafarov and Gunnarsson, 2008). The other five studies that we found regarding the efficiency of hospitals in Croatia using DEA method- ology did not analyse cost efficiency. In their analysis, they either did not use healthcare expenditures as inputs (Rabar, 2010, 2013; Blecich et al., 2024) or else did not use healthcare expenditures as the only inputs (Dukić Samaržija et al., 2018; Hodžić et al., 2019). Since we did not find any study on the cost ef- ficiency of hospitals, this is the first time that the cost efficiency of 19 general hospitals is calculated in Croatia. Jafarov and Gunnarsson (2008) evaluated the efficiency of social spending in Croatia and the EU-15, the EU-10, Cyprus, Malta, and OECD countries. They concluded that the inefficiency of the Croatian healthcare system primarily stems from high expenditures, as well as extended hospital stays, elevated drug costs, and minimal levels of private healthcare financing. Buljan and Šimović (2022) analyse the efficiency of the healthcare system in Croatia and compare it with other EU countries in the period 2013-2018. Croatia has the lowest overall efficiency in the EU, with a healthcare expenditure efficiency of only 57% in 2018. Although cost efficiency is high (100%), system efficiency is only 48%, which means that Croatia could achieve the same health outcomes with fewer resources. Three studies on the efficiency of hospitals in Croatia highlight similar issues regarding resource allocation. Rabar (2010; 2013) and Blecich et al. (2024) find inefficiency due to the excess of beds and doctors in some hospitals. Hodžić et al. (2019) carried out research into the efficiency of healthcare ex- Central European Public Administration Review, Vol. 23, No. 2/2025 197 Romario Marijanović, Mihaela Bronić, Simona Prijaković penditures in Croatian counties for the period from 2010 to 2017, arguing that one of the main causes of inefficiency should be sought in better or- ganisation of primary healthcare. Dukić Samaržija et al. (2018) analysed the efficiency of Croatian hospitals, focusing on 28 specific hospitals included in the DRG (Diagnostic-Related Groups) system for the classification of diabetes without comorbidities and complications. According to this study, the main source of inefficiency is the number of days spent in hospitals, which should be decreased. Another reason for inefficiency is also overspending on drugs and materials, which should also be reduced. For measuring the efficiency of health services as an input variable, authors often use health expenditures, health expenditures per capita, or health ex- penditures as % GDP (Buljan and Šimović, 2022). There are several reasons in the literature why healthcare expenditures are used as an input variable. First, they represent costs that hospital management can control, which leads to more efficient financial management. The second reason is that expenditures are used to describe the economic burden. Expenditure analysis helps to as- sess government spending and shows where costs can be reduced, enabling higher efficiency (Jafarov and Gunnarsson, 2008; Slijepčević, 2019; Azreena et al., 2018; Yi et al., 2020; Wu, 2023; Hodžić et al., 2019). Andrews and Emvalomatis (2024) note that measuring actual health out- comes is difficult due to limited data and high costs. As a result, research- ers frequently rely on proxy indicators instead. Common outcome proxies include the number of inpatient episodes, outpatient visits, and the length of hospital stays. To better reflect both case complexity and severity in assess- ing healthcare output, studies commonly use inpatient days. This approach aims to capture the intensity of care and resource usage, with longer stays generally indicating more complex or severe cases. An excellent overview of variables and models used for efficiency measurement in healthcare can be found in Andrews and Emvalomatis (2024). They argue that there is a consid- erable variation in the use of inputs, outputs, and price variables in interna- tional studies, suggesting that the use of variables in healthcare productivity and efficiency literature rests on the balance between data availability and the research scope. In addition, Kruse et al. (2018) also conducted a system- atic review of hospital efficiency studies at the EU level, identifying the wide range of used methodologies and variables, and highlighting the challeng- es of comparing efficiency across different healthcare systems. The output healthcare variables used in the previous cost efficiency DEA analysis of the Croatian healthcare system varied. Buljan and Šimović (2022) regarding the efficiency of the whole Croatian health system used the number of available hospital beds, the number of CT and MR scanners, and the number of doc- tors. Jafarov and Gunnarsson (2008) used the number of available hospital beds, the density of physicians, pharmacists, and healthcare workers, and the number of immunisation vaccines. As output, Dukić Samaržija et al. (2018) used the number of cases/discharges (a performance indicator that measures hospital activity relevant for DRG payments, given that it is an activity-based reimbursement system). Hodžić et al. (2019), used as outputs the number 198 Central European Public Administration Review, Vol. 23, No. 2/2025 Analysis of the Cost Efficiency of Public General Hospitals in Croatia of examinations, the number of patients per bed, and the vital index. Rabar (2010) used as outputs the number of hospital treatment cases and days of hospital treatment. 3 Data and Methodology According to the Law on Health Care (2024), Croatia’s healthcare system is structured into four levels: primary, secondary, and tertiary care, as well as health institutes. Primary healthcare is primarily provided through healthcare centres, where patients receive basic check-ups, consultations, and treatment for minor health issues. Secondary healthcare is offered through general and specialised hospitals and specialist consultations. General hospitals provide a broad range of services, including surgery, internal medicine, paediatrics, gynaecology and obstetrics, while ensuring patient accommodation and nu- trition. Specialised hospitals focus on specific diseases or age groups, offer- ing specialist consultations and hospital treatment, and also providing patient accommodation and nutrition. Specialist-consulting services involve complex medical procedures and diagnostic services, which are performed in policlin- ics, day hospitals, and healthcare centres (they do not include accommoda- tion). Tertiary healthcare is delivered by clinics, clinical hospitals, and clinical hospital centres, which handle the most complex medical cases, offer a wide range of services, and often engage in higher education and scientific re- search. Health institutes include state health institutes (such as the Croatian Institute of Public Health and the Croatian Institute of Emergency Medicine), public health institutes of regional self-government units, and emergency medicine institutes of regional self-government units. Until January 1, 2024, general hospitals were established by regional self-gov- ernment units, such as the City of Zagreb or Split-Dalmatia County (with the exception of the general hospital in Vukovar, which was founded by the Re- public of Croatia). However, starting January 1, 2024, the Republic of Croatia became the founder of all general hospitals, as outlined in the Law on Amend- ments to the Law on Health Care (2023). Many authors use the deterministic non-parametric frontier method – Data Envelopment Analysis (DEA) to assess the cost efficiency of public hospitals (Andrews and Emvalomatis, 2024). By calculating the cost efficiency, it is pos- sible to determine how well a hospital uses its resources to get the best pos- sible health outputs/outcomes. Each hospital is a decision-making unit (DMU), i.e., the object under evaluation is a member of a group that produces compa- rable results using comparable inputs. DEA determines the efficiency limit of 1, limiting input from below and outputs from above. Inefficient DMUs should aim for the efficiency limit, and every deviation from the frontier (efficiency score less than 1) is considered inefficient. DEA analy- sis, in addition to providing an evaluation of the efficiency of the observed units, also identifies examples of best practices that can serve as examples for improving inefficient units (Buljan and Šimović, 2022). Efficiency is meas- Central European Public Administration Review, Vol. 23, No. 2/2025 199 Romario Marijanović, Mihaela Bronić, Simona Prijaković ured by the ratio of output to input, where input represents the resources used in the production process, and output is the results that are achieved using these inputs. The advantages and, at the same time, the reasons for the popularity of the DEA method are that it enables the simultaneous analysis of a number of different inputs and outputs without prior assumptions about the functional form of their connection. Input and output data are used to form the efficiency frontier as a linear combination of the best units in the sample. The best units are those that achieve the highest output with a given input level or use the smallest combination of inputs to achieve a given out- put level. Then, efficiency indicators are calculated based on the distance of each individual unit from the efficiency frontier. Efficient units located at the efficiency frontier are assigned the highest indicator value of 1, while for oth- er units located below the efficiency frontier, the indicator value is between 0 and 1. The efficiency indicator represents the room for efficiency improve- ment, i.e. the maximum value by which a unit could increase its outputs with given inputs or reduce its inputs with a constant output value. The efficiency indicators of the input-oriented DEA analysis show how much inputs could be reduced proportionally without compromising the achieved outputs. The most commonly used models in the DEA analysis are (1) the Charnes, Cooper and Rhodes (1978) model, which assumes that the production function shows a constant return to scale (CCR model), and (2) the Banker, Charnes and Cooper (1984) model which assumes a variable return to scale (BCC model). For choosing the orientation of the model, one should take into account whether the unit has a greater influence on inputs or on outputs. Since healthcare decision makers have more control over inputs than outputs, we have chosen the input-oriented DEA model which is confirmed by inter- national literature (Zubir et al., 2024). Variable return to scale assumes that a proportional increase in input results in a more or less proportional output in- crease. This BCC model has been chosen because the health sector operates in conditions of imperfect competition and has limited budgets and regula- tory constraints (Buljan and Šimović, 2022). The formulation of the model is: 𝑚𝑚 max 𝜃𝜃 =∑𝑢𝑢𝑗𝑗𝑦𝑦𝑗𝑗0 + 𝑢𝑢0 𝑗𝑗=1 𝑠𝑠 ∑𝑣𝑣𝑖𝑖𝑥𝑥𝑖𝑖0 = 1 𝑚𝑚 𝑖𝑖=1 𝑠𝑠 ∑𝑢𝑢𝑗𝑗𝑦𝑦𝑗𝑗𝑗𝑗 −∑𝑣𝑣𝑖𝑖𝑥𝑥𝑖𝑖𝑗𝑗 + 𝑢𝑢0 ≤ 0 𝑗𝑗=1 𝑖𝑖=1 𝑣𝑣𝑖𝑖 ≥ 0; 𝑢𝑢𝑗𝑗 ≥ 0. The given model is used to obtain the value of efficiency Θj, the optimal input vi and the optimal output ui. 200 Central European Public Administration Review, Vol. 23, No. 2/2025 Analysis of the Cost Efficiency of Public General Hospitals in Croatia Most important in the DEA analysis is the selection of inputs and outputs, which significantly influence the results. Thus, it is recommended that only fundamental inputs and outputs be used (Blecich et al., 2024). To calculate the cost efficiency of hospitals in Croatia, as outputs, we gathered data for four years – 2015, 2016, 2021 and 2022 – for 19 hospitals from the State Au- dit Office reports. Specifically, we used data from the Reports on the Com- pleted Audit for 2016 (which includes data for 2015 and 2016), and Reports on the Completed Audit for 2022 (which includes data for 2021 and 2022). As an input variable, we used data for the 2015, 2016, 2021 and 2022 from the Ministry of Finance on total expenditures and outlays without investments in building facilities, calculated in mil. euro (Graph 1). Since, for e.g., the hospital in Bjelovar in 2021 spent around 20 mil. euro for construction objects, we excluded expenditures for investments in building facilities for all analysed hospitals. A similar input variable is used in many other research projects (e.g., Buljan and Šimović, 2022; Hodžić et al., 2019). Graph 1. Total expenditures and outlays without investments in building facilities for 19 general hospitals, 2015, 2016, 2021, and 2022 (in mil. €) 90 80 70 60 50 40 30 20 10 0 2015 2016 2021 2022 Source: Authors. Each general hospital performs three types of activities: hospital healthcare (where patients are treated and stay in the hospital for longer periods), day hospital (where patients come to the hospital for a day) and polyclinic-consul- tative healthcare (where patients come to the hospital to do consultative and diagnostic examinations). As output variables, we decided to use: the number of days in hospital treatments for hospital healthcare (as in e.g., Rabar, 2010; Central European Public Administration Review, Vol. 23, No. 2/2025 201 Romario Marijanović, Mihaela Bronić, Simona Prijaković Dukić Samaržija et al., 2018; Blecich et al., 2024), the average beds/chairs oc- cupancy rate in day hospital (similarly to e.g., Hodžić et al., 2019), and the number of polyclinic-consultative services provided (similarly to e.g., Dukić Samaržija et al., 2018; Hodžić et al., 2019; Rabar, 2010). For outputs, we used data from Financial Audit Reports from the State Audit Office for general hos- pitals for 2015, 2016, 2021 and 2022, because that was the only source where we could find output variables for all three types of hospital activities. For more information about the variables used, see Table 1. We did not include the number of beds or doctors in hospitals as an output in- dicator because Rabar (2010; 2013) and Blecich et al. (2024) find inefficiency due to excess of beds and doctors in some Croatian hospitals. Also, Imani et al. (2022) concluded that hospitals with higher bed numbers have lower ef- ficiency than other hospitals. In addition, we do not think that a hospital is efficient if it has more beds, but for efficiency, it is more important that the existing beds are used. Thus, we use as output indicator the average bed oc- cupancy rate in a hospital (like Azreena et al., 2018; Nwagbara et al., 2016; Vrabková and Lee, 2023; Yi et al., 2020). Table 1. Definition of variables for each general hospital Variable Definition and measurement Source Input Total expenditures and outlays without Expenditures x1j investments in building facilities. Based on data MoF (2025) from a hospital’s financial reports (in million €). Outputs The number of days of hospital treatment in Days y1j hospital healthcare (in 000). State Audit The beds/chairs occupancy rate in the day Beds y2j Office (2018; hospital (in %). 2024) The number of services in polyclinic-consultative Services y3j healthcare (in 000). Source: Authors. 4 Results The correlation matrix for all variables in all years 2015, 2016, 2021 and 2022 are presented in Table 2, and it can be concluded that there is no high cor- relation between variables. To reduce computations and increase efficiency discrimination among DMUs, according to Sean et al. (2005), if there is a cor- relation between two variables higher than 0.9, one of the variables can be excluded. We tested the variable number of doctors and it was highly cor- related with expenditures, thus for this reason, it is also excluded from the 202 Central European Public Administration Review, Vol. 23, No. 2/2025 Analysis of the Cost Efficiency of Public General Hospitals in Croatia analysis, even though it has been used in many research projects (e.g., Buljan and Šimović, 2022; Hodžić et al., 2019; Rabar, 2010). All data used are pre- sented in Table A1 in the Appendix. Table 2. Correlation matrix Expenditures Days Beds Services Expenditures 1 Days 0.63 1 Beds 0.48 0.34 1 Services 0.73 0.58 0.45 1 Source: Authors. The descriptive statistics is in Table 3 for all four years and reveal significant differences in all values of the variables. Hospital Varaždin has the highest to- tal expenditures and outlays (82.7 mil. euro) and the highest number of days in treatment (275.2 th.). In contrast, hospital Pula-Pola has the highest num- ber of services provided (2,945.8 th.), while hospital Slavonski Brod has the highest beds/chairs occupancy rate for day hospitals (239%). Hospital Knin reports the lowest expenditures and outlays (6.7 mil. euro) and the lowest number of services provided (146.2 th.). Finally, hospital Gospić has the low- est number of days in treatment (16.1 th.), while hospital Vukovar has the lowest beds/chairs occupancy rate in a day hospital (16%). Table 3. Descriptive statistics for the variables of each general hospital Variables Minimum Median Mean Maximum Standard deviation Input Expenditures 6.7 27.0 31.1 82.7 18.3 Outputs Days 16.1 68.3 75.2 275.2 49.1 Beds 15.8 83.6 85.7 238.6 37.6 Services 146.2 1,047.0 1,153.8 2,945.8 620.2 Source: Authors. Analysis of cost and super efficiency conducted using the input-oriented DEA method with a variable return to scale for the years 2015, 2016, 2021 and 2022, are presented in Tables 4 and 5. In our study, the efficiency frontier includes hospitals that can achieve the best possible health outcomes with the least amount of resources (total expenditures and outlays). After calculat- ing cost efficiency, we also calculate super efficiency to rank all cost efficient Central European Public Administration Review, Vol. 23, No. 2/2025 203 Romario Marijanović, Mihaela Bronić, Simona Prijaković general hospitals (score of 1). General hospitals with super efficiency infinity are the benchmarks. Cost efficiency was higher in the COVID-19 pre-pandemic period than in the pandemic period (Tables 4 and 5). Like other authors we observe during pan- demic cost efficiency decreased (e.g., Hamdollahzadeh et al., 2024). This was probably because hospitals were operating under special restrictions and re- organisation which increased costs in general hospitals. However, the level of cost efficiency did not change significantly during the observed period for most of the general hospitals analysed. General hospitals that were most efficient before the pandemic (Pula-Pola and Varaždin) continued to be the most efficient during the pandemic. Similarly, those general hospitals that were least efficient before the pandemic (like Dubrovnik and Vukovar) also remained the least efficient afterward. Comparing our results with the study by Blatnik et al. (2017), which analysed the technical, cost, and allocative ef- ficiency of 12 Slovenian general hospitals from 2005 to 2014 using the DEA method, we observe a similar pattern. That study also emphasised that ef- ficiency did not change significantly over the years: hospitals that were inef- ficient initially remained so for the next nine years, while efficient hospitals maintained their status. According to our findings, cost efficiency among Croatian general hospitals varies considerably, with only 7 or 8 out of 19 general hospitals achieving full efficiency (score of 1) each year, while the remaining general hospitals are inefficient. On average, the efficiency score is 0.93 (or 93%) in 2015, 0.86 (or 86%) in both 2016 and 2021, and 0.84 (or 84%) in 2022, indicating that on average general hospitals could maintain the same output level while reduc- ing their input by 7%, 14% or 16%, respectively. The cost efficiency of general hospitals ranges from 48% to 100%. Our findings (see Figure 2, and Tables 4 and 5) show that the following hospi- tals were cost-efficient (cost efficiency = 1) in all analysed years: Knin, Našice, Pula-Pola, and Varaždin. Požega and Zadar were cost-efficient in 2022. Gospić was cost-efficient in 2015, 2016, and 2021; Šibenik-Knin in 2015 and 2021; Ogulin in 2015; Virovitica in 2015 and 2016; Zabok in 2016, 2021, and 2022; and Slavonski Brod in 2021 and 2022. 204 Central European Public Administration Review, Vol. 23, No. 2/2025 Analysis of the Cost Efficiency of Public General Hospitals in Croatia Table 4. Cost efficiency and super efficiency results and rankings for the 19 Croatian general hospitals, ranked by highest efficiency score in 2016 2015 2016 General hospital Cost Super Cost Super Rank Rank efficiency efficiency efficiency efficiency Pula - Pola 1 Benchmark 1. 1 Benchmark 1. Varaždin 1 Benchmark 1. 1 Benchmark 1. Knin 1 1.2821 3. 1 1.5080 2. Gospić 1 2.1439 2. 1 1.2724 3. Zabok 0.9778 0.9778 9. 1 1.1520 4. Virovitica 1 1.1146 4. 1 1.0481 5. Našice 1 1.1092 6. 1 1.0363 6. Ogulin 1 1.1135 5. 0.9756 0.9756 7. Čakovec 0.9738 0.9738 10. 0.9045 0.9045 8. Šibenik-Knin 1 1.0073 7. 0.8927 0.8927 9. Bjelovar 0.8056 0.8056 15. 0.8778 0.8778 10. Slavonski Brod 0.9406 0.9406 12. 0.8442 0.8442 11. Vinkovci 0.9449 0.9449 11. 0.8417 0.8417 12. Požega 0.9097 0.9097 13. 0.7421 0.7421 13. Koprivnica 0.7248 0.7248 17. 0.7393 0.7393 14. Zadar 0.8829 0.8829 14. 0.6389 0.6389 15. Dubrovnik 0.9821 0.9821 8. 0.6325 0.6325 16. Vukovar 0.6725 0.6725 18. 0.6282 0.6282 17. Karlovac 0.7919 0.7919 16. 0.6212 0.6212 18. Average 0.9267 - - 0.8599 - - Source: Authors. Central European Public Administration Review, Vol. 23, No. 2/2025 205 Romario Marijanović, Mihaela Bronić, Simona Prijaković Table 5. Cost efficiency and super efficiency results and rankings for the 19 Croatian general hospitals, ranked by highest efficiency score in 2022 2021 2022 General hospital Cost Super Cost Super Rank Rank efficiency efficiency efficiency efficiency Pula - Pola 1 Benchmark 1. 1 Benchmark 1. Slavonski Brod 1 Benchmark 1. 1 Benchmark 1. Varaždin 1 Benchmark 1. 1 Benchmark 1. Zabok 1 1.8504 3. 1 1.9552 2. Knin 1 1.7257 4. 1 1.8250 3. Našice 1 1.1507 5. 1 1.1619 4. Požega 0.6249 0.6249 14. 1 1.1503 5. Zadar 0.8476 0.8476 9. 1 1.0005 6. Čakovec 0.9212 0.9212 7. 0.9607 0.9607 7. Gospić 1 1.9437 2. 0.9193 0.9193 8. Ogulin 0.9455 0.9455 6. 0.9001 0.9001 9. Karlovac 0.8647 0.8647 8. 0.7972 0.7972 10. Virovitica 0.7828 0.7828 12. 0.7412 0.7412 11. Vinkovci 0.7897 0.7897 11. 0.7118 0.7118 12. Koprivnica 0.8029 0.8029 10. 0.7096 0.7096 13. Bjelovar 0.7553 0.7553 13. 0.6779 0.6779 14. Šibenik-Knin 1 Benchmark 1. 0.5664 0.5664 15. Vukovar 0.4958 0.4958 16. 0.5397 0.5397 16. Dubrovnik 0.5836 0.5836 15. 0.4810 0.4810 17. Average 0.8639 - - 0.8424 - - Source: Authors. Notably, Gospić, Knin, Našice, and Ogulin consistently lie near the frontier’s origin – indicating they operate with relatively low input and output levels (Table A1 in Appendix). Their proximity to the origin signals input minimisa- tion, though it doesn’t necessarily reflect optimal output quality or quantity. Rather, from an efficiency standpoint, these general hospitals are making ef- fective use of limited resources. In contrast, hospital Pula-Pola stands higher on the efficiency frontier, indicat- ing that it is performing well relative to its peers – achieving relatively high outputs with its inputs. Similarly, hospital Varaždin is positioned very high and close to the efficiency frontier, indicating that it is also among the top per- formers in terms of converting inputs into outputs. However, it should be not- ed that this positioning reflects relative performance within the sample, not absolute optimisation. DEA evaluates a hospital’s performance against other 206 Central European Public Administration Review, Vol. 23, No. 2/2025 Analysis of the Cost Efficiency of Public General Hospitals in Croatia hospitals rather than against a theoretical maximum (Jorge et al., 2006), i.e., efficiency is determined based on how well a hospital performs compared to its peers using the same set of resources. Figure 2. Cost efficiency for 19 general hospitals in 2015, 2016, 2021 and 2022, ranked by highest efficiency score in 2022 Pula - Pola Dubrovnik 1 Slavonski Brod Vukovar 0.8 Varaždin Šibenik-Knin 0.6 Zabok 0.4 Bjelovar 0.2 Knin 2015 0 2016 Koprivnica Našice 2021 2022 Vinkovci Požega Virovitica Zadar Karlovac Čakovec Ogulin Gospić Source: Authors. Figure 2 also presents cost efficiency for 19 general hospitals. General hospi- tals mostly achieve the same (in)efficiency scores in all years, except for some. Hospitals Dubrovnik, Zadar, Karlovac, and Požega exhibit the most differences in inefficiency scores between the two years – 2015 and 2016. For example, the decrease in the efficiency of hospital Dubrovnik from 98% in 2015 to 63% in 2016 was due to an increase of 1.4 mil. euro of expenditures and outlays in 2016, and simultaneously a lower number of services and days in treatment while beds/chairs occupancy rate were higher. The decrease in the efficiency of hospital Zadar from 88% in 2015 to 64% in 2016 was due to an increase of 1.9 mil. euro of expenditures and outlays in 2016, and simultaneously a lower number of services and days in treatment, while beds/chairs occupancy rate were higher. Hospitals Šibenik-Knin, Požega, and Zadar exhibit the most dif- ferences in inefficiency scores between the two years – 2021 and 2022. For example, a decrease in cost efficiency of hospital Šibenik-Knin from 100% in 2021 to 57% 2022 occurred because expenditures and outlays increased by 3.2 mil. euro while days in treatment and the number of services declined (beds/chairs occupancy rate remained the same). To rank all cost efficient general hospitals, we calculated super efficiency for observable years (Tables 4 and 5). General hospitals with super efficiency Central European Public Administration Review, Vol. 23, No. 2/2025 207 Romario Marijanović, Mihaela Bronić, Simona Prijaković score of infinity are unique in their characteristics, and there is no similar gen- eral hospital that could serve as a reference sample for them. Those hospitals are considered benchmark (best practice) general hospitals, and they all share rank 1. The benchmark hospitals operate at the frontier of efficiency, mean- ing they use the least amount of input to produce the most output. These benchmarks could serve as standards, showing how less efficient general hospitals can improve by mimicking their practices. Hospitals Pula-Pola and Varaždin were benchmark institutions in 2015 and 2016. In 2021 the bench- mark institutions were Pula-Pola, Varaždin, Slavonski Brod, and Šibenik-Knin, while in 2022 only Pula-Pola, Varaždin, and Slavonski Brod were so rated. Hos- pital Pula-Pola had the highest number of services provided in 2015 and 2016, and Šibenik-Knin in 2021. Hospital Slavonski Brod had the highest beds/chairs occupancy rate in 2022, while hospital Varaždin recorded the highest expen- ditures and outlays in both 2021 and 2022, as well as the number of days in treatment throughout all observing years. 5 Discussion This study adds to the literature by measuring cost inefficiencies in Croatian general hospitals. It identifies persistent benchmarks and inefficient gen- eral hospitals, offering a data-driven foundation for policy reforms aimed at enhancing financial sustainability in Croatia’s healthcare system. It is impor- tant to notice that benchmark general hospitals (the most efficient ones) in each year are the largest general hospitals (in terms of expenditures) (except Slavonski Brod in 2015, Dubrovnik in 2021, and Zadar in 2021 and 2022) (Table A1 in Appendix). In addition, benchmark general hospitals on average in the analysed four years had much lower total due liabilities in total expenditures (12.4%) than low efficiency general hospitals (36.8%) (Table A1). This might be due to economies of scope and/or scale. Economies of scope refer to cost advantages gained by producing a variety of products using shared resources, while economies of scale refer to cost advantages gained by increasing pro- duction of a single product. Lindaas et al. (2025) show that general hospitals producing a diversified mix of services typically achieve greater cost efficiency through joint production of services (economies of scope). Furthermore, liter- ature on hospital economies of scale confirms that larger hospitals – particu- larly those with 200-300 beds – often operate at an optimal scale, benefiting from cost efficiencies unavailable to smaller hospitals (Giancotti et al., 2017). Interestingly on the other hand, some general hospitals reported the low- est expenditures (below 16 mil. euros), yet were still classified as efficient (cost efficiency = 1), but not as benchmark hospitals. Našice and Knin in all four years, Gospić in 2015, 2016 and 2021, and Ogulin in 2015. This may in- dicate effective resource management and operational efficiency in these facilities, despite limited financial resources. Smaller general hospitals could be more efficient due to simpler organisational structures and lower costs. Their limited scope of services enables more targeted resource allocation, re- sulting in reduced expenditures while still ensuring adequate service delivery. 208 Central European Public Administration Review, Vol. 23, No. 2/2025 Analysis of the Cost Efficiency of Public General Hospitals in Croatia However, smaller general hospitals often lack access to the latest technol- ogy, leading specialists, or the ability to perform complex interventions, so their efficiency should be assessed in relation to the scope and complexity of the services they provide. In Slovenia, DEA results showed that medium and relatively small general hospitals, such as Brežice and Trbovlje, consist- ently scored at or near full technical and cost efficiency, in contrast to large university hospitals which underperformed (Blatnik et al., 2017). In Slovakia, a regional DEA window analysis also suggested that regions with fewer beds and less advanced technological infrastructure often achieved higher health- care technical efficiency scores, implying that smaller-scale operations with simpler input structures can sometimes outperform more complex systems (Vaňková and Vrabková, 2022; Stefko et al., 2018). The least efficient general hospital in all years of our analysis was Vukovar (cost efficiency score below 70%). Similarly, Dubrovnik had a cost efficiency score below 70% in all years except in 2015. According to Pecoraro et al. (2021), such differences can be a consequence of poor management, such as planning and local organisation of health. Thus, these two general hospitals should be prioritised as the best candidates for further cost efficiency analysis. Looking at the broader picture, one of the most striking observations from this cost efficiency analysis is the recurrent deficit faced by all general hospi- tals in Croatia. This raises important questions about their financial sustain- ability. Similar problems exist in other Central and Eastern European (CEE) countries like Poland where in 2018 a majority of county hospitals (55.3%) re- ported a gross financial loss, and nearly half (48.5%) faced overdue liabilities (Dubas-Jakóbczyk et al., 2020). How is it possible that almost all Croatian general hospitals continue to op- erate in deficit year after year; i.e. why general hospitals cannot cover their expenditures with their revenues and why do they create overdue liabilities? How to reduce deficits without compromising the achieved outputs? It is al- ready mentioned that hospital efficiency is affected by internal and external factors and that there is no universal policy or magic formula that can broadly enhance performance across all hospitals (Asbu et al., 2020). However, the first step involves analysing the efficiency of hospitals to identify which ones are less efficient according to various criteria, followed by further analysis to pinpoint internal factors they could change – such as adjusting outpatient- to-inpatient ratios, staffing issues, or medication procurement practices – to improve the efficiency of less efficient hospitals. Literature review points out that Croatian general hospitals face deficits be- cause of problems relating to their revenues and expenditures. On the rev- enue side, the DRGs, which determine the pricing for services provided by general hospitals, appear to be set too low (Horvat, 2024). If the current DRG prices do not adequately cover the costs of services, they need to be reevalu- ated and increased. Insufficient reimbursement for the services rendered by general hospitals contributes to their financial struggles and inefficiencies. This is an external factor that influences hospital efficiency, which lies outside Central European Public Administration Review, Vol. 23, No. 2/2025 209 Romario Marijanović, Mihaela Bronić, Simona Prijaković a general hospital’s immediate control and requires broader interventions at the health system or cross-sectoral level (responsibility of the Ministry of Health and Government). Research by Kalanj et al. (2021) confirmed that the introduction of DRG-based hospital financing in Croatia during 2009-2018 did not significantly improve hospital cost efficiency. Despite reductions in the av- erage length of stay, number of beds, and hospitalisations, the average cost per DRG-weighted case increased by 17%. Research shows that many other CEE countries face significant financial challenges due to the debts accumu- lated by public hospitals, and one of the key contributing factors is the inad- equate pricing of public hospital services, which is often set below the actual cost of providing care (Jovanović, 2020; Dubas-Jakóbczyk and Kozieł, 2020). On the expenditure side, as already mentioned, less efficient general hospi- tals (such as Dubrovnik and Vukovar) should be prioritised for further analysis to identify specific causes of inefficiency. Some of these causes of inefficien- cy are elements that general hospitals can manage and change directly. For example, as the major share of general hospital expenditures and outlays is directed towards employee costs and materials, further research should be conducted to explore the impact of these expenditures and outlays on gener- al hospital cost efficiency. In both 2021 and 2022, 19 general hospitals in Cro- atia allocated an average of around 60% of their total expenditures and out- lays to employee costs and 20% to materials costs (e.g., medicines, food for patients, medical consumables) (MoF, 2025). For example, in 2021 and 2022 the general hospital in Dubrovnik spent more on material costs than the aver- age for all general hospitals, and the general hospital Vukovar spent more on employee costs than the average for all general hospitals. Understanding the specific allocation of these costs can guide targeted interventions to reduce inefficiencies in the most impactful areas. Also, there may be an excess of doctors in certain hospitals, which contributes to higher personnel costs with- out necessarily improving service delivery, as argued by Rabar (2010; 2013) and Blecich et al. (2024). Additionally, some Croatian doctors may be splitting their working time between public and private healthcare sectors, reducing their effective working hours in public general hospitals. If this is the case, the system may need to consider policies similar to those in Slovenia, where doc- tors are prohibited from working in private hospitals while employed in the public sector. Alternatively, a system could be implemented to ensure that doctors are only compensated for the hours they spend working in public hospitals, thus preventing the misuse of public funds. The high expenditure on materials raises questions about potential inefficiencies in medication use. The same is argued by Jafarov and Gunnarsson (2008) and Dukić Samaržija et al. (2018). Are (expensive) medications being used unnecessarily? Bubaš (2022) analysed the Croatian hospital system from 2015 to 2022 and, on the example of clinical hospital centres, showed that almost all outstanding liabil- ities were attributed to material expenses, specifically, unpaid medicines and medical supplies. The State Audit Office (2024) argues that numerous general hospitals have problems with transparent tracking of medication consump- tion and public procurement practices. Inefficiencies in these areas could be a major contributor to the financial deficits experienced by general hospitals. 210 Central European Public Administration Review, Vol. 23, No. 2/2025 Analysis of the Cost Efficiency of Public General Hospitals in Croatia Similarly, Dubas-Jakóbczyk et al. (2020), argue that in Poland, the financial instability and indebtedness of public hospitals result from a complex inter- play of external and internal factors. At the external level, contributing issues include insufficient funding mechanisms, inadequate tariff structures, weak governance of the hospital sector, oversized and inefficient infrastructure, centrally regulated salary increases for medical staff, and a lack of compre- hensive health needs assessments. At the internal level, factors such as poor financial and managerial practices – particularly in cost containment, weak oversight by hospital owners, and aging infrastructure requiring capital in- vestment – further exacerbate financial difficulties. The same authors point to significant variation in financial performance across hospitals, with both highly indebted and financially stable institutions coexisting, underscoring the importance of these individual, hospital-specific factors. A recent scoping review of hospital financial performance in Europe, Dubas-Jakóbczyk et al. (2025), also found that public hospitals in many CEE countries (including Croa- tia) consistently run deficits and accumulate debts, particularly for pharma- ceutical and medical products and personnel costs. These deficits are often attributed to weak management accountability and lack of staff cost control. Taken together, these findings show that public hospitals across the region – not only in Croatia – frequently operate under chronic financial strain, ac- cumulating arrears despite ongoing reform efforts. Our study complements existing research from CEE, where public hospital in- efficiencies, debts and overdue liabilities are a widespread concern, especially due to misalignment between service costs and reimbursement, and poor cost control in areas such as pharmaceuticals and staffing (e.g., Dubas-Jakób- czyk et al., 2025). However, unlike most previous studies, our analysis offers a detailed hospital-level comparison based on cost efficiency scores. This allows us to propose concrete, evidence-based strategies for cost optimisation and better alignment between resources and services for each general hospital. In doing so, our research contributes a novel, data-driven approach to under- standing and improving hospital cost efficiency in Croatia and potentially in similar CEE health systems. 6 Conclusion This study addresses a critical challenge facing Croatia’s healthcare system, mounting financial obligations in general hospitals. The central question was whether cost efficiency of general hospitals – measured through input-orient- ed DEA – can reveal opportunities for reducing expenditures without com- promising healthcare outputs. This is the first time that the cost efficiency of 19 Croatian general hospitals has been calculated. Using the input-oriented BCC DEA model, we evaluated 19 general hospitals across two pre-pandemic years (2015-2016) and two pan- demic years (2021-2022). Cost efficiency scores ranged from 48% to 100%. On average, the efficiency score is 0.93 (or 93%) in 2015, 0.86 (or 86%) in both 2016 and 2021, and 0.84 (or 84%) in 2022, indicating that on average general Central European Public Administration Review, Vol. 23, No. 2/2025 211 Romario Marijanović, Mihaela Bronić, Simona Prijaković hospitals could maintain the same output level while reducing their input by 7%, 14% or 16%, respectively. Though overall efficiency declined during COV- ID-19 – likely due to operational disruptions – individual hospital performance remained largely consistent. Pula-Pola and Varaždin emerged as persistent benchmarks, while Vukovar consistently scored below 70%. Moreover, larger hospitals – measured by total expenditures – consistently demonstrate high- er cost efficiency when compared to their peers. Also, in the analysed four years benchmark general hospitals (with higher cost efficiency) on average had much lower total due liabilities in total expenditures (12.4%) than low efficiency general hospitals (36.8%). Our study demonstrates that cost-efficiency assessment can pinpoint both high-performers and underperformers, offering a roadmap for targeted managerial and policy reforms. While no universal efficiency solution exists, because general hospital efficiency is influenced by internal and external fac- tors, Croatia’s general hospitals can benefit from data-driven identification of inefficient hospitals and strategic efforts to emulate top performers. By adopting practices from benchmark general hospitals, less efficient general hospitals could achieve substantial cost savings without reducing service lev- els. This aligns with national and international findings that emphasise the need for continuous performance monitoring and the dissemination of best practices for resource use and general hospital management. Our research underscores the existence of cost inefficiencies within Croatia’s general hospitals and highlights the potential for substantial cost savings. If a hospital has low cost efficiency, it may indicate operational issues. Thus, further analysis, especially in less efficient hospitals, can guide decisions like reallocating staff or reducing bed numbers. In the future, it would be very in- teresting to further analyse the least cost effective general hospital (Vukovar) and explore the impact of employees and materials costs on general hospital cost efficiency. It would also be interesting to find out why the largest general hospitals are usually the most cost efficient ones (benchmarks). Our findings have direct implications for public administration and hospital governance. Based on the results, decision-makers in the health sector, such as the Ministry of Health, hospital founders, and financing bodies, could in- troduce regular performance monitoring, adjust hospital payment models (e.g., DRG pricing), analyse and improve staffing efficiency, and strengthen cost control in key spending categories like pharmaceuticals and materials. Additionally, more systematic use of financial and audit reports could support evidence-based management decisions. Recent research highlights that poli- ticians and public managers in Croatia, including those in healthcare, often consult public sector financial reports; however, these are still underutilised as primary tools for decision-making (Barbieri et al., 2025). Greater reliance on such reports could support more effective management and cost efficiency in public hospitals. By applying these measures, public administration can sup- port the long-term financial sustainability and operational efficiency of Croa- tian general hospitals. 212 Central European Public Administration Review, Vol. 23, No. 2/2025 Analysis of the Cost Efficiency of Public General Hospitals in Croatia The major limitation of this paper’s analysis is that we used the inputs and outputs that were accessible to us, but other inputs and outputs might bet- ter reflect the efficiency of public general hospitals (e.g., pharmaceutical costs – how much medication has been spent in each general hospital or case-weighted inpatient discharges). Thus, this is only the first step in the cost efficiency analysis of Croatia’s general hospitals. Unfortunately, from the currently available data, it was not possible to find out the structure of general hospitals’ materials costs (how much was separately spent on medi- cines, food for patients, and medical consumables). Thus, there is a need for the Ministries of Health and Finance to produce more detailed data regard- ing the functioning of public general hospitals. Improving the availability and granularity of hospital-level data – especially on pharmaceutical and material costs – would not only enhance national performance monitoring, but also facilitate international benchmarking and research collaboration. This would enable comparative studies using harmonised indicators and DEA method- ologies that could situate the Croatian general hospital’s performance within an international framework. Funded by the European Union–NextGenerationEU. Views and opinions expressed are however those of the authors only and do not necessarily reflect those of the European Union or the European Commission. Neither the European Union nor the European Commission can be held responsible for them. The use of AI (Artifical Inteligence) model: The authors acknowledge the use of OpenAI. (2025). 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Data on used variables on 19 general hospitals in Croatia during years 2015, 2016, 2021 and 2022 General Expenditures Due liabilities in total Days Beds Services Cost Year hospital (in mil. €) expenditures (in %) (in 000) (in %) (in 000) efficiency Benchmark – best practice Varaždin 2016 49.1 20.7 275 105 1.382 1 Varaždin 2021 77.4 17.8 174 97 1.524 1 Varaždin 2022 82.7 17.7 184 129 1.737 1 Pula - Pola 2016 46.9 16.2 118 180 2.946 1 Varaždin 2015 47.7 15.2 273 126 1.692 1 Pula - Pola 2015 43.3 13.4 128 112 2.812 1 Pula - Pola 2021 75.9 10.2 74 130 2.149 1 Šibenik-Knin 2021 44.8 9.4 61 100 2.162 1 Pula - Pola 2022 76.7 5.7 92 121 2.283 1 Slavonski Brod 2021 52.9 5.4 92 168 1.160 1 Slavonski Brod 2022 59.8 5.1 92 239 1.313 1 Efficient Gospić 2015 7.5 15.9 20 91 311 1 Zabok 2022 29.9 9.4 64 148 1.702 1 Gospić 2021 10.4 9.7 19 120 327 1 Zabok 2021 27.0 11.0 62 144 1.513 1 Knin 2022 10.2 61.7 35 100 304 1 Knin 2021 9.4 61.1 34 82 237 1 Knin 2016 6.7 23.2 38 36 146 1 Knin 2015 7.6 18.2 36 55 309 1 Gospić 2016 7.4 17.6 20 67 416 1 Našice 2022 15.5 2.3 26 57 859 1 Zabok 2016 18.1 8.7 70 91 1.397 1 Našice 2021 15.1 5.7 27 59 825 1 Požega 2022 25.8 3.4 46 153 866 1 Virovitica 2015 18.3 15.6 62 100 1.028 1 Ogulin 2015 7.9 19.9 26 25 478 1 Našice 2015 10.5 14.9 36 47 698 1 Virovitica 2016 18.8 20.9 61 85 1.484 1 Našice 2016 10.9 19.5 34 45 777 1 Šibenik-Knin 2015 27.8 8.3 78 100 1.755 1 Zadar 2022 68.5 4.4 100 75 2.095 1 218 Central European Public Administration Review, Vol. 23, No. 2/2025 Analysis of the Cost Efficiency of Public General Hospitals in Croatia General Expenditures Due liabilities in total Days Beds Services Cost Year hospital (in mil. €) expenditures (in %) (in 000) (in %) (in 000) efficiency Near-efficient Dubrovnik 2015 28.3 35.0 85 40 1.802 0.9821 Zabok 2015 17.7 7.9 63 74 1.013 0.9778 Ogulin 2016 8.0 15.4 26 63 274 0.9756 Čakovec 2015 24.2 7.9 95 100 1.210 0.9738 Čakovec 2022 38.9 6.0 88 100 1.099 0.9607 Emerging Ogulin 2021 10.3 3.0 18 38 274 0.9455 Vinkovci 2015 22.2 30.7 92 88 1.031 0.9449 Slavonski Brod 2015 44.5 15.2 158 100 2.359 0.9406 Čakovec 2021 40.0 6.7 89 100 851 0.9212 Gospić 2022 11.1 9.0 16 80 306 0.9193 Požega 2015 23.5 10.2 92 97 1.024 0.9097 Čakovec 2016 25.6 13.8 92 100 1.035 0.9045 Ogulin 2022 11.3 3.5 17 44 295 0.9001 Šibenik-Knin 2016 29.3 7.4 71 100 1.866 0.8927 Zadar 2015 42.1 11.1 122 61 2.292 0.8829 Bjelovar 2016 21.5 17.1 92 51 921 0.8778 Karlovac 2021 38.0 8.6 78 71 1.203 0.8647 Zadar 2021 64.7 9.5 105 71 1.814 0.8476 Slavonski Brod 2016 46.8 15.4 158 100 1.976 0.8442 Vinkovci 2016 23.7 37.6 87 88 1.170 0.8417 Bjelovar 2015 21.1 12.8 73 69 885 0.8056 Koprivnica 2021 32.9 9.0 68 50 693 0.8029 Low efficiency Karlovac 2022 40.8 7.0 75 79 1.298 0.7972 Karlovac 2015 25.2 1.1 90 59 1.018 0.7919 Vinkovci 2021 32.2 79.2 63 101 1.059 0.7897 Virovitica 2021 26.5 11.3 52 95 1.063 0.7828 Bjelovar 2021 31.1 39.2 59 71 1.014 0.7553 Požega 2016 24.4 23.2 80 82 928 0.7421 Virovitica 2022 29.3 8.1 53 100 1.063 0.7412 Koprivnica 2016 22.9 24.5 89 61 618 0.7393 Koprivnica 2015 22.8 19.9 87 45 654 0.7248 Vinkovci 2022 35.9 84.7 61 124 1.092 0.7118 Koprivnica 2022 38.6 5.6 69 56 811 0.7096 Bjelovar 2022 33.8 44.1 53 87 1.227 0.6779 Vukovar 2015 16.1 34.4 36 16 718 0.6725 Central European Public Administration Review, Vol. 23, No. 2/2025 219 Romario Marijanović, Mihaela Bronić, Simona Prijaković General Expenditures Due liabilities in total Days Beds Services Cost Year hospital (in mil. €) expenditures (in %) (in 000) (in %) (in 000) efficiency Zadar 2016 44.0 17.2 120 71 1.578 0.6389 Dubrovnik 2016 29.6 45.3 83 52 1.154 0.6325 Vukovar 2016 17.9 34.9 34 27 809 0.6282 Požega 2021 27.0 5.9 44 100 796 0.6249 Karlovac 2016 29.7 0.2 86 75 1.009 0.6212 Dubrovnik 2021 46.9 84.9 64 77 1.438 0.5836 Šibenik-Knin 2022 48.1 9.9 57 100 1.547 0.5664 Vukovar 2022 26.0 20.5 34 46 656 0.5397 Vukovar 2021 26.4 164.2 23 37 616 0.4958 Dubrovnik 2022 54.6 80.2 59 80 1.438 0.4810 Source: Authors. 220 Central European Public Administration Review, Vol. 23, No. 2/2025 DOI: 10.17573/cepar.2025.2.08 1.01 Original scientific article Fair Taxation of Inheritance? Michal Radvan Masaryk University, Faculty of Law, Czech Republic michal.radvan@law.muni.cz https://orcid.org/0000-0002-9858-4555 Klára Doležalová Masaryk University, Faculty of Law, Czech Republic 546809@mail.muni.cz https://orcid.org/0009-0003-9585-5609 Received: 5. 8. 2025 Revised: 1. 10. 2025 Accepted: 15. 9. 2025 Published: 11. 11. 2025 ABSTRACT Purpose: The purpose of this article is to clarify the meaning and charac- ter of inheritance tax from a legal perspective. It is necessary to identify its role within the tax system and explore its connections to other taxes. Such an approach is the only way to substantiate arguments in favour of retaining inheritance tax. For the purposes of this paper, we assume that most countries in the European Union continue to levy inheritance tax, which must therefore be justified. A small number of states, on the other hand, have abolished this tax. The hypothesis we aim to confirm or dis- prove is that inheritance tax is a traditional levy firmly embedded within the tax systems of individual countries. Design/Methodology/Approach: To achieve the aims of the paper, we follow the IMRaD methodology. Within the research section, it is neces- sary to characterise inheritance tax, identify its place within the tax sys- tem, and analyse the reasons behind its abolition in some jurisdictions. The research also includes an analytical-comparative component devoted to examining the individual structural elements of inheritance tax. This detailed analysis enables us to formulate a set of questions concerning the optimal and fair legal construction of the basic structural components of inheritance tax, which are addressed in the discussion section of the article. In the concluding section, we primarily determine whether the ar- guments for retaining or abolishing inheritance tax are more persuasive. Findings: The hypothesis that inheritance tax is a traditional levy firmly embedded within the tax systems of individual countries is confirmed. Nevertheless, the decision to impose inheritance tax remains a purely po- litical one. As is evident from the design of its structural components, the law and legal regulation can ensure that inheritance tax is implemented in a fair manner. Radvan, M., Doležalová, K. (2025). Fair Taxation of Inheritance?. 221 Central European Public Administration Review, 23(2), pp. 221–238 2591-2259 / This is an open access article under the CC-BY-SA license https://creativecommons.org/licenses/by-sa/4.0/ Michal Radvan, Klára Doležalová Academic Contribution to the Field: The research, which focuses on the fairness of inheritance tax from a legal perspective, is novel. Given that the decision to levy inheritance tax lies with political authorities, this pa- per offers options for designing the individual structural components of inheritance tax in consideration of other forms of taxation. Research Implications/Limitations: This paper does not examine the fairness of taxation from political, sociological, or psychological perspec- tives. It does not consider the possibility that populism may serve as a strategic approach for introducing or abolishing inheritance tax. Further- more, the research does not address the economic efficiency of inherit- ance taxation. Originality/Value: The topic is highly original, as it addresses the legal regulation of inheritance taxation and the design of its individual struc- tural components. The approach is applicable in all countries worldwide, regardless of whether they currently levy inheritance tax. It contributes to the discourse on inheritance taxation from a legal standpoint. Keywords: inheritance tax, estate tax, gift tax, structural component of tax Pošteno obdavčenje dediščine? POVZETEK Namen: namen članka je razjasniti pomen in naravo davka na dediščino z vidika prava. Njegovo vlogo je treba opredeliti v davčnem sistemu ter raz- iskati povezave z drugimi davki. Tak pristop je edini način, da utemeljimo argumente v korist ohranitvi davka na dediščino. V članku predpostavlja- mo, da večina držav v Evropski uniji še vedno ima davek na dediščino, zato ga je treba utemeljiti. Manjše število držav je ta davek odpravilo. Hipote- za, ki jo želimo potrditi ali ovreči, je, da je davek na dediščino tradicionalna dajatev, trdno umeščena v davčne sisteme posameznih držav. Načrt/metodologija/pristop: za dosego ciljev prispevka sledimo metodo- logiji IMRaD. V raziskovalnem delu je treba opredeliti davek na dediščino, določiti njegov položaj v davčnem sistemu in analizirati razloge za njego- vo odpravo v nekaterih jurisdikcijah. Raziskava vključuje tudi analitično- -primerjalno komponento, namenjeno preučevanju posameznih struk- turnih elementov davka na dediščino. Ta podrobna analiza nam omogoča oblikovati nabor vprašanj o optimalni in pravični pravni zasnovi osnovnih strukturnih sestavin davka na dediščino, na katera odgovarjamo v razpra- vljalnem delu članka. V sklepnem delu predvsem ugotovimo, ali so prepri- čljivejši argumenti za ohranitev ali za odpravo davka na dediščino. Ugotovitve: hipoteza, da je davek na dediščino tradicionalna dajatev, trdno umeščena v davčne sisteme posameznih držav, je potrjena. Kljub temu odločitev o uvedbi tega davka ostaja izključno politična. Kot je raz- vidno iz zasnove njegovih strukturnih sestavin, lahko pravo in pravna ure- ditev zagotovita, da se davek na dediščino pobira na pravičen način. Akademski prispevek k področju: raziskava, ki se osredotoča na pravič- nost davka na dediščino s pravnega vidika, je novost. Ker je odločitev o uvedbi davka na dediščino v domeni političnih organov, članek ponuja možnosti za oblikovanje posameznih strukturnih sestavin tega davka ob upoštevanju drugih oblik obdavčitve. 222 Central European Public Administration Review, Vol. 23, No. 2/2025 Fair Taxation of Inheritance? Raziskovalne implikacije/omejitve: članek ne obravnava pravičnosti ob- davčitve s političnega, sociološkega ali psihološkega vidika. Ne upošteva možnosti, da bi populizem lahko služil kot strateški pristop k uvedbi ali odpravi davka na dediščino. Poleg tega raziskava ne obravnava ekonom- ske učinkovitosti obdavčitve dediščine. Izvirnost/vrednost: tema je zelo izvirna, saj obravnava pravno ureditev obdavčitve dediščine in zasnovo njenih posameznih strukturnih sestavin. Pristop je uporaben v vseh državah po svetu, ne glede na to, ali trenutno imajo davek na dediščino ali ne. Prispeva k razpravi o obdavčitvi dediščine z vidika prava. Ključne besede: davek na dediščino, davek na zapuščino, davek na darila, strukturna sestavina davka JEL: K34, K40 1 Introduction The discussion about the fairness of taxation is never-ending. The reason is hidden in the fact that every person has a different perception of taxes: some people still believe that taxes are legal theft, while others pay taxes as they feel it is not only a legal obligation but also an ethical issue. Most of the popu- lation stays somewhere between these two poles. They are ready to pay taxes if they feel they are fair and they get adequate service from the state and/or local self-government units. Fair taxation is not only connected to the absolute amount of every single tax being paid in every single tax period. The perception of tax fairness is primar- ily strongly connected to the mixture of taxes that taxpayers have to pay. In other words, it is not easy to explain why the recurrent property should be collected if the tax is paid from the net income after the taxation (by income taxes); many people see property tax as a second taxation of their income. The inheritance tax is then viewed even more negatively: the heir receives the property acquired by the deceased, obtained from income already taxed once. This problem comes to the fore, especially in the case of family property inherited from close relatives. The purpose of this article is then to clarify the meaning and the character of inheritance tax from the legal point of view. It is necessary to identify its role in the tax system and find connections to other taxes. Such an approach is the only way to defend the arguments for retaining the inheritance tax. For the purpose of this paper, we really assume that most countries in the European Union still levy the inheritance tax, which must be justified. A small number of states, on the other hand, abolished this tax. The hypothesis we will confirm or disprove is that the inheritance tax is a traditional tax firmly anchored in the tax systems of individual countries. To reach the aims of the paper, we follow the IMRaD methodology. Within the research part, it is necessary to characterize the inheritance tax and to Central European Public Administration Review, Vol. 23, No. 2/2025 223 Michal Radvan, Klára Doležalová define its sub-categories. It is also needed to identify the place of inheritance tax in the tax system (tax mix) and to point out the connections between the inheritance tax and other taxes, mainly income taxes (such as personal income tax and corporate income tax) and other property taxes (gift tax, property transfer tax, taxes on acquisition of property, general wealth tax, and recurrent property tax). Later, we will analyse the reasons for abolishing the inheritance tax in countries where such a tax was abolished in recent dec- ades. The Research must also include an analytical-comparative part devot- ed to individual structural components of the inheritance tax. The detailed analysis, in combination with the partial comparison between the European States, will allow us to create a set of questions asking for the optimal and fair legal construction of basic structural components of the inheritance tax, such as the person of taxpayer, the tax base construction, the type of tax rate/rates, the corrective elements, the tax administration and collection. These questions are to be answered in the discussion part of the article. Spe- cial attention will be paid to the relations between the inheritance tax and other taxes with regard to fairness in taxation and efficient tax administra- tion. In the concluding section, we then synthesize the knowledge gained, summarize the results, and determine whether the arguments for retaining or abolishing the inheritance tax prevail. Unfortunately, the current legal literature focusing on inheritance tax is lim- ited. Even “the Bible” of the tax law – Thuronyi’s Tax Law Design and Drafting (Thuronyi, 1996) – does not include a specific chapter dealing with the inher- itance tax. The inheritance tax is only mentioned in the chapter on the taxa- tion of wealth (Rudnick and Gordon, 1996). The same applies to the chapter on wealth taxation by Boadway, Chamberlain and Emmerson (2010) or the wealth taxation study by OECD (2018). A legal regulation of the inheritance tax in OECD countries is analysed in the OECD’s Tax Policy Studies – Inherit- ance Taxation in OECD Countries (OECD, 2021). The inheritance tax was also studied in the general report and national reports of the EATLP 2025 con- gress (EATLP, 2025). From the economic, social, and political points of view, the number of scientific publications is much higher. They are focusing on in- tergenerational wealth mobility (Adermon, Lindahl and Waldenström, 2018; Bastani and Waldenström, 2021; Brunetti, 2006; Kopczuk, 2013; Wolff and Gittleman, 2014), effects of inheritance taxation on business (Burman, Mc- Clelland and Lu, 2018; Tsoutsoura, 2015), or the conflict between gift tax and inheritance tax (Bernheim, Lemke and Scholz, 2004; Joulfaian, 2004; Joulfa- ian, 2005; Poterba, 2001). Some papers are more general, i.e., Kopczuk (2009), some discuss specific issues in detail. E.g., Elinder, Erixson and Ohlsson (2012) examined the impact of inheritances on heirs’ labor and capital income, while Farhi and Werning (2010) offer progressive estate taxation. 224 Central European Public Administration Review, Vol. 23, No. 2/2025 Fair Taxation of Inheritance? 2 Research 2.1 Inheritance Tax Characteristics Inheritance tax, along with the closely related gift tax and property transfer tax/tax on the acquisition of property, constitutes a traditional category of (property) transfer taxes that has historically played a significant role in the tax systems of many countries. These taxes are linked to a change in ownership and are levied on a new owner’s acquisition, transfer, or succession of property. Systematically, the inheritance tax and the gift tax belong to the group of taxes on capital transfers. When assessing these taxes, it is essential to distin- guish whether the transfer of ownership occurs during the owner’s lifetime or upon their death. Inheritance tax applies when an heir acquires both movable and immovable property from a deceased owner (mortis causa). Inheritance involves the acquisition of property without consideration, thereby increasing the total wealth of the heir. In contrast, gift tax applies to gratuitous transfers of property between living individuals (inter vivos). Gift tax is levied not only on donations based on gift contracts but also on other gratuitous acquisitions of property resulting from legal acts. These may include, for example, debt forgiveness or the gratuitous assignment of a claim (Radvan, 2025). A common feature of both inheritance and gift taxes is that they are imposed on gratuitous acquisitions of property and are classified as irregular taxes, since they are not collected on a regular periodic basis but only when a trans- fer occurs (Sobotovičová and Janoušková, 2018, 11). Due to the close relationship between these taxes, they are often governed by a single legislative framework. Common rules typically apply to aspects such as valuation methods and the determination of tax exemptions. In some jurisdictions, property donated within a specific period before the deceased’s death is included in the inheritance tax base (three years before death in Ja- pan, or seven years in the United Kingdom) to ensure tax fairness, particularly in systems employing progressive tax rates. Another example of the interrelation between these taxes involves gener- ation-skipping. The generation-skipping generally means lower rates for close relatives and higher rates for distant relatives and unrelated persons (Adermon, Lindahl and Waldenström, 2018; Bastani and Waldenström, 2021; Brunetti, 2006; Kopczuk, 2013; Wolff and Gittleman, 2014). However, the generation-skipping principle can also be reflected in situations when a per- son inherits property and subsequently gifts it to their descendant within a certain period. In that case, the amount of gift tax may be reduced by the amount of inheritance tax already paid. In some cases, tax rates themselves may be coordinated, such that gift tax rates are set at double the rate of in- heritance tax (Radvan, 2025). It is important to distinguish between inheritance tax and estate tax, as they differ in terms of what is subject to taxation. While inheritance refers to the Central European Public Administration Review, Vol. 23, No. 2/2025 225 Michal Radvan, Klára Doležalová property transferred to a specific heir, the estate encompasses all property bequeathed by the deceased (Sobotovičová and Janoušková, 2018, 71). Es- tate tax is levied on the total value of the deceased person’s estate before its distribution among beneficiaries. The tax base is therefore the aggregate val- ue of the estate, and the tax liability is borne jointly and severally by the heirs, or it is settled by the estate administrator (Sheposh, 2025; Radvan, 2025). In contrast, inheritance tax is imposed on the individual share received by each heir, meaning that each person pays tax separately based on their portion of the inherited property. In systems with a progressive tax rate, it is generally assumed that the total amount collected through the estate tax will exceed the sum of inheritance tax payments collected individually from each heir. From this perspective, inheritance tax is considered an in personam tax, while estate tax qualifies as an in rem tax. In the context of tax fairness, inheritance tax should ideally be cumulative, meaning that all inheritances received by the same taxpayer during their lifetime would be aggregated to determine their tax liability. However, this method of calculating the tax base would entail significant administrative complexity (Kubátová, 2006, p. 255; Radvan, 2025). This paper uses the term “inheritance tax” in the broader sense, including the estate tax. If some parts of the text deal specifically with the estate tax, the term “estate tax” is used. 2.2 Classification of Inheritance Tax in the Tax System Inheritance tax is a specific form of taxation on the transfer of property that occurs as a result of the death of the deceased. Alongside gift tax and estate tax, it belongs to the category of so-called capital transfer taxes. These taxes are not subject to a regular tax period, as they apply to a one-off transfer of property between entities. However, this does not prevent a single taxpayer from paying this tax multiple times, depending on how often they become an heir or a donee. A common characteristic of these taxes is the gratuitous nature of the transfer, whereby, unlike the real estate transfer tax, the new owner does not provide any consideration for the property received (Kubá- tová, 2006, p. 255; Radvan, 2025). The other elements of the relation be- tween the inheritance tax and the gift tax are explained above. Inheritance and gift taxes also incorporate elements of personal taxation. A typical example is the application of a progressive rate for multiple gifts, where the tax liability is determined based on the total value of gifts received by a single recipient (Kubátová, 2006, p. 255). The acquisition of property through inheritance or gift leads to an increase in the total value of the tax- payer’s assets and can thus be considered a form of income. For this reason, it is necessary to regulate the relationship between capital transfer taxes and income taxes to avoid double taxation. When inheritance and gift taxes are levied, inheritances and gifts should be exempt from income tax. Conversely, if no capital transfer taxes are imposed, inheritances and gifts are generally subject to income tax unless specific exemptions are provided under income tax legislation (Radvan, 2025). 226 Central European Public Administration Review, Vol. 23, No. 2/2025 Fair Taxation of Inheritance? 2.3 Reasons for Abolishing the Inheritance Tax Inheritance tax is traditionally classified as a property tax with a long history. It is one of the oldest tax institutions, which, in the past, together with gift tax, represented a significant source of public revenue. Since the beginning of the 20th century, however, their share of total tax revenues has gradually declined. It is their low yield that is the key factor contributing to the reduc- tion or complete abolition of these taxes in several countries. According to recent data, capital transfer taxes typically account for less than 0.2% of GDP in OECD countries (Radvan, 2025). However, the share of inheritance and gift taxes in total tax revenue varies considerably across OECD countries. In the absence of uniform legislation at the European Union level, each country reg- ulates this area independently. Different approaches to the taxation of prop- erty transfers consequently lead to significant variations in the revenue gen- erated from these taxes (Sobotovičová and Janoušková, 2018, 14). Among the countries with the highest revenues from inheritance and gift taxes are France and Belgium, where high yields result from a modern approach to de- termining the tax base (Radvan, 2025). Over the past decades, several countries, including the Czech Republic, Slo- vakia, and Austria, have moved to abolish the inheritance tax entirely (Rad- van, 2025). The most frequently cited reason for this decision is the low yield of inheritance tax. If its average yield is around 0.2% of GDP, this share must be even lower in many countries. Moreover, its collection is administratively demanding, and the unfavorable ratio between revenues and the costs of administration has led many countries to conclude that this tax is uneconom- ical and ineffective. A typical example is the Czech Republic, where inheritance and gift taxes were abolished on 1 January 2014. It was primarily due to exemptions granted to close relatives, which rendered the tax revenue almost negligible. According to tax administration data, the revenue collected was so low that, to the costs of administration, tax collection proved uneconomical. Slovakia applied a similar approach in 2004, when the inheritance tax was abolished as part of a tax reform. Prior to 2004, the inheritance tax rate in Slovakia was progressive, based on the value of the property and the relation- ship between the deceased and the heir. According to the explanatory memo- randum to Act No. 554/2003 Z. z., on the tax on the transfer and transition of real estate, this taxation system proved to be both unfair and ineffective (Národná Rada SR, 2023). Another fundamental objection to inheritance tax is the risk of double taxa- tion. Critics argue that property subject to inheritance tax was typically ac- quired from income that had already been taxed. Thus, its re-taxation con- tradicts the principle of tax fairness (Kubátová, 2006, p. 246). Consequently, inheritance tax is generally unpopular among taxpayers. Some opinions even describe it as a so-called deterrent tax, as it may discourage individuals from Central European Public Administration Review, Vol. 23, No. 2/2025 227 Michal Radvan, Klára Doležalová the long-term accumulation of assets and their potential growth across fu- ture generations (Radvan, 2025). Opponents of inheritance tax also commonly argue that it unfairly penal- izes individuals who have saved and limited their own consumption during their lifetime to accumulate wealth for their descendants (Sobotovičová and Janoušková, 2018, p. 70). The issue of abolishing inheritance tax is often a subject of political debate, largely because society perceives this tax as un- fair. Furthermore, the tax impacts heirs at a particularly sensitive time in their lives, which further diminishes its popularity among taxpayers. As a result, the abolition of inheritance tax is frequently a politically popular move. 2.4 Structural Components of the Inheritance Tax The following part of the paper deals with selected structural components of the inheritance tax: the taxpayer and the object of taxation, the tax base and the tax rate, and the corrective elements. The tax administration aspects, including the tax collection and the budget destination, are also partially included. The person of the taxpayer and the object of taxation are strongly connected issues. In fact, the decision of whether to collect the estate tax or the inher- itance tax is based on the national civil law traditions and the legal system. While the Anglo-American system is based on the estate administrator (trus- tee), who is responsible for the administration of the estate until the estate shares are transferred to the heirs, the continental legal system prefers to transfer inheritance shares to heirs shortly after the deceased’s death. The taxation follows the civil law regulation: the estate tax is paid by the trustee, while heirs are responsible for the inheritance tax. Assuming that the inherit- ance tax rate is usually progressive, the inheritance tax should be more ben- eficial for the taxpayers, especially if there are more heirs. In most cases, the heir liable for inheritance tax is a natural person, but it is not impossible for a legal entity to become the heir. The method of acquiring the inheritance, i.e., based on the deceased’s will or by law, respectively, or a combination of both methods, has no influence on the determination of the taxpayer. Under no circumstances shall joint and several liability apply to tax- payers in relation to inheritance tax. As the inheritance can also be perceived as an income, the heir is liable in fact to two taxes: a specific inheritance tax, and a general income tax (usually personal income tax, in the case of legal entities, corporate income tax). The legislator should be aware of these consequences and prepare legal regula- tions to avoid double taxation on income from inheritances. National regulations usually set several inheritance tax groups depending on the relationship between the deceased and the heir. These tax groups do not necessarily copy the inheritance groups as defined by civil law. The closer the relationship is, the lower the inheritance tax rate will be. Increasing tax-free allowances or even complete exemption cannot be ruled out either. 228 Central European Public Administration Review, Vol. 23, No. 2/2025 Fair Taxation of Inheritance? The object of the estate tax is the property left by the deceased. In contrast, the inheritance tax is levied on property acquired by the heir by inheritance on the deceased’s date of death (mainly on the basis of a specific authority – court, notary – decision). In this case, property refers to immovable property and movable property, which, in addition to movable items, also includes se- curities, cash in any currency and form (including non-cash forms, i.e., deposits in accounts, etc.), receivables (monetary and non-monetary), property rights (e.g., copyrights and similar rights), and all other property values. The division of assets into movable and immovable property affects the col- lection of tax and the rules of how to avoid double taxation (OECD, 2025). In the case of real estate located abroad, tax is not usually collected, whereas tax is always collected on real estate located in the country that collects the inheritance tax, regardless of the nationality or residence of the deceased. In the case of movable property, if the deceased was a citizen of the coun- try that collects the inheritance tax at the time of death and had permanent residence there, tax is levied on all of their movable property regardless of where it is located (domestically or abroad). If such a person did not have per- manent residence in the country that collects the inheritance tax but was still a citizen of this country, tax is levied only on their movable property located in this country. The same procedure would apply to a foreigner; tax would be levied only on their movable property located in the country that collects the tax. This system is apparently the most common (it is used both in Europe and outside Europe, e.g., in Hong Kong and Singapore – Rudnick and Gordon, 1996, p. 325). The above rules should be considered general rules, and in spe- cific cases, it is always necessary to refer to the relevant international double taxation treaty, which takes precedence in application according to the lex specialis derogat legi generali principle. Inheritance taxes are characterized by an extensive list of exemptions. For greater clarity, it is advisable to divide them into personal exemptions and material exemptions. Concerning personal exemptions, the most frequent are the thresholds for close relatives of the deceased and persons living in the same household. The closer the family relationship is, the higher the thresh- old is. Specific thresholds are mostly set for individual inheritance groups. In some cases, only widows and widowers and children are exempt from paying the tax. In these cases, the heir is not often even required to file a tax return, in which they would have to prove their entitlement to the exemption. The other personal exemptions are connected to charitable and other public benefit purposes; the acquisitions of property by universities, research insti- tutions, churches, NGOs, public benefit corporations, foundations, etc., are also exempt from inheritance tax. The most frequent material exemptions are connected to pension insurance of the deceased or specific deceased’s claims for compensation. In some countries (e.g., Belgium – Bourgeois, De Raedt, Richelle Graulich and Desmyt- tere, 2025; France – Beltrame and Quilici, 2025; Germany – Desens, 2025), exemptions are available to support family businesses. Other states (e.g., Bel- Central European Public Administration Review, Vol. 23, No. 2/2025 229 Michal Radvan, Klára Doležalová gium – Bourgeois, De Raedt, Richelle Graulich and Desmyttere, 2025; France – Beltrame and Quilici, 2025; Germany – Desens, 2025; Ireland – Matikonis, 2025; Poland – Prejs, 2025; Spain – Varona Alabern, 2025; Singapore – Rudnick and Gordon, 1996) allow exemptions for residential property. The exemp- tion might be conditioned: e.g., the Polish housing relief concerns residential property up to 110 m2, and the acquired person must reside in the property and not sell it for at least five years (Prejs, 2025). Other exemptions are ap- plied to support agricultural production (e.g., France – Beltrame and Quilici, 2025; Ireland – Matikonis, 2025; Serbia – Ilić Popov and Cvjetković Ivetić, 2025; Slovenia – Štemberger Brizani and Kovač, 2025). In order to determine the inheritance tax liability, it is necessary to correctly calculate the tax base and assign the appropriate tax rate to it. The estate tax base is the value of the property; in the case of the inheritance tax, the value of the property acquired by each heir (as determined in the inheritance proceed- ings). The value is reduced by any proven debts of the deceased, reasonable costs associated with the deceased’s funeral (funeral expenses), and other items such as administrative costs, including the remuneration of the estate administrator, court and administrative fees, bank charges, costs related to the valuation of the property, etc. The value itself can be set specifically for the inheritance procedures, including tax proceedings. However, if the value- based system is being used for the recurrent property tax, it is reasonable to use this value for the immovable property. The same statement applies to any movable property where the price is evident from any public register. In most countries, the inheritance tax rate is slidingly progressive: the amount of tax payable by each heir depends on their relationship to the deceased and the value of the acquired property. It is therefore directly proportional to the value of the property. However, e.g., in the US, a fixed tax rate is used, which is even increased in the case of so-called generation-skipping transfers. If inheritance tax is payable, the heirs are required to file an inheritance tax return. In contrast, in common law countries, a single estate tax return is filed by the estate administrator. When assessing tax, the tax office primarily relies on the tax return but may also use other available evidence (the inheritance file from the court or notary’s office). If the taxpayer fails to file a tax return within the statutory deadline or fails to cooperate with the tax office, the tax office may assess the tax without the taxpayer’s cooperation, as it has all the necessary information for its decision in the inheritance file. The assessed tax is communicated to the taxpayer, and the due date is also specified. In almost all countries that collect any form of inheritance tax, the tax rev- enue belongs to the state (central) budget. 3 Discussion Based on the research and analysis of the structural components of the inher- itance tax, several questions appeared concerning the optimal and fair legal 230 Central European Public Administration Review, Vol. 23, No. 2/2025 Fair Taxation of Inheritance? construction of the inheritance tax generally and basic structural components specifically. 3.1 What is the (Legal) Sense of the Inheritance Tax? Inheritance tax is a frequently debated topic; despite numerous arguments supporting its abolition, there are also many voices advocating for its reten- tion. The purpose of the inheritance tax cannot be evaluated solely from an economic perspective, as its social functions must also be considered, includ- ing aspects such as social justice, equal opportunities, and limiting the con- centration of wealth. Inheritance and gifts can contribute significantly to wealth inequality among individuals, as recipients typically have no control over these factors. Acquir- ing wealth in this manner may lead to undeserved advantages that under- mine the fundamental principle of equal opportunity. It is generally assumed that individuals with comparable incomes will have similar economic stand- ing, but inheritance can cause substantial disparities in wealth without any merit on the part of the recipient, who did not have to sacrifice time or effort to acquire the assets. Some proponents of stricter inheritance tax regulation argue that high-value inheritances may foster economic passivity, where recipients lose motivation to work because they are not required to generate their own income. Con- sequently, inheritance taxation is often advocated as a tool to level the play- ing field and enhance equality of opportunity (Sobotovičová and Janoušková, 2018, p. 70). It is also assumed that inheritance tax can influence the economic behavior of heirs. A higher tax burden reduces the net value of the acquired property, which can incentivize increased labor participation and higher savings rates (OECD, 2021, p. 58). From the perspective of tax fairness, it is legitimate for inheritances and gifts, as forms of gratuitous income, to be subject to taxation, since heirs or do- nees acquire them without direct effort or merit (Radvan, 2025). Some opin- ions even hold that inheritance should be taxed at a higher rate than income earned through one’s own labor, as the tax system should primarily reward individual effort and productivity (OECD, 2021, p. 42). Inheritance tax serves a redistributive function, as the untaxed transfer of large amounts of wealth across generations could lead to the concentration of wealth within a narrow segment of the population. Taxing these transfers helps mitigate intergenerational inequality. Certain countries apply inheritance tax to encourage the preservation of wealth within families. In such legal frameworks, the inheritance tax rate is lower for transfers between direct family members, while transfers outside the family are generally taxed at higher rates. Central European Public Administration Review, Vol. 23, No. 2/2025 231 Michal Radvan, Klára Doležalová An equally important argument for maintaining the inheritance tax is its fis- cal significance at the local level. Although its share of total public revenue is relatively low in international comparison, in some countries, the inheritance tax remains an important source of income for municipal and regional budg- ets (Sobotovičová and Janoušková, 2018, p. 7). For inheritance tax to be perceived as fair, its corrective elements must meet basic quality criteria. The most important structural element is the threshold value, which is linked to inheritance tax groups, as discussed in more detail below. 3.2 What is the Role of the Inheritance Tax in the Tax System? This question aims to clarify the relationship between the inheritance tax and other taxes. The closest is the relation to other property transfer taxes, main- ly the gift tax (Bernheim, Lemke and Scholz, 2004; Joulfaian, 2004; Joulfaian, 2005; Poterba, 2001) and the property transfer tax. If the country collects all three types of taxes, the taxpayers may speculate on the timing of transfers. Gift taxes usually have higher tax rates, lower thresholds, or other disadvan- tages compared to the inheritance tax, so the idea might be not to transfer the property during the lifetime. The property transfer tax thus comes into consideration. Moreover, the property transfer tax may have an even lower tax rate than other transfer taxes, especially in the case of high property val- ues. However, specifically in the transfer within the family, the contracting parties may tend to undervaluate the property to decrease the tax base. A solution may be found, for example, in the Belgian regulation, considering acquisitions based on another legal title than the transfer due to death (e.g., a contract, including a gift) as a legacy, i.e., subject to the inheritance tax De Raedt, Richelle Graulich and Desmyttere, 2025). The other conflict of the inheritance tax is with the income taxes. From both the legal and economic aspects, inheritance is income and, therefore, is liable to personal or corporate income tax. The legislator must be aware of this pos- sible double taxation, and the exemption of inheritance from income taxation must be secured. 3.3 Estate Tax or Inheritance Tax? As stated above, the object of the estate tax is the property left by the de- ceased. In contrast, the inheritance tax is levied on property acquired by the heir by inheritance on the deceased’s date of death. In fact, the decision of whether to collect the estate tax or the inheritance tax is predetermined by the civil law traditions and regulations. 3.4 How to Set the Inheritance Tax Groups? The assignment to the inheritance tax groups is essential due to the thresh- olds and the tax rates being applied. Because of the principle of uniform ter- minology in law, it would be reasonable to define the inheritance tax groups 232 Central European Public Administration Review, Vol. 23, No. 2/2025 Fair Taxation of Inheritance? in the same way as the inheritance groups for the purposes of civil law (inher- itance law). Such a solution contributes to the clarity of the legal system and the consistency in legal terminology. The sub-question is connected to the status of the divorced spouse; also, in this case, the inclusion of the divorced husband/wife/partner should be the same in tax and civil law regulations. An exception to the rule of consistency in legal terminology could be widows and widowers. The inheritance tax could benefit them more, on the presump- tion that the inherited property was community property in which the spous- es participated jointly. Another reason might be the desire to leave the sur- viving spouse sufficient assets to provide for subsequent independent living. 3.5 Is it Necessary to Measure the Value of the Inheritance Specifically for the Inheritance Tax? Generally, it is not necessary to measure the value of the inheritance specifi- cally for the inheritance tax. The value of the estate or the inheritance (prop- erty acquired by each heir) is usually previously determined in the inheritance (civil law) proceedings. In doing so, it is even suggested that the values used for other tax purposes can be used to set the value of the inheritance (e.g., the value of the immovable property used for the recurrent property tax). Of course, for inheritance tax purposes, the value should be reduced by debts, funeral expenses, and other administrative costs, so that the inheritance tax base expresses the net income of the heirs. 3.6 Progressive or Linear Tax Rate? The research shows that almost all countries that collect the inheritance tax prefer the progressive tax rate (Farhi and Werning, 2010). Even if the linear tax rate is used, the progressivity in taxation is secured by the thresholds. The other widely spread phenomenon is the generation-skipping, i.e., lower rates for close relatives and higher rates for distant relatives and unrelated persons (Adermon, Lindahl and Waldenström, 2018; Bastani and Waldenström, 2021; Brunetti, 2006; Kopczuk, 2013; Wolff and Gittleman, 2014). The progressivity in inheritance taxation, however, means certain demands on the legislator. Primarily, the absolute tax rate must not be extremely high, representing a choking effect of the inheritance tax. Also, legislators must be aware of other taxes connected with the transfers of property (property transfer tax, gift tax) in the rate design so that taxpayers are not forced to speculate on vari- ous forms of wealth transfer during their lifetime. Extremely high taxation of property can also lead to the creation of specific legal entities, such as dona- tions, foundations, or trusts, to optimize tax duties. The taxation of transfers to and out of these entities should then also be taken into account when set- ting the tax rates (Burman, McClelland and Lu, 2018; Tsoutsoura, 2015). Central European Public Administration Review, Vol. 23, No. 2/2025 233 Michal Radvan, Klára Doležalová 3.7 How to Deal with Repeated Inheritance? A repeated inheritance means that the heir dies soon after acquiring the inheritance, or even before the inheritance proceedings are completed. It means that the same inheritance would be taxed twice in a short period of time, which is manifestly unfair. Only a limited number of countries (e.g., the US, Japan, and Hong Kong) offer solutions from partial exemption to a single assessment, while in Portugal, the tax rate can be halved if there is a second or further inheritance of the same property within five years (Rudnick and Gordon, 1996, p. 318; do Rosário Anjos, 2025). 3.8 What Corrective Elements are Necessary? The most essential corrective element in the inheritance tax construction is the threshold. Thresholds are very strongly connected to the inheritance tax groups: the closer the relationship between the deceased and the heir is, the higher the threshold is. Many countries apply full exemption for direct rela- tives in the first inheritance tax group, usually consisting of spouses and chil- dren, sometimes also other persons living in the shared household. The rea- sons are primarily the intergenerational wealth mobility (Adermon, Lindahl and Waldenström, 2018; Bastani and Waldenström, 2021; Brunetti, 2006; Kopczuk, 2013; Wolff and Gittleman, 2014), and, in the case of family busi- ness, also the effects of inheritance taxation on business (Burman, McClel- land and Lu, 2018; Tsoutsoura, 2015). The other reasons, connected mainly to spouses, might be the presumption that the inherited property was gained jointly by the partners, or the desire to leave the surviving spouse adequate financial sources for subsequent independent living. The full exemption for the direct relatives can also be limited to children only. The reason is the so-called generation-skipping transfer, i.e., a situation when the taxpayer avoids taxation by leaving property to heirs two or more genera- tions distant. The emphasis on the maintenance of minor children may also be reflected in the determination of the age of the children in relation to the amount of the exemption. The other limitation could be the only exemption in a spouse’s lifetime to prevent situations where a young woman/man mar- ries older men/women several times in her/his life in order to inherit their wealth. Interestingly, historical Luxembourg’s wealth tax law only allowed the acquisition of certain assets by inheritance between spouses to be exempted if there are children born of the marriage (Rudnick and Gordon, 1996, p. 317). Concerning material exemptions, many of the reasons mentioned above also argue for partial or full exemption of primary residences. Support for agricul- ture can be reflected in the exemption of agricultural land. It should also be added that there is a possibility to combine several corrective elements, such as the full exemption (i.e., the threshold) and a lower tax rate. 234 Central European Public Administration Review, Vol. 23, No. 2/2025 Fair Taxation of Inheritance? 3.9 Is it Necessary to File the Inheritance Tax Return? On the assumption that inheritance courts, notaries, trusties, etc., exercise in some sense a delegated public administration and that the complete informa- tion about the deceased, heirs, property and its value, etc., is available online, there is no need to file the inheritance tax return. The tax office can get all the necessary information on its own, without the taxpayer’s cooperation. Such a solution aims to reduce administrative costs and save time for the taxpayer. Of course, all the general principles of effective collaboration between the tax office and the taxpayer must be followed in the tax procedure. 3.10 How to Secure Inheritance Tax Payments? The inheritance tax is, by its very nature, a tax in rem, which means the tax- payer does not necessarily have the means to pay for it. From these perspec- tives, the estate tax seems to be more effective, especially if the trustee, as a taxpayer, has an adequate time to exchange assets for funds. Nevertheless, for both estate and inheritance taxes, general instruments preventing non- payment of taxes are available. The most common instruments, regulated in the general tax codes, are the postponement of tax payments and the pay- ment of tax in instalments. The more beneficial conditions for these tools (more extended period, lower or no additional fees or interests, etc.) can also be explicitly set for the property transfer taxes, including the inheritance tax. The other securing institute is a surety: in the case of the estate tax, the heir(s) are the sureties, while in the case of the inheritance tax, the trustee or the other heirs can guarantee the tax payments. 4 Conclusion Fairness, as a fundamental principle of the tax system, is a key criterion for assessing the legitimacy of any tax, and this issue is particularly sensitive in the case of inheritance tax. While the fiscal significance of this tax is relatively limited in most countries, the rationale for its retention often lies in consid- erations of fairness. The following section, therefore, focuses on the differ- ent dimensions of tax fairness to inheritance tax and outlines the conditions under which it can be perceived as a legitimate and equitable component of the tax system. Tax theory primarily distinguishes between horizontal and vertical fairness. Horizontal fairness assumes that individuals with the same level of income or wealth should bear a similar tax burden. In other words, people in comparable financial situations should not be disadvantaged from a tax perspective sim- ply because one acquired their wealth through personal labor, while the other did so through inheritance or a gift. According to this principle, taxpayers with similar ability to pay should not be subject to different tax rates (Nováková, 2007, p. 23). From this perspective, inheritance tax can be viewed as a tool to equalize conditions between recipients of inherited wealth and individuals who generate capital through their efforts (OECD, 2021, p. 43). Central European Public Administration Review, Vol. 23, No. 2/2025 235 Michal Radvan, Klára Doležalová Inheritance tax can also promote the principle of vertical equity, which is based on the premise that individuals with higher incomes or greater wealth should bear a larger tax burden than those who are economically less advan- taged. To achieve this objective, a progressive tax rate is commonly applied, ensuring that entities acquiring a greater volume of assets through inherit- ance are subject to higher tax liabilities (OECD, 2021, p. 43). Inheritance often represents a significant increase in the total wealth of the heir, and progressive taxation can help reduce wealth inequalities within so- ciety. The transfer of wealth between generations without taxation tends to concentrate wealth and distort equal opportunities for future generations. Such an approach can lead to the emergence of a wealth elite whose eco- nomic standing reflects their privileged family background rather than their efforts. Inheritance tax can mitigate this effect and contribute to a more level playing field for subsequent generations (OECD, 2021, p. 43). The hypothesis of this paper, stating that the inheritance tax is a traditional tax firmly anchored in the tax systems of individual countries, was confirmed. Nevertheless, the decision of whether to collect any inheritance tax or not is solely political. If politicians are brave enough to continue to levy or renew the inheritance tax, they must explain it to the taxpayers – the voters. For inherit- ance tax to be perceived as fair by taxpayers, it must be structured to reflect the taxpayer’s actual economic situation accurately. An important mechanism in this regard is not only the application of a progressive tax rate but also the introduction of tax-free thresholds, which protect small inheritances from disproportionate taxation. As is evident from the other design of the inherit- ance tax structural components mentioned above, the law and legal regula- tion can make a fair inheritance tax happen. 236 Central European Public Administration Review, Vol. 23, No. 2/2025 Fair Taxation of Inheritance? References Adermon, A., Lindahl, M. and Waldenström, D. (2018). 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Inheritances and the distribution of wealth or whatever happened to the great inheritance boom? Journal of Economic Inequality, 12(4), pp. 439–468. http://dx.doi.org/10.1007/s10888-013-9261-8. 238 Central European Public Administration Review, Vol. 23, No. 2/2025 DOI: 10.17573/cepar.2025.2.09 1 Original scientific article From Co-Creation to Circular Cities: Exploring Living Labs in EU Governance Frameworks – A Literature Review Mari-Isabella Stan Ovidius University of Constanța, Romania isabella.stan@365.univ-ovidius.ro https://orcid.org/0000-0001-7509-4038 Tănase Tasențe Ovidius University of Constanța, Romania tanase.tasente@365.univ-ovidius.ro https://orcid.org/0000-0002-3164-5894 Received: 22. 5. 2025 Revised: 5. 9. 2025 Accepted: 9. 9. 2025 Published: 11. 11. 2025 ABSTRACT Purpose: This paper provides a comprehensive and integrative literature review of how Living Labs (LLs) are conceptualised, implemented, and evaluated within the European Union’s governance frameworks. It aims to trace the evolution of LLs beyond their original innovation rhetoric and to assess their actual contributions to co-creation, participatory govern- ance, and circular transitions. Design/Methodology/Approach: Using a PRISMA-compliant systematic literature review methodology, the study screened 403 peer-reviewed publications from the Web of Science Core Collection. Following the ap- plication of rigorous inclusion criteria, 77 eligible studies were analysed. A co-occurrence analysis of 360 keywords was conducted using VOSviewer to identify ten thematic clusters that structure the field. The findings are discussed across four dimensions: institutional anchoring, collaborative learning, socio-economic transition, and methodological consolidation. Findings: The review reveals that LLs function as hybrid governance infra- structures that foster innovation only when they are embedded in stable institutional settings and aligned with multi-level governance systems. While many LLs claim inclusivity, their actual transformative capacity is often constrained by power asymmetries, weak institutionalisation, and methodological fragmentation. Nevertheless, high-performing LLs dem- onstrate significant value in facilitating systemic learning, promoting cir- cular practices, and enabling democratic experimentation. Practical Implications: The findings emphasise the need for standardised evaluation frameworks, long-term funding mechanisms, and stronger in- Geršić, T., Vretenar, N., Jardas Antonić, J. (2025). Country Attractiveness for Conducting Clinical Trials – A Literature Review. 239 Central European Public Administration Review, 23(2), pp. 239–269 2591-2259 / This is an open access article under the CC-BY-SA license https://creativecommons.org/licenses/by-sa/4.0/ Mari-Isabella Stan, Tănase Tasențe stitutional pathways for LL outcomes to inform policy. Policymakers and practitioners are urged to move beyond pilotism and adopt LLs as em- bedded tools of governance. Originality/Value: Unlike previous studies that focused narrowly on sec- toral applications or isolated urban experiments, this review is the first to systematically map the evolution of Living Labs across four governance- oriented dimensions: collaborative anchoring, democratic learning, circu- lar innovation, and methodological evaluation. By linking these dimen- sions to the structural conditions of institutional consolidation within EU public policy frameworks, the article provides a novel conceptual synthe- sis that bridges fragmented scholarship. It advances the field by offering an integrated perspective that captures the multifunctional role of Living Labs as infrastructures for systemic governance innovation. Keywords: co-creation, European Union, Living Labs, participatory governance, public policy, urban experimentation Od soustvarjanja do krožnih mest: raziskovanje živih laboratorijev v okvirih upravljanja EU – pregled literature POVZETEK Namen: članek ponuja celovit in integrativen pregled literature o tem, kako so živi laboratoriji konceptualizirani, izvajani in vrednoteni znotraj upravljavskih okvirov Evropske unije. Cilj je slediti razvoju živih laboratori- jev onkraj izvorne inovacijske retorike ter oceniti njihove dejanske prispev- ke k soustvarjanju, participativnemu upravljanju in krožnim prehodom. Načrt/metodologija/pristop: z uporabo sistematične metodologije pre- gleda literature v skladu s PRISMA je študija pregledala 403 recenzirane publikacije iz zbirke Web of Science Core Collection. Po uporabi strogih vključitvenih meril je bilo analiziranih 77 ustreznih študij. S programom VO- Sviewer je bila izvedena analiza sopojavljanja 360 ključnih besed za identi- fikacijo desetih tematskih grozdov, ki strukturirajo področje. Ugotovitve so obravnavane skozi štiri razsežnosti: institucionalna vpetost, sodeloval- no učenje, družbeno-ekonomski prehod in metodološka konsolidacija. Ugotovitve: pregled razkriva, da živi laboratoriji delujejo kot hibridne upravljavske infrastrukture, ki spodbujajo inovacije le, kadar so umeščeni v stabilna institucionalna okolja in usklajeni z večnivojskimi sistemi upra- vljanja. Čeprav številni živi laboratoriji deklarirajo inkluzivnost, je njihova dejanska transformativna zmožnost pogosto omejena zaradi asimetrij moči, šibke institucionalizacije in metodološke razdrobljenosti. Kljub temu visoko uspešni živi laboratoriji izkazujejo pomembno vrednost pri pospeševanju sistemskega učenja, spodbujanju krožnih praks in omogo- čanju demokratičnega eksperimentiranja. Praktične implikacije: ugotovitve poudarjajo potrebo po standardiziranih okvirih za vrednotenje, mehanizmih dolgoročnega financiranja ter moč- nejših institucionalnih poteh, po katerih bi rezultati živih laboratorijev in- formirali javne politike. Odločevalci in praktiki naj presežejo »pilotizem« (pretirano zanašanje na pilotne projekte) in žive laboratorije sprejmejo kot vgrajena orodja upravljanja. Izvirnost/vrednost: drugače kot pretekle študije, ki so se ozko osredo- točale na sektorske uporabe ali osamljene urbane eksperimente, je ta 240 Central European Public Administration Review, Vol. 23, No. 2/2025 From Co-Creation to Circular Cities: Exploring Living Labs in EU Governance Frameworks – A Literature Review pregled prvi, ki sistematično mapira razvoj živih laboratorijev skozi štiri na upravljanje usmerjene razsežnosti: sodelovalno vpetost, demokratič- no učenje, krožne inovacije in metodološko vrednotenje. S povezovanjem teh razsežnosti s strukturnimi pogoji institucionalne konsolidacije zno- traj okvirov javnih politik EU članek ponuja novo konceptualno sintezo, ki premošča razdrobljeno znanstveno produkcijo. Področje nadgradi z in- tegriranim vidikom, ki zajame večfunkcijsko vlogo živih laboratorijev kot infrastruktur za sistemske inovacije upravljanja. Ključne besede: soustvarjanje, Evropska unija, živi laboratoriji, participativno upra- vljanje, javne politike, urbano eksperimentiranje JEL: H83, R58, O35 1 Introduction Over the past two decades, Living Labs (LL) have become a significant ref- erence point in discussions about innovation, participation, and public policy transformation within the European Union. Initially conceptualized as collab- orative spaces for user-centred experimentation, Living Labs have gradually evolved into instruments for addressing complex societal challenges through real-world co-creation processes (Bulkeley et al., 2016; Voytenko et al., 2016; Westerlund et al., 2018). Their appeal lies in the capacity to bring together diverse stakeholders – public authorities, citizens, researchers, and business- es – to test and develop context-sensitive solutions that respond to local and regional needs. Despite their growing diffusion across Europe, the conceptualization and implementation of Living Labs remain highly heterogeneous. While some LLs are embedded in strategic urban governance frameworks (Bifulco et al., 2017; Bradley et al., 2022), others function as short-term pilot projects with limited institutional anchoring or long-term impact (Mukhtar-Landgren, 2021; Muur and Karo, 2023). Moreover, literature often treats Living Labs as a catch- all term, encompassing a wide variety of practices that differ significantly in methodology, purpose, and degree of citizen involvement. This ambiguity has created challenges for both academic inquiry and policy learning, highlighting the need for a systematic synthesis of the knowledge produced to date (Arias et al., 2025; Wehrmann et al., 2023). In particular, the growing relevance of Living Labs within EU policy frameworks – especially in areas such as sustainability, circular economy, digital transfor- mation, and participatory governance – calls for a deeper understanding of their functions, impact, and the institutional structures that support their im- plementation. Existing studies often examine particular sectors, cities, or indi- vidual cases, but frequently fail to synthesize these findings within a broader theoretical or comparative framework (Backhaus and John, 2025; Bhatta et al., 2025b; Broekema et al., 2023). As a result, the field lacks a consolidated view of how Living Labs contribute to public sector innovation, what thematic patterns structure current research, and where conceptual or empirical gaps persist. Central European Public Administration Review, Vol. 23, No. 2/2025 241 Mari-Isabella Stan, Tănase Tasențe Unlike previous studies that focused narrowly on sectoral or city-specific ap- plications, this review is the first to systematically trace the evolution of Liv- ing Labs across four distinct governance dimensions – collaborative anchor- ing, democratic learning, circular innovation, and methodological evaluation – while also identifying the structural conditions that enable or inhibit their institutional consolidation within EU public policy frameworks. This literature review examines how Living Labs are positioned as tools for co-creation and experimental governance within the EU. By synthesizing peer-reviewed research, the study highlights four key dimensions. First, it ex- plores how Living Labs foster collaborative governance by engaging diverse stakeholders in shared decision-making. Second, it analyzes their role in pro- moting learning processes that support institutional adaptation and innova- tion (Eneqvist et al., 2022). Third, it considers their contribution to circular and socio-economic transitions, aligning local action with broader sustainabil- ity goals (Arciniegas et al., 2019; Bouzarovski et al., 2023). Finally, it reviews emerging methodological frameworks that enhance the evaluation and inte- gration of Living Labs into public policy (Furlan et al., 2024; Zingraff-Hamed et al., 2020). Together, these insights clarify the potential and limits of Living Labs as instruments of systemic transformation in EU governance. This article aims to provide a structured and integrative overview of how Liv- ing Labs have been studied in the context of public policy and governance within the European Union. To guide the analysis, the following three re- search questions were formulated: RQ1: How are Living Labs integrated into EU governance and public policy in- novation frameworks, and what roles are they assigned within these processes? RQ2: What forms of co-creation and stakeholder engagement are highlighted in the literature, and how do these practices shape the functioning of Living Labs? RQ3: What conceptual clusters and recurring themes emerge in the academic discourse on Living Labs, particularly in relation to their governance structures, implementation challenges, and policy impact? By addressing these questions, the article offers a coherent overview of how Living Labs are defined, implemented, and interpreted within EU policy and governance frameworks. It clarifies the ways in which Living Labs are used - as platforms for innovation, as mechanisms for stakeholder participation, and as tools for institutional change. The review also highlights the variety of co-cre- ation practices described in the literature, distinguishing between inclusive, collaborative models and more limited or symbolic approaches. In addition, it identifies common challenges - such as weak institutional integration, un- equal power dynamics, and difficulties in evaluating long-term impact. Rather than compiling isolated findings, the article builds an integrated framework that helps researchers and policymakers better understand the potential and limitations of Living Labs and provides a foundation for more systematic fu- ture research and practice. 242 Central European Public Administration Review, Vol. 23, No. 2/2025 From Co-Creation to Circular Cities: Exploring Living Labs in EU Governance Frameworks – A Literature Review To position this contribution within the broader state of the art, it is necessary to clarify how Living Labs are defined in this study and which conceptual mod- els provide the analytical anchors for our review. We adopt a governance-oriented definition of Living Labs as real-world, multi-stakeholder infrastructures that organize iterative cycles of co-cre- ation to inform and adjust public decision-making (Westerlund, Leminen and Habib, 2018; Scholl and Kemp, 2016). Two conceptual anchors structure our approach. The first is provided by platform- and function-based typologies, which differentiate product-, service-, process-, and policy-oriented labs and emphasize the contrast between technology-driven and policy-oriented ex- periments (Westerlund et al., 2018; Scholl and Kemp, 2016). The second an- chor stems from transition-oriented taxonomies that classify labs according to their role in exploring, shaping, or institutionalizing systemic change (McCrory et al., 2020; 2022). Building on these perspectives, our review advances the state of the art by systematically mapping ten keyword co-occurrence clus- ters into four governance dimensions—institutional anchoring, collaborative learning, circular transition, and methodological consolidation—thus offering a novel synthesis that clarifies how Living Labs function as infrastructures for governance innovation in the EU context. 2 Methodology 2.1 Methodological Design This study follows a systematic literature review (SLR) approach designed to synthesize existing knowledge on the use of Living Labs in public policy inno- vation and experimental governance within the European Union. The review was conducted according to the PRISMA 2020 (Haddaway et al., 2022) guide- lines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), ensuring methodological transparency, replicability, and academic rigor. 2.2 Inclusion and Exclusion Criteria To ensure consistency and relevance, only peer-reviewed articles and pro- ceedings papers published between 2008 and 2025 were considered. These documents had to be written in English, Spanish, French, Portuguese, and accessible through Open Access, allowing for full-text analysis. The studies were required to explicitly address Living Labs (including terms such as “urban living labs” or “territorial living labs”) and to link these to at least one core theme: public policy, governance, co-creation, policy experimentation, pub- lic sector innovation, or regional development. All studies had to be situated within the geographical boundaries of the European Union or refer specifical- ly to EU institutions or programs. Publications that did not meet these criteria were excluded. Book chapters (n = 15) and early access articles (n = 8) were removed due to lack of defini- tive peer-review status at the time of screening. Additionally, thematic exclu- Central European Public Administration Review, Vol. 23, No. 2/2025 243 Mari-Isabella Stan, Tănase Tasențe sion was applied based on Web of Science categories. Technical fields such as Computer Science, Engineering, Medical Informatics, and Telecommuni- cations were filtered out, as they do not address the participatory, institu- tional, or governance dimensions that are central to the Living Lab concept. Conversely, thematic categories relevant to governance, sustainability, policy design, urban planning, and social innovation were retained. After applying these criteria, 193 eligible studies remained. 2.3 Data Source and Database Selection The literature search was performed exclusively in the Web of Science Core Collection. This database was selected for its comprehensive coverage of high-impact peer-reviewed journals and its robust filtering tools that enable precise refinement by discipline, publication type, and geographic focus. Web of Science is particularly suited for interdisciplinary research combining polit- ical science, sustainability, urban studies, and innovation policy - disciplines at the heart of the Living Lab framework. 2.4. Search Strategy The search strategy employed a structured Boolean logic to combine themat- ic, conceptual, and geographical dimensions. The final query was: TS = (“living lab*” OR “urban living lab*” OR “territorial living lab*”) AND TS = (“public polic*” OR “policy innovation” OR “governance” OR “policy experi- mentation” OR “co-creation” OR “public sector innovation” OR “regional devel- opment”) AND ALL = (“European Union” OR “EU” OR “European Commission” OR “Austria” OR “Belgium” OR “Bulgaria” OR “Croatia” OR “Cyprus” OR “Czech Republic” OR “Denmark” OR “Estonia” OR “Finland” OR “France” OR “Germany” OR “Greece” OR “Hungary” OR “Ireland” OR “Italy” OR “Latvia” OR “Lithuania” OR “Luxem- bourg” OR “Malta” OR “Netherlands” OR “Poland” OR “Portugal” OR “Romania” OR “Slovakia” OR “Slovenia” OR “Spain” OR “Sweden”) This formulation ensured thematic relevance (Living Labs and public governance), conceptual focus (innovation, co-creation, experimentation), and geographical delimitation (EU-specific cases). 2.5 Study Selection Process The initial search in the Web of Science database identified 403 records. No duplicates or automation-based exclusions were necessary. All titles and ab- stracts were manually screened, leading to the exclusion of 210 studies that were either unrelated to the EU context, misused the term “Living Lab,” or 244 Central European Public Administration Review, Vol. 23, No. 2/2025 From Co-Creation to Circular Cities: Exploring Living Labs in EU Governance Frameworks – A Literature Review lacked a focus on policy or co-creation. From the 193 full-text articles selected for eligibility assessment, 2 could not be retrieved. Of the remaining 191, a further 114 were excluded for similar reasons, resulting in a final selection of 77 studies that met all inclusion criteria. The stages of this selection process are detailed in Figure 1. Figure 1. PRISMA flow diagram illustrating the selection process of studies on Living Labs within the EU context Identification of studies via databases and registers Records removed before screening: Records identified from*: Duplicate records removed Databases (n = 1) WoS (n = 0) Registers (n = 403) Records marked as ineligible by automation tools (n = 0) Records removed for other reasons (n = 0) Records screened Records excluded** (n = 403) (n = 210) Reports sought for retrieval Reports not retrieved (n = 193) (n = 2) Reports assessed for eligibility Reports excluded: (n = 191) Not relevant to EU governance context (n = 39) Misuse of 'Living Lab' (n = 29) No focus on policy or co- creation (n = 46) Studies included in review (n = 77) Reports of included studies (n = 77) Source: Authors’ own elaboration. Central European Public Administration Review, Vol. 23, No. 2/2025 245 Included Screening Identification Mari-Isabella Stan, Tănase Tasențe 2.6 Keyword Co-occurrence and Cluster Analysis To deepen the understanding of conceptual patterns emerging from the se- lected studies, a co-occurrence analysis of author keywords was conducted using VOSviewer. From the 77 retained articles, a total of 360 unique key- words were extracted. Applying a minimum occurrence threshold of two, 56 keywords met the criteria and were included in the analysis. The resulting se- mantic network, illustrated in Figure 2, identified ten thematic clusters that offer a structured analytical framework for organizing the literature and un- derstanding the key conceptual dimensions of Living Lab research. Figure 2. Keyword co-occurrence network generated with VOSviewer, illustrating ten thematic clusters that structure the conceptual landscape of Living Lab research Source: Authors’ own elaboration. The co-occurrence analysis of keywords reveals ten interconnected themat- ic clusters that map the conceptual landscape of Living Lab research. At the core lies the urban and institutional embedding of Living Labs, where con- cepts such as collaboration, governance, and sustainability reflect their role as experimental platforms within smart cities and public innovation ecosystems. This is closely linked to their function as adaptive governance tools anchored in municipal structures. A second thematic dimension emphasizes learning and scaling processes, where frameworks such as impact assessment, the qua- druple helix, and urban experiments highlight the iterative nature of knowl- edge co-production and policy refinement. In parallel, Living Labs emerge as catalysts for economic and social innovation, promoting circular economies, co-design, and urban transitions that respond to local development challeng- es. Reinforcing their participatory nature, another cluster points to democrat- 246 Central European Public Administration Review, Vol. 23, No. 2/2025 From Co-Creation to Circular Cities: Exploring Living Labs in EU Governance Frameworks – A Literature Review ic governance practices, with terms like citizen participation and stakeholder engagement underlining their inclusiveness and legitimacy. The spatial di- mension is further elaborated through place-based experimentation, as Living Labs adapt to community needs and urban regeneration efforts. Additional clusters explore their institutional architecture, particularly the role of collab- orative and multi-level governance in coordinating diverse actors and sustain- ing innovation. A transdisciplinary perspective complements this, recognizing Living Labs as hybrid spaces that merge pragmatic intervention with systemic learning across disciplines. Methodological concerns are also evident, with emphasis on tools such as interpretive structural modelling and structured experimentation to guide participatory processes and policy evaluation. Fi- nally, a distinctive cluster emphasizes the role of Living Labs in connecting scientific research with societal needs through citizen science and inclusive forms of knowledge co-production. Altogether, these clusters portray Living Labs as complex, context-sensitive instruments for innovation, capable of si- multaneously addressing urban challenges, fostering societal engagement, and reshaping governance through co-creative, evidence-based practices. 2.7 From Keyword Clusters to Governance Dimensions To move from descriptive co-occurrence clusters to an interpretive gover- nance framework, a structured sense-making procedure was applied. The ten clusters generated through VOSviewer (Figure 2) were first reviewed inde- pendently by two coders with expertise in governance and policy analysis. Each cluster was provisionally assigned to one of four overarching mecha- nisms identified in the state-of-the-art literature: (i) institutional anchoring (Westerlund, Leminen, and Habib, 2018; Scholl and Kemp, 2016), (ii) collabo- rative learning (McCrory et al., 2020; Bhatta, Vreugdenhil, and Slinger, 2025a), (iii) socio-economic and circular transitions (Amenta et al., 2019; Obersteg et al., 2020), and (iv) methodological consolidation (Broekema, Bulder, and Hor- lings, 2023; Sarabi et al., 2021). In the second step, coders compared and reconciled their classifications through iterative discussion, producing a consensual mapping of the ten clus- ters into four governance dimensions. This process ensured that no empirical content was lost: all ten clusters are presented descriptively in the Results section, while their aggregation into four dimensions forms the analytical lens developed in the Analysis section. This procedure follows best practices in systematic reviews, where inductive clustering is combined with deductive theoretical anchoring to enhance transparency and comparability across stud- ies. This approach allowed us to move beyond descriptive mapping and to generate an integrated governance-oriented framework, which constitutes the main conceptual contribution of this review. The outcome of this procedure is summarized in Figure 3, which visualizes the mapping of the ten keyword clusters into four governance-oriented di- mensions. Central European Public Administration Review, Vol. 23, No. 2/2025 247 Mari-Isabella Stan, Tănase Tasențe Figure 3. Mapping of the ten keyword clusters into four governance-oriented dimensions of Living Lab research in EU contexts Source: Authors’ own elaboration. 3 Results The keyword co-occurrence analysis of the 77 eligible studies generated a se- mantic network of ten thematic clusters, each representing a distinct but inter- connected strand of Living Lab scholarship within the European Union. These clusters reveal how the literature has evolved from localized case studies to- ward a complex research landscape structured around governance, learning, circularity, participation, methodological sophistication, and digital innovation. The first cluster highlights the institutional embedding of Living Labs in smart-city governance frameworks. Keywords such as governance, collabora- tion, and sustainability dominate this group, reflecting how municipal struc- tures integrate experimental methods into urban policy-making. Early studies in cities such as Amsterdam, Helsinki, and Barcelona demonstrated that poli- cy impact depends less on technological novelty and more on the density of cross-sectoral collaboration (Bulkeley et al., 2016; Bifulco et al., 2017; Voyten- ko et al., 2016). These findings underline the centrality of institutional anchor- ing in ensuring that Living Labs transcend isolated pilot status. A second cluster emphasizes learning and scaling processes, with keywords including impact assessment, quadruple helix, and urban experimentation. This stream of literature conceptualizes Living Labs as arenas for iterative knowledge co-production and organizational learning. Frameworks such as the Living Lab Learning Framework (Bhatta et al., 2025a) illustrate how ca- pacities are built across individual, organizational, and systemic levels, while follow-up studies identify pathways through which experimental insights become embedded into policy structures (Bhatta et al., 2025b; Fuglsang and Hansen, 2022). The third cluster captures the role of Living Labs in circular economy transi- tions. Terms such as co-design, metabolism, and waste management domi- 248 Central European Public Administration Review, Vol. 23, No. 2/2025 From Co-Creation to Circular Cities: Exploring Living Labs in EU Governance Frameworks – A Literature Review nate this group, underscoring the relevance of LLs as catalysts of systemic in- novation in urban sustainability. Projects such as REPAiR and related initiatives in Hamburg and Ghent show how participatory experimentation can translate European waste directives into neighborhood-specific planning scenarios and policy indicators (Amenta et al., 2019; Obersteg et al., 2020; Acke et al., 2020). A fourth cluster is oriented toward democratic governance and stakeholder participation. Keywords such as citizen participation, legitimacy, and co-de- cision point to the political dimension of Living Labs as sites of power redis- tribution and democratic renewal. Studies stress that LLs can only achieve legitimacy when participation is inclusive and when decision-making au- thority is effectively shared with citizens (Eneqvist et al., 2022; Campos and Marin-Gonzalez, 2023). The fifth cluster focuses on place-based experimentation and territorial an- choring, where the spatial dimension of LLs shapes both design and outcomes. Literature on urban regeneration and territorial living labs highlights how local identities, cultural heritage, and rural–urban linkages condition experimental trajectories and policy uptake (Falanga and Nunes, 2021; Oedl-Wieser et al., 2020). This perspective situates Living Labs as embedded infrastructures that mediate between place-specific needs and broader policy frameworks. The sixth cluster examines collaborative and multi-level governance architec- tures, reflecting how institutional design and legal frameworks determine the sustainability of Living Labs. Here, the focus is on coordination mechanisms, contractual arrangements, and risk allocation between municipalities, private actors, and civil society. Research shows that the degree of legal formaliza- tion and political oversight directly influences both legitimacy and long-term viability (Voorwinden et al., 2023; Mukhtar-Landgren, 2021). The seventh cluster identifies the transdisciplinary character of Living Labs, with keywords such as co-production, interdisciplinarity, and hybrid spaces. These studies conceptualize LLs as knowledge infrastructures that connect academic, civic, and professional perspectives, producing both pragmatic interventions and systemic learning (Brons et al., 2022; Kalinauskaite et al., 2021). The emphasis lies on LLs as hybrid arenas where knowledge integra- tion fosters transformative capacity. The eighth cluster addresses methodological innovation and evaluation frameworks. Literature in this group advances tools such as interpretive structural modelling, structured experimentation, and narrative analysis to assess co-creation processes and outcomes. Rather than focusing solely on outputs, these approaches evaluate the quality of interactions, learning dy- namics, and governance transformations enabled by LLs (Sarabi et al., 2021; Broekema et al., 2023). The ninth cluster explores citizen science and inclusive knowledge produc- tion, extending the participatory scope of Living Labs into environmental monitoring and civic epistemologies. By incorporating citizens as co-research- Central European Public Administration Review, Vol. 23, No. 2/2025 249 Mari-Isabella Stan, Tănase Tasențe ers, these initiatives democratize data production and expand legitimacy in governance processes (Slingerland and Overdiek, 2023). Finally, the tenth cluster highlights the role of digital and geodesign toolkits in hybridizing spatial simulation with participatory dialogue. These studies emphasize how GIS-based visualization and digital negotiation platforms ac- celerate consensus-building and translate abstract scenarios into actionable policies (Arciniegas et al., 2019; Furlan et al., 2024). Taken together, these ten clusters provide a comprehensive map of the con- ceptual terrain of Living Lab research in the EU context. They illustrate the field’s diversity, ranging from institutional and participatory perspectives to circular transitions, methodological refinement, and digital innovation. This descriptive mapping lays the empirical foundation for the subsequent anal- ysis, where the clusters are aggregated into four overarching governance dimensions that clarify how Living Labs function as infrastructures for experi- mental governance and policy innovation. The ten clusters reported above constitute the descriptive outcomes of the co-occurrence analysis (Results). In the next section (Analysis), we interpret these clusters through the two state-of-the-art anchors, integrating case ev- idence to derive four governance-oriented dimensions: institutional anchor- ing (A), collaborative learning (B), socio-economic/circular transitions (C), and methodological consolidation (D). 4 Analysis 4.1 Collaborative Governance and the Urban-Institutional Anchoring of Living Labs Initially emerging in Northern Europe as arenas for user-centred innovation, Living Labs (LLs) rapidly evolved into instruments for smart-city governance and evidence-based policymaking. This transformation, driven by municipal actors, reflects the integration of experimental methods into urban admin- istrative routines (Bulkeley et al., 2016; Munteanu et al., 2024; Voytenko et al., 2016). Comparative studies in Amsterdam, Helsinki, and Barcelona have demonstrated that the policy impact of LLs depends less on the novelty of technologies and more on the density and quality of cross-sectoral collabora- tion (Bifulco et al., 2017), indicating the centrality of institutional embedding. Nevertheless, as the concept proliferated across Europe, its meaning became diluted. Arias et al. (2025), analysing 95 cases, found that only 15% conformed to the canonical criteria of co-creation, testing, knowledge exchange, and re- al-life experimentation. Nearly half operated in controlled environments that marginalised citizen agency, illustrating a “semantic drift” that enables con- ventional testbeds or showcase pilots to adopt the LL label without participa- tory substance (Wehrmann et al., 2023). 250 Central European Public Administration Review, Vol. 23, No. 2/2025 From Co-Creation to Circular Cities: Exploring Living Labs in EU Governance Frameworks – A Literature Review This dilution is often associated with imbalances of power within LL config- urations. Backhaus and John (2025) identify three archetypes - optimizers, tailors, and co-creators – highlighting that only the latter meaningfully redis- tribute decision-making authority beyond technical experts. In the CLEVER Cities programme, nine Urban Living Labs (ULLs) in London, Milan, and Ham- burg progressed through three stages - partnership formation, governance modelling, and institutional consolidation – allowing for a gradual expansion of citizen influence over agenda-setting (Bradley et al., 2022). Trust-building, as shown in South Thamesmead, required intermediaries and “safe contact points” before residents transitioned from consultation to co-decision-mak- ing (Bradley and Mahmoud, 2024). However, the Swedish cases of Stockholm and Göteborg reveal an ongoing tension between the demand for quick, vis- ible outcomes and the slower deliberative processes that confer democratic legitimacy; in the absence of strong political oversight, such labs risk bypass- ing public scrutiny (Eneqvist et al., 2022). The relevance of LLs is especially pronounced when they are designed to ad- dress social justice issues. Energy-justice laboratories in Manchester, Metsovo, and Nyírbátor demonstrate that the success of energy retrofitting projects depended not merely on technical fixes, but on “intermediation of justice” by facilitators who aligned technical interventions with residents’ rights and rec- ognition (Bouzarovski et al., 2023). A similar conclusion emerges from Cam- pos and Marin-Gonzalez (2023), who show that LLs incorporating Responsible Innovation principles – anticipation, reflexivity, inclusiveness, and responsive- ness - are better equipped to prevent socio-technical conflicts. The territorial and spatial anchoring of Living Labs significantly shapes their ability to influence policy outcomes. In Hamburg-Altona, a circular economy LL managed to translate European waste directives into neighbourhood-specific planning scenarios, but only by aligning its experimental outputs with statu- tory governance frameworks through coordinated multi-level mechanisms (Obersteg et al., 2020). Similarly, Ghent’s bio-waste LL succeeded in promot- ing behavioural change and redefining performance metrics, yet this impact materialised only after its outcomes were formally validated within the Flem- ish Vision 2050 strategy (Acke et al., 2020). These cases highlight an important condition for the effectiveness of LLs: their integration into established insti- tutional structures that can absorb and legitimise innovation. Indeed, as Stan and Tasente (2023) argue, the capacity of public actors to foster transparency and engage meaningfully with citizens through digital communication is con- tingent upon the extent to which such practices are supported by stable gov- ernance arrangements and embedded routines. This reinforces the view that LLs yield sustainable impact not merely through experimentation, but through their alignment with broader systems of accountability and decision-making. Empirical validation of these patterns is offered by Dignum et al. (2020), who conducted a meta-analysis of 520 urban experiments across Europe. Their findings confirm that factors such as network density, existing intersectoral collaborations, and supportive political climates play an essential role in de- Central European Public Administration Review, Vol. 23, No. 2/2025 251 Mari-Isabella Stan, Tănase Tasențe termining whether LLs deliver incremental improvements or support more transformative change. Transnational, peri-urban, and rural–urban configurations introduce further complexity. The REPAiR labs in Naples and Amsterdam exemplify how dis- trict-level territorial anchoring and community identity can enhance adher- ence to circular economy principles (Amenta et al., 2019). By contrast, Ma- drid’s seven ULLs, although aligned with the Spanish Urban Agenda, lacked both citizen engagement and political uptake, limiting their systemic impact (Diaz-Sarachaga and Sanchez-Canete, 2024). At the rural–urban interface, ter- ritorial LLs in Styrian municipalities highlight the importance of flexible hor- izontal coordination to avoid reinforcing centre–periphery hierarchies (Oe- dl-Wieser et al., 2020). Beyond spatial and participatory dimensions, the legal-institutional infra- structure of LLs proves critical for their long-term sustainability. Voorwinden et al. (2023), analysing four smart-city LLs in Amsterdam, show how varying degrees of contractual formalisation shape risk allocation, stability, and the evolving role of municipalities – as both regulators and co-investors – rais- ing dilemmas of compliance and legitimacy. This perspective is deepened by Llancce et al. (2025), whose research on Rotterdam’s climate-resilient infra- structure identifies 19 governance factors – ranging from human capacity and finance to culture and communication – that determine whether pilot projects outlive their funding cycles. In Sweden, legal rigidity in smart-city ini- tiatives has curtailed local autonomy and shifted LL experimentation toward technocratic goals (Mukhtar-Landgren, 2021). However, when municipalities assume active roles - as innovators or mediators – LLs are more likely to gain social legitimacy and upscaling potential (Mukhtar-Landgren et al., 2019). Taken together, these findings underscore that the legitimacy and effective- ness of Living Labs rest on three foundational pillars: clear role allocation among actors, equitable power-sharing mechanisms, and robust institutional embedding. When these criteria are fulfilled, LLs can transcend their exper- imental status and act as constitutional devices that renegotiate the social contract of urban governance. In their absence, LLs risk reducing citizens to passive “beta-testers,” while innovation remains confined to peripheral demonstration zones. 4.2 Collaborative Learning, Democratic Legitimacy and Citizen Participation Beyond their institutional anchoring, Living Labs (LLs) are increasingly con- ceptualized in the literature as educational arenas where actors acquire new skills, reframe problems, and co-produce shared imaginaries. Drawing from constructivist and transformative learning theories, Bhatta et al. (2025a) de- velop a Living Lab Learning Framework that categorizes learning by type (con- tent, capacity, network), process (intentional vs. incidental), and level (individ- ual, team, organizational). Applying this framework to a water governance 252 Central European Public Administration Review, Vol. 23, No. 2/2025 From Co-Creation to Circular Cities: Exploring Living Labs in EU Governance Frameworks – A Literature Review project, they trace improvements in systems thinking and policy deliberation. A follow-up study identifies seven post hoc learning pathways - from knowl- edge integration to institutional norm change - emerging from a climate ad- aptation lab (Bhatta et al., 2025b). These theoretical insights are supported by empirical studies emphasizing the value of experiential learning and informal storytelling in co-creative na- ture-based LLs. Aniche et al. (2024) find that exposure to real-life contexts and openness to local narratives are key predictors of successful engagement. In Hamburg’s CLEVER Lab, sustained participation across phases was facilitat- ed by clearly defined institutional structures, credible local facilitators, and methods adapted to civic literacy levels (Arlati et al., 2021). Knowledge conti- nuity also plays a pivotal role: in Turin’s proGIreg Lab, the long-term viability of green corridors depended on community ownership, leadership stability, and shared responsibility (Battisti et al., 2024). A comparative survey of public-sec- tor LLs reveals that a balance of process learning, bounded experimentation, and genuine democratic engagement yields the most transformative results (Fuglsang and Hansen, 2022). At the core of these dynamics lies trust. Dupont et al. (2019), using the Co- coon Trust Matrix, show that transparency, reciprocity, and recognition of actors’ contributions prevent superficial or tokenistic participation. Brons et al. (2022) distinguish between two complementary LL modes: embedded laboratories rooted in everyday routines (breadth) and reflective spaces that generate critical foresight (depth). Sequencing these dimensions supports equitable stakeholder engagement, particularly in food system transitions. Istanbul’s Edible City projects further illustrate how informal environments, empathic facilitation, and flexible governance structures nurture creativity and strengthen ownership (Massari et al., 2023). Similar participatory mech- anisms have been reported in coastal regions, where trust was built through shared environmental awareness and strong place-based identities (Aivaz and Vancea, 2009; Stan et al., 2021). LLs do not only foster skill-building but also reshape collective meaning-mak- ing processes. Longitudinal research in Rotterdam’s Carnisse neighborhood demonstrates how the Resilience Lab co-produced a renewed sense of place through symbolic reinterpretation, visionary storytelling, and reimagined human–environment relations (Frantzeskaki et al., 2018, 2019). In Lisbon, the ROCK Lab mobilized cultural heritage in marginalized districts, but only when memory work was institutionally anchored and aligned with social co- hesion strategies (Falanga and Nunes, 2021). In Barcelona, the Library Living Lab transformed a conventional public library into a co-creation hub through challenge–action–return cycles, fostering civic empowerment (Vilarino et al., 2018). Similarly, dream-based visioning exercises in Swedish mobility labs en- abled participants to resist path dependency by unlocking new aspirational frames (Ebbesson, 2022). Yet inclusivity is far from guaranteed. The FIT4FOOD2030 project, which in- volved 25 LLs across Europe, exposed four persistent design dilemmas: rep- Central European Public Administration Review, Vol. 23, No. 2/2025 253 Mari-Isabella Stan, Tănase Tasențe resentation vs. deliberation, diversity vs. directionality, marginal vs. dominant actor dynamics, and challenges in defining participatory boundaries (Kok et al., 2021). Kalinauskaite et al. (2021) respond by proposing a transdisciplinary collaboration framework that emphasizes joint goal-setting, clearly defined roles, and iterative feedback loops to overcome fragmentation. In South-East- ern Europe, Belgrade’s NbS Lab shows how multi-level translation between niche innovation, urban regimes, and political landscapes is essential for in- clusive participation (Mitic-Radulovic and Lalovic, 2021). Similar tensions are reported in Catalonia’s smart-city LLs, where citizens engage in slow “power banking” to rebalance institutional dominance (Nguyen et al., 2022). Universi- ty-anchored LLs offer a promising alternative: the EPIC-WE hubs, for instance, integrate students, cultural institutions, and creative industries, simultane- ously enhancing legitimacy and innovation (Norgard and Holflod, 2025). Learning processes yield systemic impact only when integrated into formal policy cycles. Ehnert (2025) documents how Dresden’s City of the Future lab reoriented public officials from top-down planners to facilitators of change, but only after learning outcomes were strategically embedded into munic- ipal structures. Nordic experiments on autonomous buses underscore that process documentation, decision-maker engagement, and reflexive evalua- tion are key to scaling lessons beyond the pilot phase (Muur and Karo, 2023). This is echoed in platforms from Rotterdam, Leuven, and Malmö, which foster institutional change by aligning design, learning, and governance capacities (Rehm et al., 2021). These findings are further supported by evidence from consultations with students in urban planning and related disciplines, who as- sociate hands-on, community-based learning with more active involvement in public life and increased trust in institutions (Stan et al., 2023). Additional insights from participatory urban planning reveal that meaningful citizen en- gagement emerges especially when public consultations enable the articu- lation of concerns related to green spaces, cultural identity, and procedural legitimacy - suggesting that democratic learning is most effective when insti- tutions acknowledge and integrate community priorities into planning frame- works (Slave et al., 2023). Conversely, in the absence of deeper institutional integration, Living Labs tend to result in limited learning outcomes. In the Swedish case studies, in- cluding the Uddevalla Living Lab, collaborative efforts generated individu- al-level insights but fell short of triggering broader organizational or systemic change, largely due to the disconnect between voluntary engagement and formal planning structures (Pettersson et al., 2018). Institutional capacity proves essential. Freiburg’s e-mobility lab required a mix of technological expertise, participatory facilitation, risk management, and reflexive learning; failure in any area stalled progress (Teko and Lah, 2022). In Allgäu, a tourism-focused LL relied on continuous feedback loops to bal- ance resident needs with destination development strategies (Thees et al., 2020). Some labs even go beyond anthropocentric participation. Biodiversity sensing labs incorporate plants and animals as epistemic actors, broadening 254 Central European Public Administration Review, Vol. 23, No. 2/2025 From Co-Creation to Circular Cities: Exploring Living Labs in EU Governance Frameworks – A Literature Review both the scope and legitimacy of environmental monitoring (Slingerland and Overdiek, 2023). When there are no clear mechanisms to integrate outcomes into existing institutional structures, Living Labs risk remaining ethereal and temporary initiatives, lacking the capacity to generate concrete results or long-term sustainable change (Soeiro, 2021). 4.3 Socio-Economic Innovation, Circular Transitions and Rural– Urban Convergence A third stream of research frames Living Labs (LLs) as key enablers of systemic transitions across critical sectors such as waste management, water, energy, mobility, and food. This perspective emphasizes the role of LLs not just as ex- perimental zones, but as embedded infrastructures capable of guiding com- plex socio-technical change. The REPAiR project exemplifies this approach, integrating the Geodesign Decision Support Environment into regional labs that visualized the spatial impact of waste flows and facilitated the co-design of circular land-use scenarios (Arciniegas et al., 2019). The labs in Naples and Amsterdam, through cycles of co-exploration and co-governance, showed that meaningful collaboration between experts and citizens can generate en- forceable strategies for regenerating degraded wastescapes (Amenta et al., 2019). Hamburg’s circular-economy lab highlighted the need for continuous multi-level negotiation to align land-use planning with resource metabolism (Obersteg et al., 2020), while Ghent’s bio-waste lab reframed policy indicators to reflect lifecycle thinking (Acke et al., 2020). In response to crisis conditions, LLs have also demonstrated rapid prototyping capacities. The FURNISH project, developed during the COVID-19 lockdown, deployed mobile urban elements and used an iterative LOOP Scheme to mon- itor their spatial and social impacts (Aquilue et al., 2021). Berlin’s Sustainable Living Lab applied urban design thinking to co-create last-mile cycling logistics hubs, showing that early-stage end-user engagement reduces resistance to adoption (Alexandrakis, 2021). Similarly, Freiburg’s e-mobility labs conducted capacity-needs assessments to synchronise training programmes with infra- structural investments (Teko and Lah, 2022). Pilot initiatives such as Munich’s City2Share, Barcelona’s Superblocks, and Austria’s Digibus Koppl reveal five discursive strategies – from quick wins to momentum-building narratives – that justify project continuation even in the absence of immediate quantita- tive outcomes (Jung and Wentland, 2024). The integration of participatory digital tools is another key strength. Partic- ipatory geodesign in Amsterdam, Hamburg, and Naples demonstrated how combining spatial simulation with stakeholder dialogue can yield strategies that balance ambition with feasibility (Furlan et al., 2024). In Greece, Kar- ditsa’s regional energy lab successfully aligned spatial concepts, business models, and community alliances, reinforcing that integrated planning out- performs siloed sectoral approaches (Giannouli et al., 2018). In Lucca, food policy labs bridged rural–urban divides by envisioning peri-urban agricultural Central European Public Administration Review, Vol. 23, No. 2/2025 255 Mari-Isabella Stan, Tănase Tasențe parks, highlighting that systemic change depends on policy coherence and multi-scalar partnerships (Galli et al., 2024). In this regard, agroecological LLs in Italy, the Netherlands, and the United Kingdom operate as transdisciplinary platforms for rethinking food systems. These labs facilitate sustained collaboration among farmers, researchers, NGOs, and local governments through participatory activities such as work- shops, collaborative mapping, and knowledge-sharing processes. By connect- ing grassroots knowledge with scientific and policy frameworks, they foster context-specific, inclusive solutions aimed at ecological resilience and food sovereignty (Rastorgueva et al., 2025). LLs have also been pivotal in the logistics sector. Gatta et al. (2017) combine desk research, participatory engagement, and simulation modelling to de- sign urban freight policies that reflect behavioral, financial, and operational constraints. A comparative study of cycling innovation in four European cities identifies 16 recurring dilemmas - ranging from vision alignment to monitor- ing limitations – and concludes that reflexive governance and clear scale-up pathways are essential for LL success (van Waes et al., 2021). Nordic pilots with autonomous buses further show that technical viability is insufficient without institutional learning infrastructures (Muur and Karo, 2023), while studies of Swedish mobility interventions reveal that economic nudges often fail without supportive urban design (Sjoman et al., 2020). Cultural and heritage-led labs introduce an additional dimension of socio-spa- tial justice. In Split, a regional LL reconciled post-pandemic tourism with sus- tainability by promoting low-volume, high-value cultural routes and treating heritage authenticity as a form of economic capital. A Mediterranean compar- ative analysis confirms that resilience in cultural LLs requires agenda co-defi- nition among small operators, local authorities, and residents (Mandic et al., 2025). In Salerno, the “Hack the City” initiative gamified heritage revitalization through micro-interventions and co-created cultural indicators that localized the broader vision of the New European Bauhaus (Cerreta et al., 2021). Mean- while, Bremen’s biodiversity lab mainstreams more-than-human sensing by positioning plants and insects as co-researchers, thereby reframing urban ecosystem governance (Slingerland and Overdiek, 2023). However, the question of scaling remains a persistent challenge. The Edible City Solutions initiative, across cities like Andernach, Berlin, Oslo, and Rotter- dam, proposes five complementary scaling modes – scaling up, deep, wide, across, and soft – demonstrating that long-term success depends on policy in- tegration and dedicated funding streams (Plassnig et al., 2022). Survey-based research in six European capitals shows that LLs with direct access to deci- sion-making levers are significantly more impactful than peripheral demon- strators (Prendeville et al., 2018). A typology of institutional ecosystems for climate resilience identifies community-decentralized and hybrid-partnerial models as the most adaptive, provided financing strategies are diversified and context-responsive (Llancce et al., 2025). On the commercial side, Med- Tech Living Labs illustrate four collaboration archetypes – exploration, incuba- 256 Central European Public Administration Review, Vol. 23, No. 2/2025 From Co-Creation to Circular Cities: Exploring Living Labs in EU Governance Frameworks – A Literature Review tor, integrator, and impact – mapping the trajectory from research to market while underscoring the need for alignment between technological maturity and market demand (Saad and Agogue, 2024). In sum, socio-economic perspectives position Living Labs as transitional nodes that translate circular, mobility, energy, and cultural aspirations into territo- rially grounded innovation trajectories. Their effectiveness depends on inte- grative design methodologies, multi-level governance alignment, adaptive financing mechanisms, and strategic pathways for upscaling. These findings are further supported by the recent techno-ecological model proposed by Kerboua et al., (2025), which demonstrates that transitioning from uncon- trolled landfilling to energy recovery can reduce greenhouse gas emissions by up to 99.87%, while simultaneously generating electrical power. 4.4 Methodological Consolidation and Transdisciplinary Evaluation The rapid proliferation of Living Labs (LLs) has prompted an equally urgent need for methodological consolidation. Responding to this, DeLosRios-White et al. (2020) propose the Life-Cycle Co-Creation Process - a cyclical framework encompassing five iterative phases: Co-Explore, Co-Design, Co-Experiment, Co-Implement, and Co-Manage. This model serves as a procedural blueprint for nature-based urban interventions. Complementing this, Broekema et al. (2023) advanced a process-oriented evaluation method that moves beyond output metrics by analysing narrative dynamics, actor configurations, and emergent learning. They caution that a “tick-box exercise” approach to co-creation risks undermining the legitimacy of EU-funded social innovation programmes. To reduce conceptual ambiguity, several taxonomic efforts have emerged. McCrory et al. (2020) introduce a classification of four LL families - Living, Transition, Real-World, and Innovation Labs - subsequently extended into six functional modes ranging from Fix and Control to Explore and Shape (Mc- Crory et al., 2022). Westerlund et al. (2018) offer a platform-based typology based on whether the lab focuses on products, services, processes, or poli- cies, warning that unstructured diversity can lead to evaluative confusion. In a related vein, City-Lab research distinguishes policy-oriented labs from tech- nology-driven ones, suggesting that success in the former should be mea- sured through governance transformation rather than prototype adoption (Scholl and Kemp, 2016). New analytical methodologies further refine the understanding of co-cre- ation dynamics. Using Interpretive Structural Modelling (ISM), Sarabi et al. (2021) map causal hierarchies across 15 co-creation factors in nature-based LLs, identifying local learning and openness to informal contributions as sys- temic drivers. A systemic barrier model applied in Tampere, Eindhoven, and Genoa reveals that institutional capacity deficits are a key constraint in main- streaming nature-based solutions. To avoid elite capture by technical actors, Zingraff-Hamed et al. (2020) introduce an actor-mapping framework that cat- Central European Public Administration Review, Vol. 23, No. 2/2025 257 Mari-Isabella Stan, Tănase Tasențe egorizes stakeholders into four distinct roles: initiators, facilitators, influenc- ers, and beneficiaries. Digital tools play a central role in today’s hybrid LL methodologies. Geodesign exemplifies digital–dialogic hybridity by combining GIS-based visualization with stakeholder negotiation, accelerating consensus-building and enabling tangible planning outcomes (Arciniegas et al., 2019; Furlan et al., 2024). In higher education, digital platforms similarly function as infrastructural en- ablers of innovation and participation, facilitating institutional change and stakeholder engagement (Du et al., 2023). In parallel, data collaboratives emerging from Dutch city deals illustrate how co-governed data sharing requires clear legal frameworks addressing priva- cy, access, and accountability (Ruijer, 2021). Expanding the epistemic toolkit, “more-than-human citizen sensing” incorporates plants and insects as legit- imate contributors to urban knowledge systems (Slingerland and Overdiek, 2023). Within the cultural domain, the Play ReCH project combines gamifica- tion, participatory mapping, and design thinking to co-create locally validated monitoring indicators (Cerreta et al., 2021). However, methodological sophistication does not automatically translate into institutional uptake. University networks such as Italy’s RUS demonstrate that campus-based LLs can model SDG-oriented governance, but only if their findings are integrated into strategic institutional planning (Marchigiani and Garofolo, 2023). Comparative research between Dutch and Indonesian LLs highlights that performance criteria - such as co-creation depth, public im- pact, and financial sustainability - must be calibrated to local contexts (Wit- teveen et al., 2023). These findings reinforce the need for digitally competent administrations capable of leveraging citizen feedback and social media plat- forms for policy learning and adaptive governance (Stan and Tasente, 2024). In rural contexts, socio-ecological LLs require long-term institutional infra- structures beyond project-based cycles. The integration of Theory of Change workshops into groundwater governance initiatives across Italy, Greece, Tu- nisia, and Turkey has proven to be an effective model for institutional conti- nuity (Ceseracciu et al., 2025). Moreover, transition typologies suggest that “empower-and-govern” and “explore-and-shape” models demand flexible funding schemes and iterative evaluation to avoid reabsorption by dominant regimes (McCrory et al., 2022). Taken together, these methodological advances converge on three founda- tional pillars for the next generation of Living Labs: cyclical evaluation, explicit taxonomy, and hybrid digital–participatory toolkits. Standardizing these ele- ments is essential to prevent semantic drift and ensure that LLs contribute verifiably to public sector innovation. 258 Central European Public Administration Review, Vol. 23, No. 2/2025 From Co-Creation to Circular Cities: Exploring Living Labs in EU Governance Frameworks – A Literature Review 5 Discussion The results of this review demonstrate that Living Labs in the European Union cannot be understood solely as experimental spaces or pilot projects; rather, they must be framed as dynamic infrastructures of governance that connect actors, resources, and institutional logics. In this sense, the four gov- ernance-oriented dimensions distilled from the co-occurrence analysis—insti- tutional anchoring, collaborative learning, socio-economic and circular tran- sitions, and methodological consolidation—advance the conceptual field by showing how Living Labs evolve beyond isolated initiatives and acquire sys- temic relevance. From a theoretical perspective, these findings refine existing typologies. Pre- vious studies distinguished between product-, service-, process- and policy-ori- ented labs (Westerlund et al., 2018; Scholl and Kemp, 2016) or classified them according to their role in transitions (McCrory et al., 2020; 2022). Our synthesis contributes by demonstrating that the effectiveness of these categories de- pends on governance conditions. For example, policy-oriented labs are im- pactful only when they are institutionally embedded, legally recognized, and supported by political accountability. Without such conditions, the promise of co-creation risks collapsing into what Wehrmann et al. (2023) call “semantic drift,” where the Living Lab label is applied without substantive participatory substance. Thus, this review does not merely reproduce existing classifications but reinterprets them through the lens of governance infrastructures. The analysis also illuminates how Living Labs recalibrate democratic legitima- cy. While inclusivity is frequently claimed, genuine participation remains un- even. Studies reviewed here indicate that trust-building, procedural fairness, and recognition of citizen agency are decisive for moving from consultation toward co-decision (Bradley et al., 2022; Campos and Marin-Gonzalez, 2023). These insights align with frameworks of responsible innovation, which stress anticipation, reflexivity, and responsiveness (Owen et al., 2013), but they ex- tend them by emphasizing the institutional routines that enable trust to be embedded in governance systems. In this respect, Living Labs should not be seen as parallel arenas to formal policymaking, but as boundary infrastruc- tures that strengthen democratic accountability within existing institutions. The socio-economic and circular transitions dimension further clarifies the role of LLs in addressing systemic challenges. Projects such as REPAiR or CLEVER Cities demonstrate that Living Labs can translate abstract sustainabil- ity goals into territorial grounded strategies (Amenta et al., 2019; Obersteg et al., 2020). Yet, the evidence also reveals that circular pilots remain vulnerable when policy alignment and financing are absent. Here, our contribution to the state of the art lies in demonstrating that systemic impact arises not from the novelty of tools—be they GIS, geodesign, or participatory mapping—but from their integration into multi-level governance architectures that ensure continuity beyond project cycles. Central European Public Administration Review, Vol. 23, No. 2/2025 259 Mari-Isabella Stan, Tănase Tasențe Equally important is the recognition that methodological diversity, while often celebrated, has generated fragmentation. The clusters identified in this review show that evaluation approaches vary from interpretive modelling (Sarabi et al., 2021) to narrative analysis (Broekema et al., 2023), with little convergence. This lack of consolidation impedes comparative research and policy learning. By foregrounding methodological consolidation as a governance dimension, our review moves beyond descriptive cataloguing and calls for standardized reporting criteria that capture co-creation depth, learning outputs, and scale- up trajectories. Such criteria would help to preserve analytical clarity and pre- vent the Living Lab concept from becoming a diffuse metaphor. Taken together, these findings have three implications. First, they reframe Living Labs as evolving governance ecologies rather than static models of inno- vation delivery. Their value lies not in isolated outputs, but in their ability to connect experimental practices to institutional norms, thereby shaping the capacity of public administrations to act under conditions of uncertainty and contestation. Second, they show that democratization within Living Labs is not automatic; it requires explicit mechanisms for redistributing power, es- tablishing procedural fairness, and embedding trust. Third, they underscore that methodological rigour is a political issue: without standardized evalua- tion, Living Labs risk serving as symbolic showcases rather than engines of systemic change. For practitioners, the discussion highlights several managerial lessons. Munic- ipalities and funders should move beyond “pilotism” and ensure that Living Labs are structurally linked to decision-making routines. This requires legal frameworks (sandbox clauses, contractual clarity), long-term financing strat- egies, and dedicated roles for intermediaries who facilitate trust and transla- tion. It also requires that scaling is planned as a multi-modal process—scaling up, deep, wide, across, and soft—so that experiments do not remain isolated but diffuse their impact across governance layers. Finally, digital tools should be deployed not merely for efficiency, but for democratization, ensuring that technological infrastructures expand rather than restrict participation. In summary, this discussion positions Living Labs as infrastructures for gover- nance innovation in the EU context. By linking our empirical clusters to estab- lished typologies and transition theories, we demonstrate how LLs contribute to recalibrating institutions, fostering democratic learning, and enabling sys- temic transitions. This interpretive framework advances the state of the art by moving beyond descriptive accounts and by proposing a governance-ori- ented model that clarifies both the promises and the limits of Living Labs in contemporary public administration. 6 Conclusion The systematic review of Living Labs (LLs) within the European Union gover- nance context reveals that their transformative potential cannot be assumed based on format alone. While Living Labs are frequently presented as inno- 260 Central European Public Administration Review, Vol. 23, No. 2/2025 From Co-Creation to Circular Cities: Exploring Living Labs in EU Governance Frameworks – A Literature Review vative arenas for co-creation and public experimentation, their actual impact depends on how deeply they are embedded in institutional structures, how effectively they distribute agency, and how consistently they facilitate long- term learning across governance layers. What emerges most clearly is that LLs function not as standalone interven- tions, but as boundary infrastructures - interfaces through which institutions, citizens, and knowledge systems are reconfigured. Their contribution to public sector innovation stems from the extent to which they are integrated into formal decision-making routines, regulatory frameworks, and institution- al memory. Labs that remain disconnected from these systems, even when methodologically sophisticated, tend to remain marginal or symbolic. Participation within LLs remains a contested and uneven practice. Many initiatives claim inclusivity and co-creation yet fail to establish procedural mechanisms that shift the locus of decision-making beyond technical or ad- ministrative actors. Genuine collaboration is often undermined by tokenis- tic consultation formats and unaddressed power asymmetries. The review shows that only those configurations that explicitly enable shared ownership, iterative feedback, and the institutionalization of trust dynamics succeed in generating democratic legitimacy. The spatial and territorial positioning of LLs significantly influences their ef- fectiveness. Labs situated within well-connected governance ecosystems – with existing intersectoral partnerships and adaptive policy cultures - are more likely to evolve into catalysts for systemic change. In contrast, projects isolated from political uptake or implemented through rigid institutional log- ics frequently result in stalled innovation, regardless of their local relevance. As LLs expand into peri-urban, rural, and transnational domains, the necessity of context-sensitive design becomes increasingly apparent. Flexible gover- nance architectures and participatory tools that adapt to local conditions - no- tably through co-design, narrative-based engagement, and transdisciplinary mediation - are crucial to navigating the complexity of multi-scalar transitions. Where such tools are absent, LLs risk reproducing existing inequalities or rein- forcing centre–periphery divides. A major challenge lies in the methodological landscape of LL research itself. Although numerous frameworks and typologies exist, their adoption remains fragmented, and comparative insights are often impeded by the absence of standardized reporting criteria. Methodological consolidation is not merely a technical need - it is essential to ensure that the LL concept retains analytical clarity and evaluative integrity. Without this, the risk of conceptual inflation remains high, and so too the danger of policy misuse. The hybrid character of LLs - spanning digital infrastructure, civic facilitation, and institutional experimentation - introduces both strengths and vulnerabil- ities. Digital tools can support transparency, dialogue, and scenario-building, but can also marginalize participants without technological access or fluency. Central European Public Administration Review, Vol. 23, No. 2/2025 261 Mari-Isabella Stan, Tănase Tasențe The effective governance of LLs thus requires not only technical sophistica- tion, but sustained investment in civic literacy and epistemic pluralism. From a theoretical standpoint, the review invites a shift in how LLs are framed - not as fixed models of innovation delivery, but as evolving governance ecol- ogies. They should be assessed based on their capacity to recalibrate adminis- trative norms, bridge fragmented knowledge regimes, and support adaptive institutions capable of responding to complexity and contestation. This repo- sitioning situates LLs within broader trajectories of democratic governance renewal and sustainability transition. The future relevance of Living Labs will depend on how convincingly they can be institutionalized without losing their experimental vitality; how meaning- fully they can democratize the production of knowledge and policy; and how responsibly they can navigate the tensions between openness, accountabili- ty, and innovation. Only under such conditions can LLs serve not as symbolic containers, but as generative spaces where new forms of collective intelli- gence and governance take root. 7 Limitations and Future Research Directions Despite its systematic scope, this review is constrained by several structur- al limitations inherent to the Living Lab literature. A major challenge stems from the lack of standardized methodologies for defining, documenting, and evaluating Living Labs across different institutional and territorial contexts. The heterogeneity of conceptual frameworks – often varying between tech- nological, participatory, and policy-driven interpretations – complicates both comparative analysis and cumulative knowledge building. Furthermore, the absence of consistent reporting standards across case studies limits the abili- ty to assess depth of co-creation, governance integration, or long-term policy impact. While the co-occurrence analysis provides a structured overview of thematic clusters, it does not substitute for a critical appraisal of the quali- ty or replicability of individual studies. Future research should prioritize the development of harmonized evaluation metrics, longitudinal monitoring of LL outcomes, and cross-national typologies that account for local policy eco- systems. 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Sustainability, 12(20), p. 8625. https://doi. org/10.3390/su12208625 Central European Public Administration Review, Vol. 23, No. 2/2025 269 DOI: 10.17573/cepar.2025.2.10 1.01 Original scientific paper The Ombudsman as a Guardian of Good Governance: Insights from North Macedonia Natalija Shikova International Balkan University, Faculty of Law, North Macedonia n.shikova@ibu.edu.mk https://orcid.org/0000-0003-3885-7870 Received: 11. 3. 2025 Revised: 7. 5. 2025 Accepted: 9. 6. 2025 Published: 11. 11. 2025 ABSTRACT Purpose: The purpose of this paper is to present the role of the Ombuds- man in upholding the principles of good governance when protecting and promoting the rights of citizens and other individuals within a demo- cratic framework. The research focuses on the work of the Ombudsman in North Macedonia, examining its activities and its authority over public institutions when acting or failing to act. Design/Methodology/Approach: The research methods applied include desk research, an analysis of documents and reports related to the insti- tutional and legal set-up of the Ombudsman’s office in North Macedonia, and content analysis. To understand the complexities of the Ombuds- man’s competencies within the Macedonian institutional set-up, a com- parative analysis was conducted, covering examples from the EU and other global contexts. To clarify the findings, semi-structured interviews were conducted with relevant officials, including the Ombudsman of North Macedonia and its deputies. Findings: The results of this research indicate that, although the Om- budsman is empowered to protect the human rights and freedoms of in- dividuals or groups when they are violated by state authorities, its efforts to contribute towards the efficient and effective operation of public ad- ministration, and to promote the principles of good governance and the right to good administration in North Macedonia, are limited. However, this corresponds with the overall efficiency of the institution and its po- sition within the legal and political system. In general, the institutional response to the Ombudsman’s remarks is weak, as evidenced by missed hearings before the Government, delays in the adoption of its annual re- ports by Parliament, a lack of public debate, and insufficient implementa- tion of follow-up measures addressing the Ombudsman’s remarks. Fur- thermore, the Ombudsman institution does not enjoy full independence. Practical Implications: The paper is based on research conducted in 2023/2024 and provides clear and structured recommendations for the Shikova, N. (2025). The Ombudsman as a Guardian of Good Governance: Insights from North Macedonia. 271 Central European Public Administration Review, 23(2), pp. 271–299 2591-2259 / This is an open access article under the CC-BY-SA license https://creativecommons.org/licenses/by-sa/4.0/ Natalija Shikova improvement of the Ombudsman’s office in North Macedonia, aimed at achieving good governance standards. Due to its practical applicability, the recommendations can serve to improve the work of Ombudsman of- fices elsewhere in the region and beyond. Originality/Value: This research highlights the role of the Ombudsman in fostering good governance and presents it as a necessary condition for establishing a robust system for the protection of individual rights. Often, the work of the Ombudsman is analysed through its ex officio inter- ventions aimed at protecting rights when violated by state institutions. In this sense, the office intervenes with proposals, suggestions, and rec- ommendations, acting as a guardian of individuals’ rights in relation to public administration. This research presents another perspective on the Ombudsman’s role—often neglected in public discourse—by offering a broader view of its function in upholding democratic standards and good governance principles. Keywords: challenges, good governance, human rights, North Macedonia, ombudsman Varuh človekovih pravic kot varuh dobrega upravljanja: spoznanja iz Severne Makedonije POVZETEK Namen: prispevek predstavi vlogo varuha človekovih pravic pri uvelja- vljanju načel dobrega upravljanja pri varstvu in spodbujanju pravic drža- vljanov in drugih posameznikov v demokratičnem okviru. Raziskava se osredotoča na delo varuha v Severni Makedoniji ter preučuje njegove de- javnosti in pristojnosti nad javnimi institucijami pri njihovem delovanju ali opustitvi dolžnega ravnanja. Zasnova/metodologija/pristop: uporabljene raziskovalne metode vklju- čujejo preučevanje virov, analizo dokumentov in poročil, povezanih z institucionalno in pravno ureditvijo urada varuha v Severni Makedoniji, ter analizo vsebine. Za razumevanje kompleksnosti pristojnosti varuha znotraj makedonske institucionalne ureditve je bila izvedena primerjalna analiza, ki zajema primere iz EU in drugih svetovnih kontekstov. Za poja- snitev ugotovitev so bili opravljeni polstrukturirani intervjuji z relevantni- mi uradniki, vključno z varuhom človekovih pravic Severne Makedonije in njegovimi namestniki. Ugotovitve: rezultati raziskave kažejo, da je varuh sicer pooblaščen za varovanje človekovih pravic in svoboščin posameznikov ali skupin, kadar jih kršijo državni organi, vendar so njegova prizadevanja za prispevek k učinkovitemu in uspešnemu delovanju javne uprave ter za spodbujanje načel dobrega upravljanja in pravice do dobrega upravljanja v Severni Makedoniji omejena. To pa je v skladu s splošno učinkovitostjo institu- cije in njenim položajem v pravnem in političnem sistemu. Na splošno je institucionalni odziv na pripombe varuha šibek, kar se kaže v izpuščenih obravnavah pred vlado, zamudah pri sprejemanju njegovih letnih poročil v parlamentu, pomanjkanju javne razprave ter nezadostnem izvajanju na- knadnih ukrepov za obravnavo varuhovih pripomb. Poleg tega institucija varuha ne uživa polne neodvisnosti. Praktične posledice: prispevek temelji na raziskavi, opravljeni v letih 2023/2024, in podaja jasna in strukturirana priporočila za izboljšanje de- 272 Central European Public Administration Review, Vol. 23, No. 2/2025 The Ombudsman as a Guardian of Good Governance: Insights from North Macedonia lovanja urada varuha v Severni Makedoniji z namenom doseganja stan- dardov dobrega upravljanja. Zaradi svoje praktične uporabnosti lahko priporočila prispevajo k izboljšanju dela uradov varuhov človekovih pravic drugje v regiji in širše. Izvirnost/vrednost: raziskava poudarja vlogo varuha pri spodbujanju do- brega upravljanja in ga predstavlja kot nujni pogoj za vzpostavitev trdne- ga sistema varstva pravic posameznikov. Delo varuha je pogosto analizira- no skozi njegove posege po uradni dolžnosti, usmerjene v zaščito pravic, kadar jih kršijo državni organi. V tem smislu urad posega s predlogi, po- budami in priporočili ter deluje kot varuh pravic posameznikov v razmerju do javne uprave. Ta raziskava ponuja še en, v javnem diskurzu pogosto za- postavljen vidik varuhove vloge, saj nudi širši pogled na njegovo funkcijo pri uveljavljanju demokratičnih standardov in načel dobrega upravljanja. Ključne besede: izzivi, dobro upravljanje, človekove pravice, Severna Makedonija, va- ruh človekovih pravic/ombudsman JEL: K23 H83 1 Introduction This paper aims to clarify the role of the Ombudsman in upholding the prin- ciples of good governance within the political system of North Macedonia. The research examines the work of the Ombudsman in general, focusing on its authority over public institutions and the services they provide to citizens. The Ombudsman is empowered to protect the human rights and freedoms of individuals or groups when violated by state authorities, intervening with pro- posals, suggestions, and recommendations. Through this role, the Ombuds- man indirectly contributes to the efficient and effective operation of public administration, supports achieving democratic standards and promotes the principles of good governance. As a case study, this research paper focuses on the Ombudsman work in North Macedonia. Being a transitional democracy striving for European Union (EU) membership, North Macedonia’s Ombudsman faces several challenges within its public governance system. Despite its establishment as an independent body, the Ombudsman does not hold a prominent position within the political system although its prerogatives suggest it should. An enhanced role in this setup is essential for the Ombudsman to fulfil its core function: protecting human rights. However, institutional response to the Ombudsman’s remarks remains weak, hearings before the Government regarding its reports are often evaded, its annual reports acceptance are delayed by the Parliament, and follow-up measures to keep public institutions accountable are lacking. Additionally, the Ombudsman as an institution lacks complete financial inde- pendence, affecting its functional independence. On the other hand, it does not maintain separate statistics on complaints against the administration and does not report inconsistencies in how institutional and governmental bodies respond to its remarks. Therefore, it is essential to strengthen the Ombuds- Central European Public Administration Review, Vol. 23, No. 2/2025 273 Natalija Shikova man’s position to ensure that it can demonstrate and maintain strong role in upholding the principles of good governance and protection of human rights. The paper aims to identify weaknesses in the current system while also high- lighting best practices and providing recommendations for strengthening the Ombudsman’s position. It also highlights the importance of aligning the Om- budsman’s role with other non-governmental actors, such as CSOs and the media, to better achieve its objectives. 2 Methods This paper is a result of research conducted in the period November 2023 – October 2024. It is a part of the project Enhancement of Governance and Public Administration Reforms funded by the National Endowment for Democracy (NED) and implemented by the Center for Change Management (CCM). The main aim of the project was to raise awareness among citizens to seek high professional standards, efficient institutions, and success in the operation of public administration. This research envisages the need to improve institu- tional accountability, encouraging citizens to be engaged and to demand re- sponsibility from the administration for implementing the necessary reforms and applying the standards of good governance. Its particular focus was mon- itoring the work of the Ombudsman of the Republic of North Macedonia, con- sidering the institutions’ response towards citizens’ requests and complaints. The specific objective of the research was to understand the role of the Om- budsman in fulfilling the principles of good governance in North Macedonia, i.e. the protection and promotion of citizens’ rights arising from that sphere. The assumed weaknesses in the work of the Ombudsman were that the an- nual reports issued by the Ombudsman do not focus on the relationship be- tween citizens and the administration, but are narrowly focused on certain vulnerable groups, although its areas of activity are broad. Additionally, the Ombudsman’s activity over the years has been modest, with a small number of initiatives and a small amount of information, i.e. the Ombudsman institu- tion was not proactive enough. The research methods were the content analysis based on the desk research findings (analysis of documents and reports), an analysis of the documents related to the institutional and legal set-up of the Ombudsman’s office; the analysis of how the Ombudsman’s reports are managed, as well as their con- tent analysis, i.e. which aspects they cover and on which human rights are fo- cused. Additionally, comparative analyses were conducted using EU and glob- al examples to get valuable insights. To clarify the findings’ semi-structured interviews were conducted with relevant officials, including the Ombudsman of North Macedonia and its deputies. Based on that the recommendations for improvement were created. The undertaken research steps should answer the main research question, re- lated to the clarification of the role, competencies, and the power of the Om- budsman in North Macedonia to promote good governance principles, and 274 Central European Public Administration Review, Vol. 23, No. 2/2025 The Ombudsman as a Guardian of Good Governance: Insights from North Macedonia with that support the reforms towards a more efficient and effective system of public administration. 3 Results 3.1 The Ombudsperson in Its Core The protection of human rights and the elimination of their abuse are essen- tial functions of democratic governments. The Ombudsman is an institution established to contribute to the fulfilment of these goals. The increased sen- sitivity to human rights, the challenges and problems faced by the judiciary, the expansion of the functions of the public administration, as well as the commitment to fulfilling values such as transparency, accountability, and citi- zen participation in public processes, are currently leading to the strengthen- ing of the role of the Ombudsman and the increase of its function in society. Historically, institutions or officials similar to the modern Ombudsman have been observed in the Roman, Chinese, Islamic, and Spanish systems (Reif, 2004). However, the country from which the institution of the Ombudsman originated is considered to be the Kingdom of Sweden. According to the scholarship, the King of Sweden, Charles XII, after his military defeat by Russia in 1709, took refuge in the Ottoman Empire. During this period, the King es- tablished an office that was to monitor the behaviour of the Swedish adminis- tration on his behalf, and this was the beginning of the emergence of the first modern institution of the Ombudsman (Stern, 2008). After Sweden, the insti- tution of the Ombudsman was also established in Finland (1919), and then in Norway (1952), Denmark (1955), and West Germany (1956). Therefore, for a long historical period, the Ombudsman as an institution existed only in North- ern European countries. In the early 1960s, the idea of an Ombudsman was also adopted by the Commonwealth countries, and this institution was found- ed first in New Zealand (in 1962), and then in other countries (Rowat, 1964). The collapse of totalitarian regimes in Portugal, Spain, and Greece, and the process of democratization in the countries of Central and Eastern Europe after the Cold War contributed to the acceptance of the idea of an Ombuds- man in these regions as well, so it can be said that the Ombudsman institution contributed, i.e. was part of the democratization movements respectfully (Kucsko-Stadlmayer, 2008). Apart from the need for democratization, one of the most important reasons that has encouraged the increase in the number of these institutions is the idea of a welfare state, which in the 1950s swept the whole world. Within the framework of these tendencies are also the ideas of establishing mech- anisms for protecting the rights of citizens concerning public administration. The fact that the institution of the Ombudsman is easily accessible to citi- zens, it provides free assistance, and is relatively fast in comparison with the judicial system, has played a key role in the establishment of Ombudsman offices in many countries around the world (Rowat, 1964). As a result, Om- budsman institutions are considered as an alternative in situations in which Central European Public Administration Review, Vol. 23, No. 2/2025 275 Natalija Shikova judicial procedures are unavailable, or simply unrealistic to implement (Reif, 2004). Additionally, the Ombudsman institution is inherently flexible, adapt- able, and therefore acceptable to countries with different political and ad- ministrative cultures (Cheng, 1968). This contributes to the easy incorpora- tion of Ombudsman institutions into different national contexts but is also a prerequisite for the existence of institutions that have diverse organizational structures. However, certain characteristics are common to this institution, i.e. the Ombudsman as an institution is: (1) legally established, (2) functionally autonomous, (3) outside the system of administration, (4) operationally inde- pendent of both the legislative and executive branches, (5) may have a certain specialty, (6) expert, (7) non-partisan, (8) universal, (9) citizen-oriented, (10) easily accessible and socially visible (Hill, 1974). The name of the institution, its status, duties, powers, jurisdiction, and proce- dures vary between countries around the world. In Norway, the Netherlands, Australia, New Zealand, Ireland, Canada, and Malta, the original name of the institution – Ombudsman – is used. The institution is called the Parliamentary Commissioner for Administration in the United Kingdom and Sri Lanka; the Mediator of the Republic in Francophone countries such as France, Senegal, and Burkina Faso; and the Defender of the People in Spain, Argentina, Peru and Bolivia (Reif, 2004). In some countries, the institution of the Ombudsman is constitutionally established (Sweden, Norway, Spain, and the Netherlands), and in some, it is established by a law passed by the national parliament (France, Belgium, and the United Kingdom) (Kucsko-Stadlmayer, 2008). Com- paratively, in most cases, the Ombudsman is appointed and dismissed by the parliament of the country. However, in the United Kingdom, the Ombudsman is appointed by the executive (or the King/Queen), in France by the Council of Ministers, while in some countries by the President of the State (Turkey, Ka- zakhstan, etc.). Regarding his/her dismissal, in some countries, the Ombuds- man cannot be dismissed from the office before the end of his/her term of office (Austria). In many countries around the world the Ombudsman cannot be reappointed (France, Israel, and Azerbaijan). In some countries, there is no limit on the re-appointment of an Ombudsman (Sweden, Norway, and Fin- land), while in some countries the Ombudsman can only be appointed twice (Russia, Portugal, and Ireland) (Kucsko-Stadlmayer, 2008). In terms of the functions of the institution, the classic function of the Om- budsman is to investigate citizens’ complaints against the executive branch by acting on complaints or ex officio. However, in recent years, Ombudsmen around the world have been given new functions. Therefore, in addition to investigating complaints for the protection of human rights, these institu- tions are also gaining new roles in combating corruption, preventing abuse of power by elected and high-ranking public officials, eliminating conflicts of interest, preventing nepotism (Reif, 2004), or like in North Macedonia to mon- itor the principle of the equitable representation with the public administra- tion. The powers (scope of control) of Ombudsman institutions are different in different countries and they are generally shaped by the aforementioned political and administrative traditions in the countries in which they are es- 276 Central European Public Administration Review, Vol. 23, No. 2/2025 The Ombudsman as a Guardian of Good Governance: Insights from North Macedonia tablished. For example, in Sweden, in addition to the central government and local authorities, the army and the judiciary are also under the control of the Ombudsman (Capozzola, 1968). In Norway, local self-government, ministerial decisions, court decisions, and the work of auditors are outside the Ombuds- man’s jurisdiction. Ombudsmen generally have the authority to investigate, request relevant documents, hear citizens, review the decisions of relevant public institutions, and create reports on them. However, the Ombudsman institution is not a judicial body and does not have the power to impose sanc- tions (Letowska, 1990). In principle, no financial fees are required to file a complaint in front of the Ombudsman. Citizens can often communicate their complaints directly. How- ever, in some countries such as the United Kingdom and France, a complaint cannot be submitted directly to the Ombudsman, and citizens can do so through a senator, or member of a Parliament (MP). With the exception of countries like the United Kingdom, Belgium, and Luxembourg, Ombudsmen have a general authority to act ex officio, as well as to conduct investigations upon the complaints (Kucsko-Stadlmayer, 2008). 3.2 The Ombudsman and the Principles of Good Governance The importance of the Ombudsman is also reflected in the fact that current- ly, only a few countries in the world have not established such an institution (Zahid Sobaci and Hatipoğlu, 2023). In general, the role of the Ombudsman is to receive, investigate, and resolve complaints from citizens regarding the ac- tions or inaction of the public administration. Therefore, in addition to parlia- mentary control and judicial review, the Ombudsman is a control mechanism of the public administration, i.e. of the executive branch. The Ombudsman is not a judicial body and cannot replace the role of the judicial authorities, but in a democratic state, it has a complementary role. To understand the role of the Ombudsman in promoting of the principles of the good governance it is necessary to clarify what is meant under the concept of good governance, and how the related standards can be effectuated. 3.2.1 The Concept of Good Governance Good governance is the basis of democratic decision-making. It increases democracy and contributes towards social and economic development. Al- though there are numerous attempts to define the concept of good gov- ernance, for some theorists it is a complicated activity that does not have many practical consequences (Doornbos, 2001). However, to understand its essence, according to most authors, the concept of good governance should be divided into its constituent components (principles) (Gisselquist, 2012). Nevertheless, although there are many definitions of what constitutes good governance, they all share common elements. The principle of transparency is one of them and is related to the openness of institutions, i.e. making information generated by institutions available to the public through various mechanisms. A way to achieve transparency is to Central European Public Administration Review, Vol. 23, No. 2/2025 277 Natalija Shikova strengthen freedom of information, known as the right of access to public information – a right that provides the opportunity for citizens and other so- cial entities to seek and receive information from the work of a certain in- stitution that has the character of the public. This mechanism is a powerful (although usually underused) instrument for controlling the activities of the government and public administration. Another aspect of transparency is the proactive publication of information by institutions in a generalized man- ner, as well as the creation of electronic services for citizens. In addition to transparency, the principle of participation is extremely important for good governance. Through this principle, non-state actors have the opportunity to provide government actors and, in general, society with knowledge, different views, and attitudes. This ensures fairness in the processes, i.e. it contributes to decisions and policies being not only legal but also correct and appropriate, i.e. it ensures the democratic legitimacy of decisions. However, participation must be based on certain criteria that allow for the diversity and appropri- ateness of participants. The criteria must prevent bias, i.e. the articulation of vested interests. Therefore, they must guarantee impartiality and objectivity in the selection of participants (Shikova, 2022). The principle of accountability is also important for good governance. It is a social relationship in which the actor feels obliged to explain and justify his behaviour to someone else (Bovens, 2005). One of the most important results of this democratic principle is the premise that those who exercise public powers must be responsible for how they use those powers since they exercise them towards the citizens, and in their name. Accountability gains greater significance if it is linked to the assumption of political responsibility by political leaders concerning their political programs (Peters, 2008). Access to information and transparency directly affect accountability and help the functioning of the above-described mechanisms that ensure it. Good governance also encompasses the principle of effectiveness. It is the achievement of a result that corresponds to the goals set by the institution. Every institution has to act effectively, and this entails the need to act effi- ciently and economically. Applying the principle of effectiveness means that in performing its function, the public administration considers the available resources in relation to the goals it needs to achieve, and on this basis creates practically feasible alternatives for action. Before choosing one of them, the options need to be considered and the possible effects of the choice need to be explained (Cerrillo-i-Martínez, 2023). There are also some traditional mechanisms for guaranteeing accountability such as elections and periodic audit reports related to public spending (Agere, 2000). But apart from them, the new accountability mechanisms that have emerged recently are more flexible and help to overcome the limitations of traditional mechanisms. Some of them are the introduction of the institution of the Ombudsman, the formation of decentralized power structures, the in- troduction of mechanisms for citizen participation in policy-making process- es, the strengthened role of the media, as well as measures for strengthened internal administrative control. 278 Central European Public Administration Review, Vol. 23, No. 2/2025 The Ombudsman as a Guardian of Good Governance: Insights from North Macedonia 3.2.2 The Ombudsman and Good Governance Principles Through its activities, the Ombudsman improves the functioning of pub- lic administration and contributes to good governance. In this context, the Ombudsman institution helps to strengthen the efficiency, functionality, transparency, and accountability of public administration, educates the cit- izens, and this increases citizens’ trust in public institutions. Therefore, the Ombudsman institution directly backs the achievement of democratic stan- dards. This corresponds with focused investigation of the activities of public officials, external financial audit, various internal methods and mechanisms, as well as a strengthened role of the Ombudsman. This role of the Ombuds- man arises from global trends, in which, in light of economic and other prob- lems, the state is forced to respond to growing public expectations. There- fore, it is extremely important to balance the interests of the individuals and groups with the public interest, to connect them and accommodate them. Although the public servants should be dedicated to the public interest, that is not always the cases, i.e. often, there are occasions in which public ser- vants avoid or even refuse to do what is essentially expected of them, i.e. to decide, act, propose, defend, etc., or simply to be responsible. Therefore, in this social setting, the role of the Ombudsman gains importance. The Om- budsman as an institution influences and promotes the ethics, and responsi- bility of public servants, and through its acting towards complaints of human rights violations, it directly targets the unlawfulness, abuse of power, and unfair behaviour (Pliscoff, 2019). Unclear administrative procedures additionally burdened with various bu- reaucratic manoeuvres can directly affect the protection of citizens’ rights. As a result of past legacies, the administrative state was (and still is to some extent) highly bureaucratic, and hence, under the influence of EU integra- tion processes, it can be observed that established concepts and related un- derstandings are already changing. As a result, the state is becoming more service-oriented toward citizens and more aware that the services provided should be within the framework of legality and the principles of the rule of law (Leyland and Anthony, 2016). By failing to act or acting outside the estab- lished legal competencies, the rights of the citizen are affected, especially the rights of those who are marginalized and stigmatized by the majority commu- nity (such as homosexuals, transgender people, people with disabilities, and even in some cases women). Although the duties, powers, and procedures of the Ombudsman vary from country to country, increased awareness of human rights has paved the way for the specification of international standards related to the structure and powers that the institution should have. In this regard, there are numerous regional and international initiatives, as well as international organizations that assist the standardization process. In addition to establishing standards for the structure and functioning of the Ombudsman, another issue is need to assess the effectiveness of the work of a particular institution (Zahid Sobaci and Hatipoğlu, 2023). Central European Public Administration Review, Vol. 23, No. 2/2025 279 Natalija Shikova 3.2.3 Classical vs. Human Rights Ombudsman in Upholding Good Governance Principles In theory and practice, there is a division between classical and human rights ombudsmen, and those two models or a hybrid one can be found in most European countries, considering their role in promoting good governance by monitoring administrative behaviour and protecting and promoting human rights. The classical model is often in Scandinavian countries (to which compe- tencies over jurisdiction to human rights are given in addition to their primary role in administrative justice), while the human rights Ombudsman and hy- brid ones are typical for the countries that transitioned to democracy, mostly Eastern European countries. The Ombudsman institutions play a variety of roles in building good governance by monitoring the administrative activity in the country and in protecting and promoting human rights. Their acting can be observed by monitoring the “legality” of the public administration, embracing notions of equality, fairness, and good governance. Human rights monitoring is mainly considered an enlargement of the classical or initial role of the Ombudsman after functioning for a relatively long time (for example Sweden, Finland, Netherlands, etc.). On the other hand, when it comes to the younger democracies, the typical model is human rights, or hybrid model of the Ombudsman with priority in its human rights protection function. The ef- forts of the Ombudsman which follows the classical model, are more visible in the promotion of good governance in public administration, and its additional competencies in human rights contribute to monitoring of a state’s compli- ance with human rights obligations. In that sense, the direct use of human rights norms can be used to determine if the administrative conduct is in line with the laws. For instance, in the Netherlands, the Ombudsman uses human rights norms as “orientation criteria” in the assessment of the administrative conduct that is in question. The classical Ombudsman institution investigates administrative conduct if the administration violates the legal interests of the individual if the administration is not fulfilling specific obligations imposed by an administrative act, or in cases when the administration by its acting vi- olates the principles of good administration and transparency. This example can be found in Greece where the institution is considered to be a human rights Ombudsman with classical ombudsman powers, but the majority of complaints are against poor administrative practices and not human rights protection (Reif, 2004). The Human Rights Ombudsman, as an institution mainly occurred after the collapse of the Soviet Union and the beginnings of the democratization of Central and Eastern Europe. In their attempts to establish democracies, these countries started to redesign or create new institutions that would en- hance the rule of law, overcome bureaucratic practices, and improve human rights records. Therefore, the countries established national human rights institutions, attempting in the same time, and within the same institution to address human rights protection and poor administration. Those institu- tions often have a predominated mandate and that is human rights protec- tion. In essence that is misleading, since although the term “ombudsman” is 280 Central European Public Administration Review, Vol. 23, No. 2/2025 The Ombudsman as a Guardian of Good Governance: Insights from North Macedonia used, most of those institutions are close to the Human Rights Commission model, instead of institutions that have a mandate to protect administra- tive justice. There are theoreticians who argue that the role of the human rights Ombudsman is more important in the countries that went through the transition to democracy (the ones in Central and Eastern Europe, in com- parison to the established democracies) since the Ombudsman can help in the development of democracy, strengthen the rule of law and influence the modernization of the state institutions. Through its acting it can draw attention to needed legislative changes, harmonization of the laws, reform of the structure and the institutions of the government, and change of the public authorities’ practices (Bizjak, 2001). Nevertheless, classical and hybrid Ombudsman institutions play a crucial role in fostering democratic accountability and development by function- ing as both horizontal and vertical mechanisms of oversight within a dem- ocratic state. This dual role enables Ombudsmen to enhance the effective- ness of public administration while contributing to the broader objectives of good governance. The Ombudsman institutions are increasingly seen as instrumental in achieving good governance, which is often linked with public administration and human rights protection. In many countries, the execu- tive branch has historically dominated governance, often at the expense of weaker legislative and judicial branches, prompting efforts to strengthen these institutions, particularly during democratic transitions or post-conflict reconstruction. These efforts frequently involve reforming the executive or administrative branches to address legacies of authoritarian rule, human rights violations, administrative inefficiency, corruption, and the absence of democratic norms. Establishing classical or hybrid Ombudsman institutions has become a common response, with the aim of enhancing accountability and promoting democratic governance. These institutions—especially hybrid ones with mandates in human rights protection, anti-corruption, or enforce- ment of leadership codes—function as mechanisms of horizontal account- ability by independently investigating administrative conduct, recommending legal or policy reforms, reporting to legislatures and the public, and in some cases, initiating legal action. However, the effectiveness of an Ombudsman is closely tied to the quality of democracy in a given state; in states lacking democratic structures, Ombudsmen face significant operational challenges, and any regression in democratic governance can directly impair their ability to function. In a well-functioning democracy, Ombudsman institutions help ensure that the administrative branch remains accountable to the public and operates within legal and ethical boundaries (Reif, 2004). For an Ombudsman institution to serve effectively as a mechanism of hori- zontal accountability, it must be structurally independent of the executive or administrative branch of government—a fundamental requirement—along with other factors that influence its overall effectiveness. Vertical accountabil- ity is often associated with the ability of citizens to hold leaders accountable through regular, free, and fair elections. However, the Ombudsman enhances this process by allowing individuals to file complaints about unlawful or unjust Central European Public Administration Review, Vol. 23, No. 2/2025 281 Natalija Shikova administrative behaviour. In doing so, they subject government conduct to impartial review, potentially resulting in criticism or, where empowered, more substantial consequences. In that way, the Ombudsman reinforces democrat- ic governance and positions it closely with the principles of good governance. By working to improve all the core elements such as transparency of public administration, the accountability of public authorities, public participation, and application of principles of fairness, the Ombudsmen institutions help in building good governance. It is obvious that at some point, the Ombudsman as a concept and even as an institution was removed from its legal roots in the administrative law (Erk- kila, 2020). It expanded outside the Scandinavian context since it was main- ly seen as a country milestone towards democratic accountability and good governance. After the collapse of totalitarianism, within the countries in Eu- rope that established them, the institutions were modified and adjusted to the specific social, economic, cultural, and political contexts upon which the success of the institution depended. This novelty of the institution affected its legitimacy and public perception, considered to be even at some point “a legal transplant.” Those issues have to be borne in mind when assessing the efficiency of a particular institution in protecting good governance prin- ciples. It is without doubt the institution’s effectiveness will be limited if it is dependent on the executive. This could create a ‘patron-client relationship’, and in general will influence not only public perception but also well percep- tion of the administrative institutions towards it. The effectiveness depends on the function that has been given to the institution, but on the other hand, it depends on the personality of the office holder. Lack of responsiveness of all public authorities and less proactivity in some cases led to the phenom- enon of ‘institutional hypocrisy’, where the institution finds the reasons for ineffectiveness in a lack of resources, although in most cases the institution’s effectiveness depends upon office holder authority, the public support that enjoys as well as the responsiveness of all public authorities towards the in- stitution (Dragos, 2021). As it is now, in younger democracies, the Ombudsman Institution’s primary role appears to focus more on providing an additional layer of constitutional oversight rather than ensuring the implementation of good governance prin- ciples by the administration. However, its effectiveness must be understood within the broader context of the country’s democratic tradition, whereas the institution is often seen more as symbolic affirmations of democratic values than as practical tools for enforcing accountability and administrative integ- rity (Balica, 2011) The mere establishment of the Ombudsman Institution, as outlined in the Constitution and its governing statute, has not automatically led to enhanced legal protection for citizens in their interactions with public authorities. Its effective implementation depends on time, the presence of a democratic framework, a supportive legal and political culture, as well as general level of democracy (Dragos, 2021). There are certain theoretical debates accompanied with some empirical evi- dence, that are assessing the capacities of the Ombudsman institution in de- 282 Central European Public Administration Review, Vol. 23, No. 2/2025 The Ombudsman as a Guardian of Good Governance: Insights from North Macedonia veloping the norms of good administration (Dragos & Neamtu, 2017). Based on the powers that has, the Ombudsman institutions are classified as basic or classical model, the rule of law model, and the Ombudsman that follows the human rights model (Kucsko-Stadlmayer, 2008). If the standards of as- sessments are applied that take into consideration the legal norms, the good administration principles, and human rights (Remac, 2014), arguably only in the systems where the good administration is used as the main standard of assessment, the Ombudsmen can provide content, and the institution have more potential to materially develop the concept of good administration materially. The examples of their acting can include checklists for good ad- ministrative practice, the codes of good administrative behaviours, as well as taking initiatives to tackle the existing and systemic maladministration. On the other hand, other types of Ombudsmen will be limited in that regard, and can only apply the existing legal provisions within the initiated cases. Even in a sort of advanced model, this limitation can be observed in the case of the EU Ombudsman as well, where the institution is developer of norms of good ad- ministration predominately in the area of free access to information, but has a rather limited role as developer of norms of good administration through individual decisions. However, the power to apply and to present the princi- ples understandably should not be underestimated in creating good admin- istration norms, although legally this can be more seen as an interpretation, and giving meaning to the existing principles (Dragos & Neamtu, 2017). 3.2.4 EU Practices Considering the EU practices, the European Administrative Space is a growing body of European administrative standards. The administrative convergence of the EU is also reflected through the general administrative procedures. One of the most recent initiatives is the codification of the EU administrative procedural law as Model Rules applicable to all procedures carried out by the EU institutions, bodies, offices, and agencies. In South-Eastern Europe, the ongoing reforms of the general administrative procedural acts are an interac- tion between the legalistic tradition and the political and managerial pressure for the rationalization of public administration. The general administrative procedure is one of the key components in the system of legal protection of citizens. This system is complex and consists of an interdependent set of legally regulated institutions, procedural protection in public administration, national and international judicial control over administrative acts and ac- tions, judicial protection of constitutional rights (most often in constitutional courts), and among them protection through the Ombudsman. It guarantees of open access to the public information and protection of human rights and fundamental freedoms. All these efforts are in line with the right to good administration, part of the Charter of Fundamental Rights of the EU (2000), stipulated in Article 41. The right to good administration indicates that every person has the right to have his or her affairs handled impartially, fairly, and within a reasonable time by the institutions, bodies, offices, and agencies of the Union. This right includes (a) the right of every person to be heard, before any individual measure that would adversely affect him or her is taken; (b) the Central European Public Administration Review, Vol. 23, No. 2/2025 283 Natalija Shikova right of every person to have access to his or her file, while respecting the legitimate interests of confidentiality and professional and business secrecy; (c) the obligation of the administration to give reasons for its decisions. Every person has the right to have the Union reimburse any damage caused by its institutions or by its servants in the performance of their duties, under the general principles common to the laws of the Member States. Every person may write to the institutions of the Union in one of the languages of the Trea- ties and must have an answer in the same language (European Union, 2000). The European Code of Good Administrative Behaviour is a European Ombuds- man’s document, that in 2002 was approved by the European Parliament. The Code shares best practices and promotes – within the institutions and beyond – a harmonized European citizen-centered administrative culture that listens to and learns from, interactions with citizens, businesses, and stake- holders. The Code is a guide to practical steps towards greater effectiveness, transparency, and accountability of public administration. All European cit- izens and residents benefit from good administration. The European Code of Good Administrative Behaviour is a vital instrument for putting the prin- ciple of good administration into practice. It helps citizens understand and exercise their rights and promotes the public interest in an open, efficient, and independent European administration. Creating an agreed and harmo- nized service culture in the EU is increasingly challenging, and the institutions are becoming aware of the practical business case for a citizen-centered ap- proach. The Code therefore concretises the concept of good administration and encourages administrations to reach the highest standards. It also acts to raise citizens’ awareness of what administrative standards they have the right to expect and serves as a useful guide for civil servants in their relations with the public (European Code, 2002). Therefore, the Code strongly affirms the Ombudsman role in protecting good governance principles. 3.3 The Ombudsman in North Macedonia The protection of citizens from the decisions of state bodies is a contemporary process and follows recent developments in which the citizen is perceived as the essence of the modern administrative state. Based on that position, the state has various duties and this encompasses the responsibility of adminis- trative bodies, as well as legal remedies that are available to citizens faced with abuse of power. The direct impact on the protection of human rights can also be seen in the legal framework of North Macedonia regarding fundamen- tal rights, which is largely in line with European standards. However, some mechanisms are not yet fully functional and they are a potential barrier to the full enjoyment of the granted rights. This particularly affects those whose rights are most often threatened and highlights the role of the Ombudsman as a guardian of citizens’ rights concerning the public administration. The Ombudsman in North Macedonia is a human rights Ombudsman (Народен правобранител), and that role is predominant. The Ombudsman mainly deals with the complaints concerning the treatment of persons deprived of their liberty (e.g. detainees, prisoners, persons in psychiatric facilities), police con- 284 Central European Public Administration Review, Vol. 23, No. 2/2025 The Ombudsman as a Guardian of Good Governance: Insights from North Macedonia duct, property rights, social and economic rights, and unreasonable delays in obtaining decisions in court and administrative proceedings feature promi- nently. That differs from the classical Ombudsman’s primary role is to investi- gate the complaints that consider that the administration of government was conducted in an illegal, unfair, or improper manner. Although appointed by the legislative, its nomination is done by the executive, making it a less inde- pendent institution, whereas both the executive and the legislative branches are not very responsive to the recommendations and reports of the Human Rights Ombudsman. 3.3.1 Legal Framework According to the Constitution of the North Macedonia (North Macedonia) (1991) (article 77 and Constitutional amendment XI), and the Law on the Ombudsman (2003), the Ombudsman is an independent national institution with the authority to protect the human rights and freedoms of individuals or groups of citizens when they are violated by the state authorities. The Law on the Ombudsman stipulates the condition for election, dismissal, competenc- es and way for working of the Ombudsman (Law on the Ombudsman 2003, article 1). The Ombudsman is elected for a term of eight years, with the right to one more election (Constitution of the Republic of North Macedonia, 1991, article 77). The election of the Ombudsman is upon so called Badinter majority, under which the Parliament elects the Ombudsman with a majority of votes from the total number of Members of Parliament, whereby there must be a majority of votes from the total number of Members of Parliament belonging to communities that are not in the majority in North Macedonia (Constitution of the Republic of North Macedonia, 1991, Constitutional amendment XI). Upon the Constitution and the Law, the Ombudsman is a body that protects the constitutional and legal rights of the citizens and any other individuals when they are violated with the acts and omissions of the bodies of the state administration and others institutions and bodies that have public authorities (Constitution of the Republic of North Macedonia, 1991, article 77; Law on the Ombudsman 2003, article 2). The Ombudsman’s powers do not extend to the private sector or the judiciary, except in cases of unjustified delay in the court procedure or irresponsibility of the judicial services (Law on the Om- budsman 2003, article 12). In this sense, the Ombudsman has no legislative, executive, or judicial powers and is neither a prosecution body nor an inspec- tion body. The Ombudsman is a control mechanism that intervenes with pro- posals, suggestions, recommendations, etc. Its role is ethical and moral and its activities are primarily aimed towards promoting and improving the efficient and effective operation of public administration, so the citizens and other in- dividuals can exercise of their rights. The Ombudsman has an educational and advisory role as well (ombudsman.mk). Summarized, the principles that underpin the work of the Ombudsman are independence, impartiality, professionalism, conscientiousness, objectivity, accountability, and urgency in terms of promoting, respecting, and protect- ing human rights and freedoms. The Ombudsman is independent in perform- Central European Public Administration Review, Vol. 23, No. 2/2025 285 Natalija Shikova ing its function. It performs its competences according and within the frame of Constitution, law and international agreements that are ratified upon the Constitution. In its acting, the Ombudsman can call as well upon the princi- ple of fairness (Law on the Ombudsman 2003, article 3). The Ombudsman of the Republic of North Macedonia received additional responsibility with the adoption of the Ohrid Framework Agreement in 2001. Namely, according to the Law and in practice the Ombudsman takes the measures for protection of the principles of non-discrimination and equitable and fair representation of the members of the communities in the bodies of the central power, the local - self-government unities and public institutions and services (Law on the Ombudsman 2003, article 2), i.e. in all state and local government bodies and public institutions. Every person in communication with the Ombudsman can use one of the country official languages and its script, and the institution responds on the Macedonian language and its Cyrillic script as well as on the official language and script used by the one who submitted the appeal (Law on the Ombuds- man 2003, article 15). The appeal should consist the data about the applicant, as well as the circumstances, facts and proves upon the appeal is based, how- ever there is no mandatory form that need to be followed during the submis- sion, neither process or tax fees (Law on the Ombudsman 2003, article 16). The new draft Law on the Ombudsman (which is still not brought by the Par- liament), among other things, it predicts full implementation of the Paris Prin- ciples,1 and financial independence as the basis for the functioning of the in- stitution (Draft Law for amend and supplement the Law on the Ombudsman, 2025; ombudsman.mk). 3.3.2 The Work of the Ombudsman Through its activities, the Ombudsman indirectly improves the functioning of public administration and contributes to good governance. The Ombudsman acts towards achievement of democratic standards. It intervenes: when the acts and activities of administrative bodies and other bodies within the public sector violate the individual rights of citizens and non-citizens; when respon- sible persons or other civil servants have incorrectly adopted administrative acts, incorrectly applied the laws; when they violated administrative or oth- er procedures; when they arbitrarily or incorrectly undertaken activities; and when they discriminated against people on any basis or behaved inhumanely. Considering its work the Ombudsman creates annual reports that are publicly presented and accepted in the Parliamentarian session, and upon them, the 1 The Paris Principles, adopted by the UN General Assembly in 1993 (Resolution A/RES/48/134), set out the following standards: Establishment under primary law or a constitution; Broad mandate to promote and protect human rights; Formal and functional independence; Plural- ism, representing all aspects of society; Adequate resources and financial autonomy; Free- dom to address any human rights issue; Annual report on the national human rights situation; Cooperation with national and international actors, including civil society. The accreditation process is essential as it demonstrates the credibility of the institution and ensures that these principles are applied in the national context, . 286 Central European Public Administration Review, Vol. 23, No. 2/2025 The Ombudsman as a Guardian of Good Governance: Insights from North Macedonia measures are created for the institutions to correct their behavior and im- prove human rights status. If we analyze the Annual reports of the Ombudsman office work in North Macedonia, in the last five years, that are available to the public, we can ob- serve many discrepancies. Annually, approximately, in North Macedonia there are around 3000 com- plaints directed to the Ombudsman office, which is quite a lot for the country that has less than 2 million inhabitants. Table 1: Number of the complains directed to the Ombudsman office per year. 4000 3458 3453 3500 3209 3000 2686 2802 2448 2500 2000 1500 1000 500 0 Year 2018 2019 2020 2021 2022 2023 Source: The Annual Report of the Ombudsman on the degree of granting, upholding, enhancement and protection of the human rights and freedoms, 2023. The complaints that Ombudsman office receives annually, are the most nu- merous in the area of justice, followed by the complaints in labour relations, children’s rights, penal – correctional and educational institutions. Table 2: The areas in which the complains are submitted per year. 2018 2019 2020 2021 2022 2023 Judiciary 945 639 406 436 534 488 Labor relations 335 282 258 218 288 267 Children's rights 153 246 111 254 252 231 Penal – correctional 247 267 166 162 206 166 inst. Other 1778 2019 1507 1616 1929 1650 Total 3458 3453 2448 2686 3209 2802 Source: The Annual Report of the Ombudsman on the degree of granting, upholding, enhancement and protection of the human rights and freedoms, 2023. Central European Public Administration Review, Vol. 23, No. 2/2025 287 Natalija Shikova Approximately 1/3 of the received cases are not processes in the ongoing year, meaning the office does not have sufficient capacities to proceed all the received complains annually. Table 3: The number of the processed cases by the Ombudsman office vis a vis non processed cases per year. 4500 4225 4000 3500 2802 2956 3000 2885 2543 2500 2000 1500 1000 480 388 526 273 433 500 0 Year 2019 2020 2021 2022 2023 Unprocessed cases Processed cases Source: Data from the Annual reports of the Ombudsman on the degree of granting, upholding, enhancement and protection of the human rights and freedoms, for years 2019–2023, compiled and processed by CCM. Most of the cases are initiated upon individual complaints, or complins logged by the CSOs or group of citizens, and a very small number are initiated by the Ombudsman office. For example, in 2023, only 1,93% cases are formed by the Ombudsman office own initiative, i.e. upon “heard voice” (Annual Report, 2023). That can be accounted to the Ombudsman office lack in equipped per- sonnel and understaffed, but as well as the restrictions that institution faces as a result of its semi-independent position within the political system and its codependence on the other institutions (for example Ministry of Finance approval over the Ombudsman institution budget, etc.). Additionally, still six out of ten Deputy Ombudspersons are not yet elected by the Parliament (Eu- ropean Commission, 2024). When processed and directed towards the public institutions, at the first indi- cation only in 20% of the institutions are acting and responding. This number increases as the Ombudsman office repeats its quests. The number of 20% corresponds only with response towards Ombudsman office, and does not indicates resolving of the cases, or acting upon Ombudsman remarks. This clearly shows that institutionally and practically, the Ombudsman office in- quires do not have such a strong impact over the concerned institutions. 288 Central European Public Administration Review, Vol. 23, No. 2/2025 The Ombudsman as a Guardian of Good Governance: Insights from North Macedonia Table 4: Cases initiated by the Ombudsman own initiative vis a vis complains lodged by the other parties’ complaints. 4000 3500 3416 3146 3000 2614 2748 2500 2403 2000 1500 1000 500 37 45 72 63 54 0 2019 2020 2021 2022 2023 Cases initiated by the Ombudsman office initiative Cases initiated upon received complaints Source: data from the Annual reports of the Ombudsman on the degree of granting, upholding, enhancement and protection of the human rights and freedoms, for years 2019-2023, compiled and processed by CCM. Based on the interviews conducted with the relevant officials, the institutions in the public sector are often reluctant towards Ombudsman office findings. Additionally, its annual reports that summarize office work in one calendar year reflecting the human rights situation in the country, are not seriously taken into account by the public sector. Often the Ombudsman’s Annual Report is adopted late, at the last yearly session of the Parliament, and due to the short deadline, there is no debate in regards the implementation of the recommendations part of the previous annual report. According to the deputy Ombudsman, in the last two years, no measures have been adopt- ed that need to be followed up, but only recommendations (Interview with Deputy Ombudsman Jovan Andonovski). Considering the implementation of the right to good administration and principles of good governance, the Om- budsman office does not keep separate statistics on complaints against the administration in respect of the legality, transparency, accountability, respon- sibility, conflict of interest, use of discretionary powers, etc., or at least they are not public. The reasons for this can be found in the challenges that the institution generally faces and its primary focus on the field on human rights protection instead of monitoring of the administrative conducts. As a result of its obviously week position within the political system, according to the obtained insights, in general, only 50% of the institutions are responding to the Ombudsman’s remarks; 30% of them react only after a second, or a third indication that they have not responded; and 15% of the institutions never re- spond to the Ombudsman inquires. Considering the responses that Ombuds- man receives, 40% of them are strictly formal, indicating that the remark was received and the institution will consider it, and 60% are content-wise. The ones that evade the most the Ombudsman remarks are the bodies that have special powers (Commissions, Agencies, etc.), as well as the prosecutor’s of- fices, the Ministry of Internal Affairs, and the National Security Agency. How- Central European Public Administration Review, Vol. 23, No. 2/2025 289 Natalija Shikova ever, after verification that there has been a violation of the law in respect to the human rights, the number of the institutions that are acting towards Om- budsman’s recommendations increases up to the 70% in total. When there is no response from the appropriate institution, the Ombudsman addresses the hierarchically higher authority, and in 2023, that happened 22 times. Al- though certain issues require a confrontation between the Ombudsman and the authority to which it relates, the Government does not organize such dis- cussions. The institution authority is not called to explain its position, and the Government only relies to the given answer in written form. That does not mean that the answer is adequate, considers the Ombudsman in office Naser Ziberi (Interview with Ombudsman Naser Ziberi). In addition, the Ombudsman as an institution does not enjoy full independence but is dependent in respect of the personnel, finances, and facilities. The institution does not have a suffi- cient budget to fully exercise its powers, as well as to network within interna- tional and regional associations of Ombudsman (Sakam da kazam, 2016). The Macedonian Ombudsman cooperates with the European Ombudsman, but in the European Ombudsman Association is a member - observer, i.e. an institu- tion with status B, precisely because of its dependent position. Table 5: The cases upon the institutions acted after the Ombudsman intervention vis a vis the cases that haven’t been any actions even after the Ombudsman intervention per year. 3500 3000 2921 2703 2500 2345 2186 2023 2000 1500 1000 532 425 500 506 457 500 0 2019 2020 2021 2022 2023 Acted after the Ombudsman intervention Other cases Source: data from the Annual reports of the Ombudsman on the degree of granting, upholding, enhancement and protection of the human rights and freedoms, for years 2019-2023, compiled and processed by CCM. 4 Discussion The Ombudsman in its acting supports the principle of good governance and helps to reach democratic standards. In protecting human rights, the Om- budsman’s office does not make binding decisions and impose sanctions; 290 Central European Public Administration Review, Vol. 23, No. 2/2025 The Ombudsman as a Guardian of Good Governance: Insights from North Macedonia however, it has strong, unformal power that exceeds the formal limits and directly influences society. It is evident that in North Macedonia the Ombuds- man’s role in promoting good governance principles is not so prominent, and to take a step forward the institution itself should get a more notable place in the democratic system that has tendencies to join the EU. The standards should be in place, and aligned with EU standards, but even more, a strong emphasis should be given to their implementation. To begin with, the extent to which institutions cooperate with the Ombudsman’s Office has to increase. Nonetheless, the cooperation is not a result of success but a level of institu- tional response towards the Ombudsman’s remarks. It is without doubt that this is not in consideration of a formal, provisional response, but it is related to the response that systematically and coherently addressed the Ombuds- man’s remarks. That non responsiveness points towards low level of public accountability of the public authorities and the public administration. Besides the responsibility related to the institutional responsiveness to the Ombuds- man remarks, the Ombudsman office needs to ensure a more systematic way for monitoring the implementation of its findings, as well as to measure im- plementation progress when addressing indicated shortcomings. That will increase the general transparency. Those aspects are important because in North Macedonia the citizens’ right to good administration is supported by the legal framework, but its implementation remains highly questionable, and even it in North Macedonia is a human right Ombudsman, the right to good governance is as well a right that has to be protected. Considering the general remarks about the functioning of the administration, that right is constantly violated since the institutions are not proactively publishing public data, the administrative disputes are unreasonably delayed, the appeal procedures are complex and lengthy, and the procedural shortcomings are common (Euro- pean Commission, 2023). Additionally, the debates in Parliament on Ombuds- man reports and are very limited, and there is need the Ombudsman findings and recommendations to be followed up more systematically and that can in- crease public scurunity over the work of the authorities, as well over the work of the Ombudsman institution. All of that indicated above is pointing that so far there has been lack of developments and progress related to the citizens’ rights to good administration (European Commission, 2024). To improve this situation, the Ombudsman’s role in general needs to be strengthened, and at the same time to be promoted as one of the mecha- nisms that should secure good governance principles and effectuate the right to good administration. Being the candidate country for EU membership, North Macedonia’s public sector should raise up to certain standards (Euro- pean Commission, 2024). It is without doubt that the Ombudsman should fully implement legally giv- en competencies. The most important power at the Ombudsman’s disposal is the publication of its annual reports. These reports carry significant moral and political weight, which should lead to voluntary compliance by institu- tions towards Omdurman’s remarks. This activity creates pressure on pub- lic officeholders and public institutions and it increases their accountability Central European Public Administration Review, Vol. 23, No. 2/2025 291 Natalija Shikova (Sobaci and Hatipoğlu, 2023). Given the scope of work and diversity of the Ombudsman activity, the aspect of good governance needs to be stressed whereas the special reports need to be created that investigate systemic de- ficiencies in the administrative system. Through this activity, the Ombudsman can contribute towards achieving good governance standards, a topic that is particularly relevant not only for the EU candidate countries but also for EU member states. Creating a common administrative space, in which EU cit- izens can protect their rights concerning the European administration pre- cisely through the European Ombudsman, is proof of that (ComPAct, 2023). Such a commitment in North Macedonia would not discredit the rest of the Ombudsman’s work but it will strengthen it. In this way, a general overview of the administration’s acting toward citizens’ rights would be secured, and the rights related to the separate categories of citizens (prisoners, residents of psychiatric institutions, the elderly, children...) could be a part of separate, special reports that will promote the work of the Ombudsman as a human rights defender. Currently, the annual reports of the Office of the Ombuds- man in North Macedonia have been focusing on the protection of the rights of numerous categories of citizens, but not on the general acting of the ad- ministration that violates those rights. The more focused approach will ef- fectuate the principles of good governance and in the same time will secure more scrutiny over human rights protection. Additionally, following the Eu- ropean Code of Good Governance (European Code, 2002), the Ombudsman of North Macedonia can create a National Code of Good Governance, as a set of standards that citizens can expect from the administrative acting. The Ombudsman should also keep separate statistics on complaints against the administration regarding the right to good administration that in itself em- bodies the good governance principles (legality, transparency, accountability, responsibility, conflict of interest, discretionary powers, etc.). To secure its role as a promotor of good governance principles, the Ombudsman institu- tion should create not only quantitative but qualitative reports related to the work of the administration that can be publicized periodically. To achieve this, cooperation with the European Ombudsman should be strengthened and the EU’s good practices should be considered. In these endeavours, the Ombuds- man should really on media support. The media and the civil society sector can help the institution to put pressure, influence public opinion, as well as to encourage citizen activism aimed at change (Sobaci and Hatipoğlu, 2023). The role of the Ombudsman is greater than simply handling complaints, and the institution should be focused more on raising public awareness about the general effectiveness and efficiency of the public administration (Interview with State Counselor in the Ombudsman’s Office, Vaska Bajramovska Mus- tafa). Additionally, to achieve the above-mentioned standards, and towards the successful functioning of the Ombudsman institution in general, it is nec- essary to monitor the institutional implementation of the recommendations arising from it. This will put pressure on the administration and will strength- en responsibility and accountability in the implementation of these recom- mendations, which are again in the direction of good governance protection. These special efforts will help towards society democratization that in recent 292 Central European Public Administration Review, Vol. 23, No. 2/2025 The Ombudsman as a Guardian of Good Governance: Insights from North Macedonia years has been in decline (n.b. For instance, the latest democracy index points that the Republic of North Macedonia is ranked 68th out of 210 countries and territories in the world, as a partially free country in the exercise of civil liberties and rights, Freedom House, 2024). The tendency towards EU membership and public administration reforms can help in those endeavours, but so far, the EU recommendations have not been addressed consistently, and the European Commission is repeating them yearly. The Commission is notifying the lack of Parliamentarian consen- sus for adopting important laws related to public administration reform, as well as the laws that were supposed to improve the status of the Ombuds- man’s office. The debate in the Parliament on the reports of the Ombudsman continued to be very limited and the Commission pointed to the absence of progress in citizens’ rights to good administration. This has to be further ad- dressed as well as the need for the allocation of the necessary resources for the Ombudsman Office to be able to fulfil its mandate (European Commis- sion, 2024). Apart from this, the financial independence of the institution has to be strengthened. In this line, it is important to mention that the State Audit Office recently identified systemic weaknesses, i.e. pointed out inconsistent and imprecise legal regulations that regulate the status, rights, and obliga- tions of the Ombudsman’s office employees, as well as the procedure for the election and appointment of the Ombudsman’s deputies (State Audit Office, 2023). All of these recommendations are recurrent but there is no systematic response towards them yet. Despite technical and legal challenges, in addition to responding to the cit- izens’ complaints, the Ombudsman should also act on his own initiative and so far, the institution is not so notably proactive. The Ombudsman needs to maintain neutrality, but also to ensure due respect in society. For the Ombuds- man to be successful, citizens need to believe that their complaints will have a result and that the actions taken by the institutions will be objective. The in- tegrity of the Ombudsman contributes to increasing citizens’ trust in the Om- budsman institution, as well as in the public institutions. Citizens should have a high awareness of the institution; they should be informed about the pro- cedures before it and the institution should always be accessible. To increase the visibility of the institution and emphasize its practical work, in addition to legal requirements, modern technical solutions are undoubtedly needed. All those factors affect the success of the institution but also point to weak- nesses where action needs to be taken. To improve, continuous efforts are necessary to address the shortcomings that are continuously highlighted by current and former responsible persons of the Ombudsman office, as well as by the professional and general public. In North Macedonia, the Ombuds- man’s Office has good cooperation with the media and civil sector, but there is a need for even stronger cooperation. In addition to appropriate legal and technical solutions, for the effectiveness of the Ombudsman, it is essential to have high standards of democracy and civic awareness that are mutually interconnected. Central European Public Administration Review, Vol. 23, No. 2/2025 293 Natalija Shikova 5 Conclusion This paper is based on research aimed at understanding the role of the Om- budsman in upholding the principles of good governance, specifically in protecting and promoting citizens’ rights in a democratic framework. The research focused on the work of the Ombudsman in North Macedonia, ex- amining its authority over public institutions and the services they provide to citizens. The Ombudsman is empowered to protect the human rights and freedoms of individuals or groups when they are violated by state authorities. It is a flexible and dynamic institution. Many countries around the world have established an Ombudsman institution at different levels of government (national, state, regional, and local), for different social groups (such as the disabled, children, women, and minorities) and in different sectors (such as universities, media, health services, etc.). However, it is difficult to say that the Ombudsman institution is very powerful and functions successfully in every country. For a powerful Ombudsman, some requirements need to be met, including maintaining the independence of the institution. A prerequisite for this is that the functioning of the Ombudsman institution is guaranteed by a constitution and laws, and this relates to the appointment of the Ombuds- man and its, conditions regarding the repeatability and duration of the man- date, and the resources that are at the institution’s disposal. The Ombudsman also contributes to the efficient and effective operation of public administration, helps achieve democratic standards, and promotes the principles of good governance. However, the Ombudsman in North Macedonia faces several challenges. It does not maintain separate statistics for complaints against the administration (upon the right to good administration), or if such statistics exist, they are not made public. There is also a weak response from the public institutions to the Ombudsman’s remarks, including missed hearings before the Government, delayed adoption of annual reports by the Parliament, and absence of subsequent measures that should address the Ombudsman’s remarks. Moreover, the Ombudsman institution does not enjoy complete in- dependence. It is crucial to highlight the role of the Ombudsman in fostering good governance—a necessary condition for the protection of citizens’ rights. Systematic monitoring of the achievement of standards in this area is essential. There is no doubt that changes towards a modern Ombudsman institution are needed in North Macedonia not only for upholding human rights but also for democratization and protection and promotion of good governance principles. It is evident that the Ombudsman of North Macedonia is not oper- ating at its full potential in contributing to administrative efficiency and the promotion of good governance principles. Its engagement in these areas can be characterized as moderate at best, and response of the public authorities towards its findings notably limited. This underperformance stems not only from systemic barriers—such as legal, institutional, and resource-related con- straints—but also from internal shortcomings, including moderate to low lev- el of self-initiative, i.e. an inclination toward passivity in addressing key gover- nance challenges. 294 Central European Public Administration Review, Vol. 23, No. 2/2025 The Ombudsman as a Guardian of Good Governance: Insights from North Macedonia 5.1 Recommendations for Improvement Based on the conduct research and performed analysis, several recommen- dations can be envisaged. To strengthen the role and impact of the Ombuds- man, there is need to modernize and reinforce both its internal methodology of working and its external influence over the system of governance. To begin with, the Ombudsman’s Annual Report should be revised to reflect the princi- ples of good governance—principles that are especially significant in the con- text of the European Union and its commitment to a shared administrative space. Therefore, a fresh approach to the structure and preparation of the An- nual Reports is needed. Rather than compiling a single comprehensive report, the Ombudsman should consider separating findings into thematic reports, each dedicated to specific vulnerable groups—such as prisoners, individuals in psychiatric institutions, and elderly people, as well as compiling a special report that will deal with defects and flows of the administrative acting. This would allow for more detailed analyses and targeted policy responses. Equal- ly important is the need for systematic monitoring of the implementation of the Ombudsman’s recommendations. Public administration should not only be informed of these findings but held accountable for addressing them. This is a two-sided aspect, but for the general aspects of accountability, it is crucial that the Annual Report is reviewed in a timely manner—well before the final annual parliamentary session. Early review would enable substantive debate on the level of implementation of previous recommendations, allow space for the adoption of new measures based on the latest findings and keep the pub- lic institution accountable for their acting or omission to act. In that respect, both the Government and Parliament must assume responsibility for re- sponding to the Ombudsman’s reports. Their inaction, or failure to follow up on critical issues, should be subject to scrutiny. At the same time, the visibility of the Ombudsman must be increased. Citizens need to be more aware of the institution’s protective role, and public administration should recognize it as a vital check on executive power. The introduction of a National Code of Good Administration—that can be modelled like the European Code—could serve as a practical tool to standardize administrative behaviour and improve ser- vice delivery. Education is also key. Both citizens and public servants should be informed about the Ombudsman’s work and its importance in safeguarding rights. Public institutions, in turn, should become more proactive in engaging with the Ombudsman’s office and acting on its guidance. Finally, to truly em- power the Ombudsman, systemic barriers must be dismantled. This includes enacting legal reforms that solidify the office’s authority, and ensuring its op- erational independence through adequate staffing, space, and financial re- sources. Legal and administrative reforms should not take place in isolation; they must be accompanied by improvements in the overall political climate and the strengthening of democratic values and practices. 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Central European Public Administration Review, Vol. 23, No. 2/2025 299 DOI: 10.17573/cepar.2025.2.11 1.01 Original scientific article Beyond the Speculation: Mapping the Real Impacts of Digitalization on the Slovenian Healthcare Business Model Dalibor Stanimirović University of Ljubljana, Faculty of Public Administration, Slovenia dalibor.stanimirovic@fu.uni-lj.si https://orcid.org/0000-0003-0160-209X Tatjana Stanimirović University of Ljubljana, Faculty of Public Administration, Slovenia tatjana.stanimirovic@fu.uni-lj.si https://orcid.org/0000-0003-4528-8725 Received: 15. 6. 2025 Revised: 26. 8. 2025 Accepted: 30. 9. 2025 Published: 11. 11. 2025 ABSTRACT Purpose: The increasing digitalization of healthcare systems worldwide has been welcomed as a transformative force, yet its actual effects on healthcare business models remain underexplored. Moving beyond the speculation and overly optimistic expectations, this study examines the real impacts of digitalization on the Slovenian healthcare business model. Methodology: A qualitative research approach was employed, combining a comprehensive literature review with semi-structured online surveys. The study surveyed 20 prominent experts responsible for managing na- tional eHealth solutions in Slovenia. Content analysis was used to capture the perspectives of participating experts and systematically map the real impacts of digitalization on the Slovenian healthcare business model. Findings: Results indicate that digitalization significantly impacts the healthcare business model by improving operational efficiency and care coordination, optimizing data accessibility and management, and enhanc- ing patient engagement. However, due to structural and systemic chal- lenges, the impacts of digitalization on the Slovenian healthcare business model remain relatively limited at this stage and largely depend on the effective alignment of technological advancements with health, busi- ness, organizational, and socio-economic factors. Practical implications: The findings emphasize that digitalization in healthcare should not be regarded merely as a technological endeav- our, but as a strategic driver of comprehensive healthcare and business transformation. For healthcare managers and policymakers, this means Stanimirović, D., Stanimirović, T. (2025). Beyond the Speculation: Mapping the Real Impacts of Digitalization on the Slovenian Healthcare Business Model. 301 Central European Public Administration Review, 23(2), pp. 301–326 2591-2259 / This is an open access article under the CC-BY-SA license https://creativecommons.org/licenses/by-sa/4.0/ Dalibor Stanimirović, Tatjana Stanimirović investing not only in digital infrastructure but also in governance, organi- zational processes, business operations, and social dimensions. By doing so, they can maximize the benefits of digital solutions, reduce inefficien- cies, and create a more sustainable, patient-centred healthcare system. The study may assist leaders to identify bottlenecks and prioritize actions that ensure digitalization can bring measurable improvements in service delivery and public health outcomes. Originality: This research contributes novel insights by providing one of the few empirical analyses of digitalization’s impacts on the Slove- nian healthcare business model. Rather than relying on assumptions or normative expectations, it integrates the viewpoints of leading national eHealth experts and contextualizes them within broader structural and systemic framework. The study adds value by bridging the gap between global discourses on digital transformation and the realities of a small national healthcare system, thus offering lessons transferable to other countries facing similar challenges of scale, resources, and institutional inertia. Keywords: business model, digitalization, healthcare system, impacts, qualitative research Onkraj špekulacij: oris dejanskih vplivov digitalizacije na slovenski poslovni model zdravstvenega varstva POVZETEK Namen: čedalje večja digitalizacija zdravstvenih sistemov po svetu je dobrodošla kot preobrazbena sila, vendar so njeni dejanski učinki na po- slovne modele v zdravstvu še vedno premalo raziskani. Članek presega špekulacije in pretirano optimistična pričakovanja ter preučuje resnične vplive digitalizacije na slovenski poslovni model zdravstvenega varstva. Metodologija: uporabljen je bil kvalitativni raziskovalni pristop, ki je združil celovit pregled literature s polstrukturiranimi spletnimi anketami. Raziska- va je zajela 20 vodilnih strokovnjakov, odgovornih za upravljanje nacional- nih rešitev eZdravja v Sloveniji. Za zajem pogledov sodelujočih strokov- njakov in sistematičen oris dejanskih vplivov digitalizacije na slovenski poslovni model zdravstvenega varstva je bila uporabljena analiza vsebine. Ugotovitve: rezultati kažejo, da digitalizacija pomembno vpliva na po- slovni model v zdravstvu z izboljšanjem operativne učinkovitosti in ko- ordinacije oskrbe, optimizacijo dostopnosti do podatkov in upravljanja podatkov ter krepitvijo vključenosti pacientov. Vendar pa zaradi struktur- nih in sistemskih izzivov učinki digitalizacije na slovenski poslovni model zdravstvenega varstva v tej fazi ostajajo razmeroma omejeni in pretežno odvisni od učinkovitega usklajevanja tehnološkega napredka z zdravstve- nimi, poslovnimi, organizacijskimi in socioekonomskimi dejavniki. Praktične implikacije: ugotovitve poudarjajo, da digitalizacije v zdravstvu ne moremo obravnavati zgolj kot tehnološkega podviga, temveč kot strateški vzvod celovite zdravstvene in poslovne transformacije. Za me- nedžerje v zdravstvu in oblikovalce politik to ne pomeni le vlaganja v di- gitalno infrastrukturo, temveč tudi v upravljanje, organizacijske procese, poslovno delovanje in socialne razsežnosti. Tako lahko maksimizirajo ko- risti digitalnih rešitev, zmanjšajo neučinkovitosti ter ustvarijo bolj trajnos- 302 Central European Public Administration Review, Vol. 23, No. 2/2025 Beyond the Speculation: Mapping the Real Impacts of Digitalization on the Slovenian Healthcare Business Model ten in na pacienta osredinjen zdravstveni sistem. Študija lahko voditeljem pomaga pri prepoznavanju ozkih grl in določanju prednostnih nalog ukre- pov, ki zagotavljajo, da digitalizacija prinese merljive izboljšave pri izva- janju storitev in zdravstvenih izidih na ravni javnega zdravja. Izvirnost: raziskava prinaša nove vpoglede, saj je ena redkih empiričnih analiz vplivov digitalizacije na slovenski poslovni model zdravstvenega varstva. Namesto da bi se opirala na domneve ali normativna pričakovanja, vključuje poglede vodilnih nacionalnih strokovnjakov za eZdravje in jih umešča v širši strukturni in sistemski okvir. Študija pripomore k zapolnje- vanju vrzeli med globalnimi diskurzi o digitalni preobrazbi in realnostmi majhnega nacionalnega zdravstvenega sistema ter tako ponuja lekcije, prenosljive tudi v druge države, ki se soočajo s podobnimi izzivi obsega, virov in institucionalne inercije. Ključne besede: poslovni model, digitalizacija, zdravstveni sistem, vplivi, kvalitativna raziskava JEL: I15, M15 1 Introduction In recent years, the Slovenian healthcare system, much like other healthcare systems within the European Union (EU), has faced substantial structural chal- lenges. These challenges are driven by objective circumstances and cannot be avoided in the foreseeable future, necessitating fundamental changes to the current healthcare setting. Healthcare reform has thus emerged as a societal imperative, requiring policymakers to adopt a more comprehensive and inno- vative approach in the years ahead. One of the key structural reforms needed to address these challenges effectively is the digitalization of the healthcare system. A robust and integrated health information system is envisioned to facilitate precise patient tracking, streamline treatment processes, manage costs, and enhance data accessibility. Such a system would enable efficient scheduling of medical appointments, coordination of waiting lists, tracking of completed medical procedures, and evaluations of their health outcomes and costs. Additionally, health information system could improve the efficiency and transparency of public healthcare in Slovenia and optimize the opera- tional processes within healthcare institutions (MoH, 2022). Despite the un- deniable potential and opportunities offered by digitalization, misleading and overly ambitious political slogans, unrealistic predictions by certain experts, and uncritical public debates have often led to inflated public expectations that digitalization will provide miraculous solutions to all the shortcomings of the healthcare sector. However, while digitalization is not a panacea, it will undoubtedly have a pro- found and long-term impact on the entire healthcare system and its subsys- tems. This is supported by experiences from the most developed countries (Perianez et al., 2024; Wang and Xu, 2023; Majcherek et al., 2024). These experiences emphasize the importance of the healthcare system’s business Central European Public Administration Review, Vol. 23, No. 2/2025 303 Dalibor Stanimirović, Tatjana Stanimirović model, which plays a pivotal role in the system’s functioning and develop- ment (Schiavone, et al., 2021; Cosenz et al., 2024). A business model can be broadly defined as a framework of components, their roles, interconnections, and dependencies that, combined with information flows and business pro- cesses, create added value for both internal and external stakeholders (Os- terwalder et al., 2005; Zott and Amit, 2024; Snihur and Markman, 2023). By outlining the structural and functional elements of an organization, the busi- ness model serves as a foundation for setting strategic goals, providing a logi- cal operational framework for objective and data-driven business planning. The business model is sensitive to systemic changes, making it an effective tool for analysing and projecting the financial and operational implications of business policies or projects (Lanzolla and Markides, 2021; Westerveld et al., 2023). Given the rapid advancements in digitalization, which are becoming key drivers of structural and business changes in healthcare, this article ex- plores the broader, often overlooked impacts of digitalization on the health- care system’s business model. Drawing on theoretical constructs, empirical cases, and online surveys with renowned experts from the field, this article addresses two primary research objectives: 1) exploring the concept of a busi- ness model and assessing the current state of the healthcare business model in Slovenia and 2) mapping the real impacts of digitalization on the Slovenian healthcare business model. Following the introduction, the second section of the article reviews exist- ing research and literature, offering insights into the concept of the business model and its role in contemporary organizational systems. The third section outlines the qualitative research design, detailing the methodological frame- work and content analysis procedures. The fourth section presents the re- search results, with a primary focus on the current state of the healthcare business model in Slovenia and the tangible impacts of digitalization on the healthcare business model. The fifth section engages in a critical discussion, addressing open questions related to business model digitalization and its role in implementing structural reforms within the healthcare system. Finally, the sixth section concludes with key findings and closing remarks. 2 Review of Previous Research in the Field In recent years, the concept of the business model has garnered significant at- tention from professionals and academia (Aagaard and Nielsen, 2021; Ancillai et al., 2023; Leal Neto and Von Wyl, 2024). An expanding body of research un- derscores the need to examine critical success factors and mechanisms for cre- ating added value. This trend reflects a broader recognition among organiza- tions that their competitive edge and business success hinge on elements such as business expertise, innovation, human resources, business processes, ser- vice and product quality, and customer relationships – factors that are largely intangible (Miller et al., 2021; Wirtz et al., 2021; Mignon and Bankel, 2023). As interest in business success factors has grown, so too has the exploration of the business model as a wide-ranging concept. Although the term has long 304 Central European Public Administration Review, Vol. 23, No. 2/2025 Beyond the Speculation: Mapping the Real Impacts of Digitalization on the Slovenian Healthcare Business Model existed in economic theory to describe the “way of doing business”, its signifi- cance has expanded. In general terms, a business model can be defined as a framework of interconnected factors that shape an organization’s operations and underpin its success. This success may stem from the quality and unique- ness of products or services or from cost efficiencies that enable the achieve- ment of long-term goals (Bigelow and Barney, 2021; Purnomo et al., 2022). Chesbrough and Rosenbloom (2002) trace the origins of the business model concept back to Chandler’s seminal work Strategy and Structure (1969), which analysed the factors distinguishing successful from unsuccessful companies. Chandler’s research highlighted mechanisms for creating added value, opti- mizing the transformation of resources into products and services, and build- ing efficient value chains. While most studies underscore the positive impact of business models, some researchers focus on the interplay between added value, business models, and strategy. They contend that the configuration of key business factors and the management of core strategic values, such as customer relationships, ac- cess to technology, and understanding customer needs, are more critical to an organization’s growth than inventing entirely new business models. These scholars argue that opportunities for added value lie in enhancing these stra- tegic connections. Added value may come from solving systemic challenges, improving business performance, or reducing risks and costs (Bresciani et al., 2021; Mostaghel et al., 2022; Colovic, 2022). Achieving this often requires re- configuring an organization’s core values, such as adopting new approaches to customer engagement, leveraging advanced information and communica- tion technologies (ICTs), or gaining deeper insights into customer needs. Despite the increasing interest from both practitioners and academics, the term business model remains elusive, with no universally accepted defini- tion. The theoretical underpinnings of the concept remain ambiguous, and definitions vary widely, reflecting diverse research angles and interpretations. Recent research on business models spans a broad range of areas, including organizational dynamics, business processes and structures, value chains and networks, innovative and ICT-based approaches, corporate strategy and com- petitive advantage, entrepreneurship, sustainability, and ecosystem func- tions. Although these research domains often overlap and terminological ambiguities persist, the existing body of literature allows us to roughly distin- guish three predominant directions in business model research (Sjödin et al., 2020; Vaska et al., 2021; Menter et al., 2024): 1) organizational changes and new organizational forms, 2) value creation, and 3) business model innovation and digitalization. The boundaries between the outlined research directions are fluid, making it challenging to chart the business model research thus far, identify and assess the prevailing topics, and forecast the research trends and priorities in the future. The fragmented and isolated study of business mod- els from various perspectives hinders a thorough and critical evaluation of their potential impact on organizational systems. This fragmented approach often leads to a lack of motivation to transform outdated or inadequate busi- ness models, particularly within public sector organizations. As a result, these Central European Public Administration Review, Vol. 23, No. 2/2025 305 Dalibor Stanimirović, Tatjana Stanimirović organizations experience stagnation and fail to harness their full potential to deliver innovative products and services or meet the evolving and diverse needs of their users. 2.1 The Concept of a Business Model Research often roughly defines a business model as a network of factors, their interrelationships, processes, and causal links that create added value. Studies generally argue that a comprehensive business model should identify the target users, articulate the organization’s comparative advantages, spec- ify the product and service offerings, and assess cash flow, projected profit, and associated risks (Trischler and Li-Ying, 2023). Some studies are even more comprehensive and provide a broader interpretation, describing a business model as an organizational framework designed to gather, connect, and com- municate information about an organization’s operations and activities (Ver- hagen et al., 2021). In the late 1990s, the concept of a business model became closely associated with e-business and the emerging digital economy. The rise of the internet and the widespread digitalization of both private enterprises and the public sector gave birth to innovative business models, pushing e-business models into the spotlight (Bresciani et al., 2021; Ancillai et al., 2023). Since then, re- searchers and professionals have focused on understanding how digitalization and online business reshape organizational practices and influence business model components and their interrelationships. Successful business models often take inspiration from the banking and online retail sectors (Hanafizadeh and Marjaie, 2021; Palmié et al., 2022). Despite differences in structure, nam- ing conventions, characteristics, and interrelationships, several core compo- nents consistently appear across most business model definitions, concepts, and depictions (Zott and Amit, 2024; Lanzolla and Markides, 2021; Wirtz et al., 2023; Lorenz et al., 2024; Menter et al., 2024; Mignon and Bankel, 2023; Miller et al., 2021; Westerveld et al., 2023; Trischler and Li-Ying, 2023). They are summarized in Table 1. These components provide a framework for un- derstanding how business models can be utilized, adapted and optimized to meet contemporary challenges and opportunities, particularly in the context of digital transformation. 306 Central European Public Administration Review, Vol. 23, No. 2/2025 Beyond the Speculation: Mapping the Real Impacts of Digitalization on the Slovenian Healthcare Business Model Table 1. Components of a generic business model Component Description Which customer desires and needs does the Service / product offering organization's service / product offering focus on? How and to what extent does the Customer groups / organization satisfy customer desires, needs, market segmentation and expectations overall or for specific market segments? Through which channels and how does the Business / communication organization communicate with customers distribution channels and offer its services / products? What are the relationships with customers, Customer relationships / how are they maintained, and what are the connections customers' expectations regarding these relationships / connections? Business processes / Which key business processes / activities are activities / carried out within the organization, and how value configuration do they contribute to creating added value? What resources, and in what quantities, does Key resources / capabilities the organization utilize in its operations, and / capacities how effectively are they used? To what extent do various partners Business partners / contribute to the organization's operations, partner network success and efficiency, and in what way? What is the cost structure for services / Costs / expenses / products and the organization's operational expenditure activities, and are these costs aligned with the organization's business plan? Which services/products offered by the Revenues / income organization are customers willing to pay for, how much, and in what manner? Does the organization's business performance reflect as an operational Profit / added value / outcome in the form of profit/added value business performance generated through the production and sale of products or the provision of services? Source: Authors’ compilation (different sources). Central European Public Administration Review, Vol. 23, No. 2/2025 307 Dalibor Stanimirović, Tatjana Stanimirović The illustration below presents an adapted version of Osterwalder and Pigneur’s (2010) business model ontology, a widely recognized and frequent- ly applied framework for visualization and understanding business models and their components (Figure 1). Osterwalder and Pigneur (2010) developed the business model ontology as a structured framework for understanding, designing, and analysing business models. The ontology defines a business model as a conceptual tool that describes how an organization creates, deliv- ers, and captures value. It consists of nine interrelated building blocks, which together form the well-known business model depiction. The business model ontology provides a shared language for managers, entrepreneurs, and re- searchers, making it easier to visualize and innovate business models system- atically. It is widely used as a strategic management tool. Figure 1. Business model ontology INFRASTRUCTURE OFFERING CUSTOMERS Processes / Customer activities relationships Business Service / p a r t n e rs Key resources product Distribution Customer offerings channels groups Costs Profit Revenue FINANCES Source: Adapted from Osterwalder and Pigneur, 2010. This business model framework, altho ugh predominantly applied in the pri- vate sector, provides a comprehensive and transparent representation of the key factors and their interrelations that determine the success of an organi- zational system. As such, it will serve as a foundation for mapping the real impacts of digitalization on the healthcare business model in Slovenia. 3 Methods The methodological framework is adapted to the interdisciplinary nature of the research problem and encompasses a comprehensive review of existing literature on the business model, synthesis of findings, and online surveys to map the impacts of digitalization on the Slovenian healthcare business model (Yin, 2017; Braun et al., 2021; Barroga et al., 2023). By addressing the tech- nological, medical, and business dimensions of the Slovenian healthcare sys- tem, policymakers can better navigate the complexities of healthcare system operations and ensure long-term benefits for patients, healthcare providers, and society as a whole. 308 Central European Public Administration Review, Vol. 23, No. 2/2025 Beyond the Speculation: Mapping the Real Impacts of Digitalization on the Slovenian Healthcare Business Model 3.1 Research Design This study employs a qualitative research design to analyse the impacts of digitalization on the Slovenian healthcare business model. Following a com- prehensive review of existing literature on business models, the primary data collection method involved semi-structured online surveys with 20 promi- nent experts from the National Institute of Public Health who manage na- tional eHealth solutions. These surveys were conducted between January and February 2025. The study’s qualitative approach aligns with the complex and interdisciplinary nature of the research problem, which requires in-depth exploration of expert insights into digitalization and its ubiquitous impacts on the healthcare business model. The methodological framework follows a structured process: 1) designing the study and developing the survey pro- tocol, 2) conducting the surveys, 3) transcribing and coding the survey data, 4) analysing the data using qualitative content analysis, 5) interpreting the findings, and 6) reporting the results. This approach is based on established methodologies for qualitative research and content analysis ensuring rigor and reliability in the research process (Shava et al., 2021; Yadav, 2022). 3.2 Sample The sample for this study comprises 20 experts who hold leadership positions in the management of national eHealth solutions. These participants were purposefully selected based on their unparalleled expertise and extensive experience in digitalization initiatives, healthcare information systems, op- erations, and structure of the Slovenian healthcare system. The non-random, purposive sampling method ensures that participants possess the necessary knowledge to provide credible and insightful perspectives on the research topic. The selected experts represent a diverse group of individuals special- ized in information technology, medicine, economy, organization, and public health. This diversity allows for a comprehensive examination of digitaliza- tion’s effects on various components of the healthcare business model. Re- cruitment was guided by the principle of maximum variation sampling to cap- ture a broad spectrum of views and experiences (Hennink and Kaiser, 2022). The sampling procedure achieved data saturation point, ensuring that no sig- nificant new information emerged during the final stages of data collection. 3.3 Data Collection and Analysis The online surveys were conducted using a miscellaneous set of questions including open-ended questions and semi-structured format to maintain fo- cus of the research and address both consistency and flexibility in exploring emerging themes. Open-ended questions within the survey protocol were designed to elicit detailed insights into participants’ experiences, percep- tions, and evaluations of digitalization initiatives within the Slovenian health- care system. The survey questions presented below were applied: Central European Public Administration Review, Vol. 23, No. 2/2025 309 Dalibor Stanimirović, Tatjana Stanimirović 1. How would you assess the current state of the healthcare business model in Slovenia? Is there a clearly defined business model within Slovenian he- althcare system? 2. Can you identify and define the real impacts of digitalization on the busi- ness model? Provide detailed insights into how each of the business model components listed below is affected: – Infrastructure – Offering of healthcare services and products – Patient – Public health and public finance Prior to conducting the online survey, participants were provided with a de- tailed explanation of the business model concept, including its components, interconnections, and relationships on the one hand, and its characteristics, functions, and objectives on the other. Before proceeding with the survey, any uncertainties or ambiguities raised by participants were clarified and resolved, ensuring that they were able to contribute to the study as effectively and relia- bly as possible. Each online survey took approximately 90 minutes to complete and was conducted with the participants’ consent. To ensure data confiden- tiality and ethical compliance, all identifying information were anonymized. The content analysis was conducted using MAXQDA Analytics Pro 2022 (ver- sion 22.4.1), a qualitative analysis software. This tool allows for systematic coding and categorization of the survey data, enabling the identification of patterns, themes, and relationships. The content analysis followed a typical multi-stage coding process: 1) initial reading: transcripts were reviewed to fa- miliarize the researchers with the data and identify preliminary themes, 2) cod- ing framework development: codes were derived both inductively from the survey data and deductively from the literature review, 3) thematic analysis: coded data was organized into overarching themes, reflecting the viewpoints and statements of the participating experts regarding the survey questions, and 4) validation: both coders independently analysed the data to ensure reli- ability and minimize bias. The coding framework comprised 9 primary codes, categorized into 2 main areas based on the survey questions (Figure 2). These codes reflect various issues and perspectives shared by participants regarding digitalization and the healthcare business model, their interplay, and the real impacts of digitalization on the Slovenian healthcare business model. The software’s analytic capabilities were used to generate visualizations, such as code diagrams and thematic maps, to support the interpretation of findings. The results were triangulated with existing literature to validate and contextualize the insights, ensuring robust conclusions (Im et al., 2023). By combining literature review and expert surveys with systematic content analysis, this study provides a nuanced understanding of digitalization’s cur- rent impacts on the Slovenian healthcare business model. The findings aim to inform evidence-based strategies for aligning digital initiatives with systemic healthcare reforms. 310 Central European Public Administration Review, Vol. 23, No. 2/2025 Beyond the Speculation: Mapping the Real Impacts of Digitalization on the Slovenian Healthcare Business Model Figure 2. Code system developed in content analysis software Source: Authors’ research. 4 Results One of the most important segments of strategic planning and mechanisms for achieving long-term organizational goals and satisfying stakeholder needs is the business model of the organization. A comprehensive and appropriately digitalized business model facilitates the effective transformation of organi- zational resources into high-quality products and services. It represents an integral link between the organization’s strategic goals and the business pro- cesses required to achieve them. 4.1 The Impact of Digitalization on Organizational Systems and Healthcare Business Models Research consistently highlights digitalization as a driving force behind changes and development in business models (Caputo et al., 2021; Broccardo et al., 2023). According to research thus far, the influences of digitalization on business models range from minimal ICT use to a complete redefinition of the business landscape. Studies in the field further emphasize the role of digitalization in adapting organizational processes, improving business effi- ciency within and between organizations, and enhancing interactions with the broader societal environment (Wang et al., 2023; Snihur and Markman, 2023). To date research generally indicates a strong positive correlation be- tween comprehensive digitalization and business success, positioning digitali- zation as a critical factor for organizational management and value creation (Climent and Haftor, 2021; Reim et al., 2022). Lessons and experience reveal that the conversion of digital assets (e.g., infrastructure, technologies, and expertise) into strategic resources and further digitalization initiatives have Central European Public Administration Review, Vol. 23, No. 2/2025 311 Dalibor Stanimirović, Tatjana Stanimirović a significant impact on business performance, including improved products, processes, and communication efficiency (Gregori and Holzmann, 2020; As- trom et al., 2022). Nevertheless, it is important to keep in mind that business models are under constant pressure to evolve due to global trends, regulato- ry changes, shifting user behaviour, and, in particular, technological advances. In this context, successful digitalization depends on an organization’s ability to continuously adapt its business model to volatile market conditions and remain relevant and effective in a dynamic environment. Digitalization projects in healthcare focus on digitalizing clinical and business processes, as well as systematically collecting, analysing, and utilizing health- care data. These initiatives are part of comprehensive healthcare reforms that began in developed countries during the 1980s. The goals are twofold: to improve the quality and timeliness of patient care and to provide robust support for decision-making, planning, and management at both institutional and system-wide levels. However, many digitalization projects have focused on isolated segments of healthcare operations, overlooking the broader busi- ness model as a critical success factor within the healthcare system. A well- designed, digitalized business model facilitates the effective transformation of organizational resources into high-quality healthcare services and serves as a bridge between strategic goals and the processes required to achieve them. Successful healthcare reforms depend not only on technological im- provements but also on a deep understanding of business, organizational, policy, socio-economic, and other factors contained in the business model framework (Sibalija at al., 2021). Understanding how digitalization affects the healthcare system’s business model requires familiarity with the system’s ar- chitecture and operations. However, due to the rapidly changing public health conditions and technological landscape, this understanding may not always be sufficient. The business model is inherently dynamic, as demonstrated by its complex structure and variety of its components. Therefore, healthcare or- ganizations must continuously adapt their business models to keep pace with healthcare needs and demands on the population level, financial restrictions, regulatory changes, and digitalization advancements (Wirtz, 2023). However, while digitalization and technological innovation are essential, they do not guarantee public health or business success on their own. The healthcare sys- tem is a wide-ranging network of components, activities, interconnections, and dependencies that leverage information and resources to create health value for stakeholders. Such systems are intrinsically complicated, involving numerous stakeholders and multi-layered organizational structures. Achiev- ing public health and business success thus require a well-planned business model, effective implementation, and careful strategic alignment of digitali- zation projects with healthcare system’s operations and long-term goals. The following paragraphs present summaries of the responses and perspec- tives shared by the participating experts regarding the survey questions. 312 Central European Public Administration Review, Vol. 23, No. 2/2025 Beyond the Speculation: Mapping the Real Impacts of Digitalization on the Slovenian Healthcare Business Model 4.2 The Current State of the Healthcare Business Model in Slovenia The participants shared in-depth opinions and various arguments in response to the survey’s introductory question about the current state of the health- care business model in Slovenia. The existing healthcare business model in Slovenia is ill-defined and characterized by poor collaboration among stake- holders, leading to inefficiencies in decision-making, resource allocation, and service delivery. The undefined and often arbitrary business framework makes it challenging to establish clear guidelines and structures that ensure effectiveness, accountability, and long-term sustainability. Patient interaction remains weak, with limited engagement and communication, often resulting in a lack of patient-centred care and lower overall satisfaction. The current approach to business operations, which can hardly be considered a true busi- ness model, remains technologically incapacitated and underdeveloped. The digital infrastructure is often fragmented and outdated, posing significant challenges to achieving an effective digital transformation and better busi- ness and healthcare outcomes. The lack of investment in digital health infra- structure and workforce training further amplifies inefficiencies and hinders Slovenian healthcare system from achieving its desired transformational goals. The lack of coordination and agreement on financial matters between healthcare providers, policymakers, and insurers is evident in the frequent strikes of healthcare workers. This not only further complicates service de- livery but also slows down progress in digital health initiatives. Compared to other sectors, the development of the Slovenian healthcare system business model has been slow, with a significant lag in adopting digital technologies and innovative operational strategies. The organization of work is often in- adequate, characterized by rigid hierarchies and bureaucratic obstacles that hinder timely operations, responsiveness, and adaptability to evolving health- care needs. Business processes are inconsistent and fragmented, resulting in duplication of efforts, increased administrative burdens, and inefficiencies in service delivery. The healthcare system generally operates on outdated princi- ples that are misaligned with modern business paradigms, preventing it from leveraging best practices in digital innovation and healthcare management. 4.3 The Real Impacts of Digitalization on the Slovenian Healthcare Business Model Digitalization is anticipated to significantly enhance the healthcare system’s business model, provided it is implemented sensibly and effectively. Never- theless, the potential long-term effects of digitalization on the healthcare business model, as outlined by the participating experts, remain somewhat uncertain and, for now, merely hypothetical. In this study, however, we focus primarily on the real and immediate impacts of digitalization on the health- care business model. At this relatively early stage, precisely identifying and assessing the long-term effects of digitalization remains challenging. However, we can reasonably Central European Public Administration Review, Vol. 23, No. 2/2025 313 Dalibor Stanimirović, Tatjana Stanimirović map its real and current impacts on the healthcare business model key com- ponents (although not precisely defined): infrastructure, offering, patients, and public health and public finance. The table below (Table 2) outlines the impacts of digitalization on each of these core components, illustrating how digital transformation is driving significant changes across the entire Slove- nian healthcare system. Despite the undeniable potential of digitalization, its real and current impacts on the healthcare business model remain relatively limited. There are un- doubtedly many reasons for this. In collaboration with participating experts, we have identified some of the key factors. One of the primary reasons is likely the absence of a clearly defined business model within the Slovenian healthcare system that all stakeholders follow. Consequently, initiating the transformation of an entity that lacks both a formal and, in many respects, a material structure presents a significant challenge. Digitalizing such a vast and complex organizational system as healthcare is a demanding socio- technological project – one that requires a strategic approach, significant re- sources, time, expertise, and systemic support. However, Slovenia does not adequately meet any of these requirements. As a result, the business model of Slovenian healthcare largely follows the inertia of past periods, with only sporadic integration of otherwise successful and high-quality digital solu- tions. Yet, these solutions alone – without radical changes in other areas and systemic support – are insufficient to bring about deeper, more visible, and lasting improvements. Despite the growing importance and recognition of digitalization as a critical success factor, the healthcare system remains hesi- tant to implement more fundamental changes. This reluctance manifests in unwillingness to transform its business model and subsequently restruc- ture business processes, communication channels, integrate comprehensive digital solutions, and align innovative technologies with strategic healthcare goals. As a result, the rigid organizational structure and the existing inflexible business model persist, hindering the healthcare system’s ability to adapt to growing and diverse patient needs and the evolving broader environment. 314 Central European Public Administration Review, Vol. 23, No. 2/2025 Beyond the Speculation: Mapping the Real Impacts of Digitalization on the Slovenian Healthcare Business Model Table 2. The real impacts of digitalization on the healthcare business model Business Impacts of digitalization model aspects  Increased investment in digital technology – improved digital infrastructure at the national level and within healthcare providers.  Automated exchange of a significant portion of healthcare data among public healthcare providers.  Partially automated exchange of health, administrative, and financial data with regulators and government institutions.  Standardization and simplification of digitalized processes (not all business processes). Infrastructure  Enhanced oversight and monitoring of healthcare services aspect provided by healthcare providers.  Increased funding for ICT experts at healthcare providers, regulatory bodies, and government agencies.  Greater investment in digital skills training for healthcare employees.  Enabled monitoring of some performance indicators.  Adoption of digital services by healthcare providers and patients.  Digitalization is becoming an increasingly important factor in the socio-political context due to its developmental potential.  A transparent definition and list of available healthcare services and products are accessible online.  Healthcare providers, along with their contact information and the healthcare services they offer, are available online.  Certain segments of healthcare services and products are Offering offered in digital form. aspect  Availability of eHealth services, including the Patient Portal, ePrescription, eAppointment, medical test results, health documents, certificates of sick leave, etc.  Information about medications and treatments is available online.  Increased exchange and use of healthcare data for improved healthcare delivery.  Partially redefined relationships between healthcare professionals and patients, including better control over personal data and treatment processes, improved communication, and better access to information. Patient aspect  eHealth services on the Patient Portal (accessible 24/7).  Reduced costs for patients due to eHealth services, including savings on time and transport expenses.  Improved accessibility of certain healthcare services for disadvantaged patient groups.  Increased digital literacy among patients. Central European Public Administration Review, Vol. 23, No. 2/2025 315 Dalibor Stanimirović, Tatjana Stanimirović  Enhanced mechanisms for collecting and analysing data on health and financial efficiency and effectiveness of the health- care system, as well as non-health factors.  Greater transparency in expenditure and income structures. Public health  More transparent overview of public health indicators. and public  Improved evaluation of service and product pricing. finance aspect  Accessibility of certain indicators for managing healthcare pro- viders and the overall healthcare system.  Availability of certain indicators related to operational, human resources, and financial management aspects. Source: Authors’ research. Successful transformation requires an understanding of theoretical busi- ness model concepts relevant to the organization’s context and a deep com- prehension of operational processes, relationships, and interdependencies (Wirtz, 2020). It also necessitates recognizing the healthcare system’s role within a broader society (Barnett et al., 2025). Given the complexity and speci- ficity of healthcare as a public sector service, the transformation process must consider the broader context and ensure that business model components are aligned with socio-economic, policy, technological, organizational, public health, and financial factors and constraints (Lorenz et al., 2024). The future Slovenian healthcare system’s business model needs to incorporate adapta- tions beyond Osterwalder and Pigneur’s (2010) traditional business model ontology, widely used in the private sector. The healthcare system’s public nature involves more factors, with modified functions and relationships re- flecting the unique role of healthcare in modern societies and confirming the complexity of organizational systems in the public sector that generate public benefit. Public sector business models operate in a more diverse and restric- tive environment than those in the private sector. In addition to core business model elements such as infrastructure, offering, customers, and finances, public healthcare must also consider public health and public finance factors. These elements typically shape strategic objectives, operational priorities, and guide healthcare system development and sustainability (Rosati et al., 2023). This is reflected in the numerous obstacles that impede the faster adoption of Slovenian eHealth solutions, which are generally well-developed and highly advanced. For comprehensive transformation of the current healthcare busi- ness model, digitalization must be given a more significant role. It should inte- grate the fragmented elements of the business model, enhancing healthcare services, two-way communication, and patient empowerment (Stanimirović and Stanimirović, 2025). Digitalization can improve the utilization of human, material and digital resources, optimize operation and processes, ensure transparency, and enable better oversight of expenditures and incomes (Ge- hde et al., 2022). Improved data transparency allows for enhanced financial oversight and supports cost-containment measures in public health financing. A comprehensive digitalization of the healthcare business model would en- able the Slovenian healthcare system to seize opportunities for high-quality patient care, drive business and organizational restructuring, and support 316 Central European Public Administration Review, Vol. 23, No. 2/2025 Beyond the Speculation: Mapping the Real Impacts of Digitalization on the Slovenian Healthcare Business Model long-term development. By leveraging accurate and reliable clinical, financial, and administrative data, digitalization could also streamline the management of healthcare organizations and the healthcare system as a whole. 5 Discussion In modern organizational paradigms, the business model serves as a crucial tool for analysing operations, planning technological innovations, and guid- ing organizational transformation (Klos et al., 2021; Grego et al., 2024). De- spite the growing interest from the professional and academic community in business models over the past two decades, compelling studies exploring the material impacts of digitalization on healthcare business models remain scarce. Existing research generally emphasizes the complex and multifacet- ed influence of digitalization on organizational business models, confirming that comprehensive digitalization is a crucial step in developing an effective business model (Ramori et al., 2021; Kraus et al., 2021), which is essential for enhancing patient care on one hand, and improving healthcare system effi- ciency on the other. The research indicates that the real and current impacts of digitalization on the healthcare system’s business model in Slovenia can be assessed from four key aspects: infrastructure, offering, patient, and public health and public fi- nance. In these areas, digitalization demonstrates some very significant ef- fects, although perhaps not as extensive or profound as one might expect or desire at this stage. Even more far-reaching effects of digitalization can be expected in the future, likely playing a pivotal role in shaping the transforma- tion of the business model. However, the effective strategic transformation and development of a suitable business model for the Slovenian healthcare system depend not only on advancements in digital technologies but also on a deeper understanding of policy, business, organizational, socio-economic, and other critical factors (Heubeck, 2023; Bamel, 2023). While digitalization undoubtedly offers significant potential for development and positively im- pacts organizational business models, it is clear that it cannot, in isolation, drive an effective transformation of the healthcare system or improve its overall outcomes. The success of the healthcare system’s operations and effi- ciency is heavily reliant on aligning digitalization with a wide range of systemic and organizational factors (Stanimirović and Stanimirović, 2025). Moreover, the business model must be adapted to meet the needs of patients, health- care organizations, and the broader healthcare ecosystem (Oderanti, 2021). Therefore, the successful digitalization of the healthcare system’s business model requires the involvement of numerous stakeholders and the balanc- ing of often conflicting factors and interests within the healthcare system (Cosenz et al., 2024). This complexity makes implementation challenging but underscores the importance of careful planning and coordination in building a long-term, effective business model. Despite these challenges, digitalizing the business model represents a substantial opportunity for development (Perianez et al., 2024). When properly aligned with other systemic factors, Central European Public Administration Review, Vol. 23, No. 2/2025 317 Dalibor Stanimirović, Tatjana Stanimirović digitalized business models can integrate the fragmented elements of the healthcare system, enhance the utilization of organizational capabilities, and accelerate the transformation of resources into tangible value for patients and measurable public health benefits. In the context of utilizing a properly digitalized business model for implement- ing structural reforms and achieving strategic goals within the healthcare system, it is essential to recognize that digitalization may improve produc- tivity, boost business performance, and promote organizational innovation (Wirtz et al., 2023). The greatest benefits of an effectively digitalized busi- ness model are realized when investments in digital technology are combined with broader systemic measures and organizational changes. These include new strategic approaches, the reengineering of both business and health- care processes, the adaptation of healthcare services and products, and the transformation of relationships between healthcare providers and patients (Cardinaal, et al., 2024). An appropriately digitalized business model must ac- count for the unique characteristics of healthcare and facilitate better health outcomes and improved business results. Accordingly, the digitalization of healthcare business models should not be viewed or evaluated solely as a technological advancement; it also constitutes a potential economic intervention in healthcare service delivery, establishing systemic mechanisms with significant implications for efficiency, cost-effec- tiveness, and the fiscal sustainability of healthcare systems (Lange, 2023). From a public economics perspective, successful digital transformation in healthcare carries significant strategic importance, as it can enhance alloca- tive efficiency, optimize resource utilization, and support the long-term ra- tionalization of public expenditure (Stanic et al., 2023). The consistent and appropriate application of digital tools such as ePrescrip- tion, eAppointment, the Patient Portal, and centralized electronic health re- cords can optimize the use of scarce healthcare resources by reducing admin- istrative redundancies, minimizing medical errors, and streamlining clinical workflows, resulting in tangible operational efficiencies (Tagde et al., 2021). These digital tools may also improve scheduling, enhance patient treatment adherence, reduce unnecessary visits and avoidable hospitalizations, and limit the duplication of diagnostics, thereby directly contributing to efficiency gains and cost savings (Stanic et al., 2023). For example, automated appointment systems reduce waiting times and facilitate better alignment between the supply and demand of healthcare services, thereby improving public health outcomes and allocative efficiency. Furthermore, digitalization introduces mechanisms for real-time monitoring of healthcare spending, predictive data analytics, and transparent report- ing. These features support more effective workforce deployment, capacity planning, and evidence-based policy formulation (WHO, 2019). Such mech- anisms directly address common inefficiencies linked to healthcare service inertia and fragmented budget planning. While investment in digital health infrastructure is initially capital-intensive, it frequently yields a high return 318 Central European Public Administration Review, Vol. 23, No. 2/2025 Beyond the Speculation: Mapping the Real Impacts of Digitalization on the Slovenian Healthcare Business Model on investment over time by reducing expenditures, lowering administrative burdens, and enhancing preventive care, thus alleviating the strain on long- term healthcare budgets (Biggs et al., 2019). Consequently, digitalization should be regarded as a strategic investment in public sector productivity. As healthcare demands and expenditures rise due to demographic shifts and the increasing prevalence of chronic diseases, a digitally enabled healthcare system can promote better population health, greater resilience, and eco- nomic sustainability, thereby supporting broader objectives such as econom- ic growth, fiscal consolidation, and efficient public service delivery (Olu et al., 2019). Accordingly, digitalization should be embedded within national long- term expenditure frameworks and healthcare reform agendas (Perianez et al., 2024). This integration enables the synchronization of digital investment cycles with budgetary planning, ensuring sustained funding and effective oversight. The adoption of key performance indicators related to cost sav- ings, patient outcomes, and system responsiveness facilitates continuous as- sessment of return on investment and public spending efficiency (Willis et al., 2022). The findings reinforce the notion that digitalization constitutes a form of public capital investment with multifaceted returns – not only in financial terms but also in institutional resilience, transparency, and long-term adapt- ability of health systems. In Slovenia, digitalization has already begun to generate these effects, though their full realization remains constrained by several factors, including fragmented approaches, uneven development, outdated policies and regula- tions, and inconsistent implementation practices. An evaluation conducted by the Ministry of Public Administration for the 2016–2018 period suggests that the implementation of eHealth solutions, specifically the ePrescription and eAppointment systems, contributed to substantial cost savings within the Slovenian healthcare system. The Ministry estimates the cumulative financial savings to be approximately EUR 40 million in this period (MPA, 2019). 5.1 Relevance Beyond the National Context: Potential Broader Implications of the Slovenian Case While this study focuses on Slovenia, the findings hold valuable implications for similarly structured healthcare systems, particularly those across Central, Eastern, and Southern Europe, as well as other small to mid-sized, publicly funded health systems. The Slovenian public healthcare system reflects com- mon characteristics such as centralized financing, hierarchical governance, and incremental digitalization (Albreht et al., 2021), making it a relevant case study for broader international comparative analyses. Challenges faced by Slovenia – fragmented digital architecture, limited inter- institutional coordination, constrained resources, and resistance to structural change – are similarly observed in numerous EU and OECD member states (Stanimirović, 2024; Bruthans et al., 2025). By detailing technological, insti- tutional, and economic issues, this study offers a diagnostic framework that can inform policy evaluations, support strategic planning, and guide imple- Central European Public Administration Review, Vol. 23, No. 2/2025 319 Dalibor Stanimirović, Tatjana Stanimirović mentation efforts for healthcare digitalization initiatives beyond the national context. Accordingly, the systemic barriers and enablers identified herein may help shape digital transformation projects across the region. Slovenia’s grad- ual integration of eHealth services aligns with broader strategies set forth by the World Health Organization and the EU, including the European Health Data Space initiative (WHO, 2021; European Commission, 2025). This align- ment enables cross-national dialogue, collaborative initiatives, and knowl- edge transfer, particularly in areas such as interoperability standards, patient data exchange and governance, as well as information security. In this light, the Slovenian case, demonstrating both realized and potential impacts of dig- italization in healthcare, could serve as a reference point for designing scal- able, context-sensitive digital health policies in comparable regional settings. 5.2 Limitations of the Study and Future Research Directions The research framework applied in this study has one clear methodological limitation. The Slovenian healthcare system does not have a formally defined business model, so all our assumptions about the structure of the Slovenian healthcare business model and how digitalization might impact it in the fu- ture are based on theoretical constructs and surveys with experts in the field of healthcare digitalization. Despite the validated information from literature and the unquestionable expertise and experience of the participating spe- cialists, it is important to note that the potential impacts of digitalization on the transformation of the Slovenian healthcare business model have been conjectured without empirical corroboration in the real healthcare environ- ment. On the other hand, some effects of digitalization on the healthcare business model have already materialized, and the transformative impacts of digitalization can now be assessed and monitored in terms of tangible results and improvements in the healthcare system’s operations and outcomes. This was particularly evident during the COVID-19 pandemic, when digital solu- tions represented one of the few components of the healthcare system that continued to operate without significant disruption. Therefore, the issues related to the projected impacts and implications of dig- italization on the healthcare business model may raise some questions, and the research outcomes might be subject to debate. These concerns should be addressed in future studies aimed at a comprehensive analysis of the long-term impacts of digitalization on the healthcare system. Future research should include a detailed investigation of the direct effects and implications of digitalization on the healthcare business model, including simulations, modelling, and empirical testing in real-world healthcare settings. The focus of these studies should be on providing recommendations and operational guidelines for implementing proper digitalization procedures in countries striving to adapt their business model structures to rapid technological ad- vancements, thereby contributing to increased efficiency of healthcare sys- tems. Despite the methodological limitations outlined, the research reveals the complex dynamics between digitalization and healthcare, highlighting the critical importance of continuously adapting the operations of organizational 320 Central European Public Administration Review, Vol. 23, No. 2/2025 Beyond the Speculation: Mapping the Real Impacts of Digitalization on the Slovenian Healthcare Business Model systems to broader social and technological changes. It has been shown that, in this regard, the public sector lags significantly behind the private sector. 6 Conclusions Business practice demonstrates a clear correlation between digitalization and improved business model efficiency, sparking increased interest in how new technologies transform organizational models. This trend is particularly rel- evant to healthcare and other public sector subsystems, where digitalization can drive the effective integration of innovative technologies, process restruc- turing, and reorganization. This article explores these pressing issues, empha- sizing the need for further multidisciplinary research into the intricate back- ground of digitalization initiatives, business models, and healthcare systems. The study provides a comprehensive overview of business model concept, key components, and their functions. The research outlines the digitalization as one of the catalysts for the necessary transformation of the healthcare busi- ness model. It highlights the real impacts of digitalization and stresses that its full transformative potential can be realized only when all business model components, organizational frameworks, and (eco)systemic factors are suc- cessfully aligned. A thorough analysis of impacts of digitalization on health- care business models requires understanding and consideration of broader context in which digitalization takes place and healthcare operates. Successful digitalization of healthcare business models, along with their adaptability and resilience, clearly depends on integrating these diverse elements. Ultimately, all the synergies created should strengthen the efficiency of the healthcare system, fostering sustainable, patient-centred development and contributing to improved public health. Acknowledgement: The authors gratefully acknowledge the financial support of the Slovenian Research and Innovation Agency (research core funding No. P5- 0093 and project No. J5-50165). 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Journal of Management, 50(8), pp. 3183–3201. https://doi.org/10.1177/014920632 41228245. 326 Central European Public Administration Review, Vol. 23, No. 2/2025 AUTHOR GUIDELINES https://journals.uni-lj.si/CEPAR/about/submissions Lucie Sedmihradská, Eduard Bakoš BUDGET PUNCTUATIONS IN CZECH LOCAL GOVERNMENT Špela Mar, Nina Kristl, Eva Murko, Jernej Buzeti, Polonca Kovač ADVANCING THE LEGAL COMPETENCES OF PUBLIC OFFICIALS THROUGH THE ADMINISTRATIVE CONSULTATION PLATFORM: A CONCEPTUAL AND EMPIRICAL APPROACH Armenia Androniceanu, Sofia Elena Colesca TRIPLE HELIX MODEL AND ARTIFICIAL INTELLIGENCE IN PUBLIC ADMINISTRATION Tomislav Geršić, Nenad Vretenar, Jelena Jardas Antonić COUNTRY ATTRACTIVENESS FOR CONDUCTING CLINICAL TRIALS – A LITERATURE REVIEW Eva Ivanová, Katarína Štefčíková, Martina Jakubčinová IMPLEMENTATION OF THE SMART CONCEPT WITHIN THE FRAMEWORK OF THE 2030 AGENDA IN THE NUTS 3 REGIONS OF THE SLOVAK REPUBLIC Tatyana Tomova, Elena Kalfova, Simeon Petrov, Kaloyan Haralampiev ENVIRONMENTAL POLICY IMPLEMENTATION: CAN WE REDUCE FAILURES WITHOUT CHANGING OBJECTIVES? Romario Marijanović, Mihaela Bronić, Simona Prijaković ANALYSIS OF THE COST EFFICIENCY OF PUBLIC GENERAL HOSPITALS IN CROATIA Michal Radvan, Klára Doležalová FAIR TAXATION OF INHERITANCE? Mari-Isabella Stan, Tănase Tasenţe FROM CO-CREATION TO CIRCULAR CITIES: EXPLORING LIVING LABS IN EU GOVERNANCE FRAMEWORKS – A LITERATURE REVIEW Natalija Shikova THE OMBUDSMAN AS A GUARDIAN OF GOOD GOVERNANCE: INSIGHTS FROM NORTH MACEDONIA Dalibor Stanimirović, Tatjana Stanimirović BEYOND THE SPECULATION: MAPPING THE REAL IMPACTS OF DIGITALIZATION ON THE SLOVENIAN HEALTHCARE BUSINESS MODEL Issue 2 November