Further analysis is needed to determine whether overall and trust associated productivity gains are transient effects, one off shifts, or self perpetuating reorientations of organisational behaviour. Hospitals may have chosen to become trusts because they anticipated being able to increase productivity. Increases in the proportions of small purchasers were associated with increasing costs. Importantly, this study could not adjust for changes in the quality of care.

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The paper provides a case study on how the Orbán regime in Hungary has dealt with coronavirus disease 2019 (COVID-19) in 2020-2021. Despite having led worldwide rankings in pandemic-related death rates since the second part of 2020, the government was not politically shaken by COVID-19. Institutionally unrestrained, the governing majority periodically renewed emergency legal regimes to control public discourses and curtail the financial resources of opposition-led local governments. The policy conduct of the regime is discussed in the context of authoritarian populism, which is conceptualized along a strategybased approach to populism. In this, authoritarian populism is seen to generate democratic legitimacy for dismantling the institutional foundations of liberal democracy and the rule of law. This had been happening in Hungary well before COVID-19 kicked in, but the pandemic provided enhanced opportunities for this strategy. Meanwhile, fiscal policies became increasingly expansionary, signalling a partial return to the practice of preelection overspending.