Social movements and the contested institutional identity of the hospital

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Asymmetry in inter-municipal cooperation in health services – how does it affect service quality and autonomy?

Throughout Europe, local health services are increasingly being provided through various forms of inter-municipal cooperation (IMC). One of the most common forms of IMC is when small municipalities delegate the operational responsibility for providing health services to a larger host municipality. However, despite the size asymmetry usually inherent in this type of IMC, this aspect has largely been neglected in the existing literature, which mainly focuses on the size of individual municipalities. Based on data from 97 partner municipalities and 25 host municipalities in Norway, this study examines how varying degrees of size asymmetry between them affect the perceived service quality and loss of autonomy resulting from IMC in health services. From the perspective of the relatively smaller partner municipalities, the results suggest that these are likely to benefit greatly from size asymmetry in terms of improved service quality, although this would appear to be at the expense of losing decision-making autonomy to their host. However, from the perspective of the relatively larger hosts municipalities, this type of asymmetry is likely to affect service quality negatively while having no effect on decision-making autonomy.publishedVersio

Promoting coordination in Norwegian health care1

<p><strong>  </strong></p><p><strong>Introduction</strong>: The Norwegian health care system is well organized within its two main sectors - primary health and long term care on the one hand, and hospitals and specialist services on the other. However, the relation between them lacks mediating structures.</p><p><strong>Policy practice</strong>: Enhancing coordination between primary and secondary health care has been central in Norwegian health care policy the last decade. In 2003 a committee was appointed to identify coordination problems and proposed a lot of practical and organisational recommendations. It relied on an approach challenging primary and secondary health care in shared geographical regions to take action. However, these proposals were not implemented. In 2008 a new Minister of Health and Care worked out plans under the key term "Coordination Reform". These reform plans superseded and expanded the previous policy initiatives concerning cooperation, but represented also a shift in focus to a regulative and centralised strategy, including new health legislation, structural reforms and use of economic incentives that are now about to be implemented.</p><p><strong>Discussion</strong>: The article analyses the perspectives and proposals of the previous and the recent reform initiatives in Norway and discusses them in relation to integrated care measures implemented in Denmark and Sweden.</p

Implementing a health care reform through inter-municipal cooperation : Adaption and implementing the Norwegian cooperation-reform in three inter-municipal health regions

Presentation on department page: http://www.uia.no/no/portaler/om_universitetet/oekonomi_og_samfunnsvitenskap/statsvitenskap_og_ledelsesfag/ forskning_isl/isl_working_papers_seriesIn this explorative article we will try to identify some issues and questions about how the Norwegian municipalities are preparing to implement the Cooperation reform and the new health care legislation. Our main focus is on examples of measures municipalities in three Norwegian inter-municipality regions so far have developed with respect to the Cooperation reform which will be implemented from spring 2012. By comparing and contrasting this three regions, with different history and adjustment patterns, our aim is to investigate inter-municipal cooperation as an suitable organizational solutions the municipalities can use in their struggle to prepare for their new extended role as health care providers. We will also explore factors that could explain why some inter-municipality regions have progressed better than others in their collaborative efforts to adapt to the future health challenges

‘Health in All Policies’ and the Urge for Coordination: The Work of Public Health Coordinators and Their Impact and Influence in Local Public Health Policies: A Cross-Sectional Study

Building heavily on the Health in All Policies (HiAP) approach, Norway implemented the Public Health Act in 2012 to reduce social inequalities in health. Local public health coordinators (PHCs) at municipal levels were seen as tools to provide local intersectoral public health work. In this study, we examine factors related to intersectoral agency and if intersectoral work is understood as relevant to securing social justice in local policy outcomes. A national web-based survey in 2019 of all Norwegian PHCs (n = 428) was conducted with a response rate of 60%. Data were analysed through multiple linear regression, hierarchical regression modelling and structural equation modelling. Neither factors relating to community contexts nor individual characteristics were associated with intersectoral agency. Organisational factors, especially position size, being organised at the top level and having a job description, were significantly associated with perceptions of intersectoral agency. PHCs seeing themselves as intersectoral agents also found themselves able to affect annual budgets and policy outcomes. We conclude that municipal PHC positions can be important HiAP tools in local public health policies. However, organisational factors affect how PHCs perceive their influence and role in the municipal organisation and thereby their possibilities to influence local policymaking through intersectoral agencypublishedVersio

The Scandinavian Model in Healthcare and Higher Education: Recentralising, Decentralising or Both?

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The Users' Role in Primary and Secondary Healthcare in Finland and Norway

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