Associations between structures, processes and outcomes in inter-municipal cooperation in out-of-hours services in Norway: A survey study

Abstract Inter-municipal cooperation (IMC) has gained widespread recognition as a beneficial strategy for improving efficiency and quality in the provision of out-of-hours emergency care services (OOH services). Little attention, however, has been given to the additional costs of cooperation and the relational processes through which benefits and costs are likely to result. Based on survey data from 266 (77%) Norwegian municipalities involved in IMC in OOH services in 2015, this study aimed to investigate how the structure (governance form, complexity and stability) and quality (trust and consensus) of cooperation processes interact to influence the perceived outcomes (benefits and costs) o…

Promoting coordination in Norwegian health care

This is the journal's version originally published in International Journal of Integrated Care. This article is designet as ”Open Access”. © International Journal of Integrated Care: http://www.ijic.org/index.php/ijic/index Introduction: 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. Policy practice: 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 problem…

The quest for promoting integrated care in the Nordic countries – recent reform initiatives, outcomes and obstacles

Coordination between primary and secondary health care has been the core of Nordic health policy during the last decade [1]. In 2012, Norway introduced a cooperation reform aiming for strengthening integration between primary and secondary health care [2]. Previously, Denmark introduced in 2007 “The Local Government Reform” to improve integration in the health care sector. During the last decades, Sweden has restructured for a more community oriented health care system [4]. The objective of the paper are to compare integrated health policy measures and reforms and their outcomes in Denmark, Sweden and Norway, with regard to success and obstacles for improving “seamless” health care. Current…

Can bureaucrats order public health? The case of Norway

Introduction: The implementation of a new structural reform, the Coordination Reform, prioritizing a new public health agenda, was initiated to develop a more decentralized, integrated health care system in Norway in 2012. The same year, new health legislation was implemented and due to the new Public Health Act the responsibility for implementing a new public health agenda was decentralized to the local level. Historically, due to lack of funding – these issues have got low priority among local authorities. The new public health legislation reflects a shift in policy focus from treatment to illness prevention – where planning and partnership among primary end specialist health care, as wel…

Social movements and the contested institutional identity of the hospital

Taking popular protest as a common reaction to changes in hospital services as its point of departure, this paper explores how a social movement has taken on the issue of the hospital as an institution. In the wake of the transformation of Norwegian public hospitals into health enterprises (trusts), this paper explores community resistance to the proposals and plans of decision-makers to restructure hospitals. The study is based on a qualitative and quantitative analysis of the website/blog for the local hospital movement's activities from 2007 until 2017 and of its involvement and resistance in respect of three instances of proposed change to the hospital structure during this period. The …

Promoting coordination in Norwegian health care1

Introduction 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. Policy practice Enhancing coordination between primary and secondary health care has been central in Norwegian health care policy in 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 imp…

‘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 f…

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

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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 l…

Drivers and barriers of inter-municipal cooperation in health services – the Norwegian case

Inter-municipal cooperation in service delivery is widespread, as is the notion that this type of cooperation is primarily driven by economies of scale. However, the empirical results appear to be ...

Public Health Policy to Tackle Social Health Inequalities: A Balancing Act Between Competing Institutional Logics

Kvale and colleagues examine the logics of Norwegian government initiatives to respond to social inequalities in health. Whereas the individualist logic favors bounded and specialized measures and organization, the collectivist logic favors broad approaches and organizational coordination. A content analysis of Norwegian health policy documents between 2003 and 2017 shows how such specialized and integrative measures and structures are alternately introduced and hence create a pattern of priorities to tackle public health challenges alternating between a collectivist and an individualist logic. They argue that reform of service coordination to tackle social inequalities in health requires a…

Strategic mergers in the public sector: comparing universities and hospitals

Reforming hospitals through new roles of management : hospital managers' interpretation of leadership conditions in Denmark and Norway

When disease is being priced. The Translation of the American DRG system to the hospital sectors in Norway and Denmark : a tentative study aimed at a comparison between Norway and Denmark

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_series In 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 i…