Dag Olaf Torjesen

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

ABSTRACT 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 inconclusive, suggesting that additional explanatory factors are needed to explain why municipalities cooperate. This study aimed to identify the factors and conditions that influence the level of inter-municipal cooperation in health services by exploring a broad set of explanatory factors that go beyond simple economic concerns. In addition to confirming that a small population-size and fiscal stress constitute important drivers of inter-municipal cooperation, the results from this study also demonstrates the need to consider geographical location and heterogeneity relative to neighbouring municipalities as potential barriers to such cooperation.

The Quest for Promoting Integrated Care in the Scandinavian Countries – Recent Reforms, Possibilities and Problems

Abstract Integration between primary and secondary healthcare services and institutions has been at the core of health policy in Scandinavian countries over the last decade. This paper is based on an explorative case study of recent reforms in the healthcare sector and their outcomes in Denmark, Norway and Sweden. We discuss the possibilities of and problems for integrating the healthcare sector through the coordination mechanisms of hierarchy, market and network. The paper also discusses whether the institutional logic of the healthcare field is moving from a dual logic of ‘cure’ and ‘care’ towards a unifying logic of ‘integrated care’. We find that although the organisational principles that regulate the relationship between actors in the healthcare field in the three countries have changed, the challenge of achieving a mix of coordinative mechanisms that promote, rather than weaken, integration remains. However, the new organisational and regulative arrangements are an arena for increased interaction and collaboration between the actors, and thus a foundation for change towards the institutional logic of integrated health care.

The Ideas and Implementation of Public Health Policies: The Norwegian Case

In Denmark, Norway and Sweden, the municipal and regional administrative levels are in charge of implementing public health policies and measures on behalf of the state. In fact, both in Denmark (Waldorff, 2010; Vrangbaek and Sorensen, 2013) and in Norway (Report to the Storting no. 47, 2008–2009; Rommetveit et al., 2014; Torjesen and Vabo, 2014), recent reforms have emphasized the role of the municipalities in carrying out public health policies. In this chapter, we investigate the challenges of managing organizational change processes, in order to create changes in practices within the field of public health in the case of Norway. We study the relationship between changes in national policies and legislation and implementation at the municipal level. Our main question concerns how national public health policies are put into local practice. To answer this, we need to (1) investigate which ideas about the government of public health are articulated in national policies, (2) study how these policies are received and acted upon locally and (3) explain local choices regarding public health practices. Furthermore, in this chapter we present a theoretical framework focusing on major ideas on public health management and on the relation between ideas and practice in a neo-institutional perspective. This is followed by a brief presentation of the material and methods, as well as an explanation on how the empirical data are analysed. Then the analysis of the empirical data is presented, concluding the chapter with a discussion.