The end of the decentralised model of healthcare governance?
- 8 August 2008
- journal article
- review article
- Published by Emerald in Journal of Health Organization and Management
- Vol. 22 (4), 331-349
- https://doi.org/10.1108/14777260810893944
Abstract
Purpose – This paper aims to discuss recent contributions to comparative healthcare systems research, which emphasise decentralisation as a major characteristic of Scandinavian hospital systems. Whether the idea of such a “decentralised Scandinavian model” is appropriate and useful, how and why it was created, and what the alternative is, are central questions approached through a perspective gathered from historical institutionalism. Design/methodology/approach – The paper employs an analysis of primary and secondary sources on the history of Scandinavian hospital systems, a classification based on historical developments, and an explanatory framework based on historical institutionalism. Findings – The paper concludes that the idea of a decentralised Scandinavian model for hospital systems has had limited validity, constrained to the years 1970-2000. Historical trajectories and recent developments both indicate that the three systems are more different than commonly assumed, and that recently they seem to be moving in separate directions. The explanation for the developments is found in incremental dynamics, creating institutional change that to a large extent depends on national contexts. Originality/value – The paper contributes to the current discussion and research relating to classification of health care systems, and aims at developing a more elaborate understanding of the role of the hospital sectors within the Scandinavian welfare states. It challenges the idea that a single model can capture the essence of such diverse systems, and proposes an alternative to such modelling, based on a historical-institutional approach.Keywords
This publication has 15 references indexed in Scilit:
- Reform by Coincidence? Explaining the Policy Process of Structural Reform in DenmarkScandinavian Political Studies, 2007
- Institutional change and globalizationSocio-Economic Review, 2007
- Ideas and Institutional Change in Social Security: Conversion, Layering, and Policy Drift*Social Science Quarterly, 2007
- The Norwegian hospital reform of 2002: Central government takes over ownership of public hospitalsHealth Policy, 2006
- The Danish health care system: evolution - not revolution - in a decentralized systemHealth Economics, 2005
- Health Policy in Denmark: Leaving the Decentralized Welfare Path?Journal of Health Politics, Policy and Law, 2005
- The organizational pendulumScandinavian Journal of Public Health, 2000
- An Essay on Fiscal FederalismJournal of Economic Literature, 1999
- Translating Organizational ChangeAdministrative Science Quarterly, 1999
- Who Governs the Health Sector? Comparative European and American Experiences with Representation, Participation, and DecentralizationComparative Politics, 1985