Learning from different experiences: Multilevel governance of health and care services in Denmark and Norway

In the proposed study we focus on the multilevel coordination of policy-making and governance between national, regional and local levels of government. The study will concentrate on the relationships between central and local politicians, civil servants and health managers. In this way the proposed study represents an important supplement to other HELSEOMSORG funded studies, which focus primarily on service coordination at the level of physicians and nurses in primary care and specialist health services. A comparative study of different health care systems and coordination mechanisms may generate a broader basis of knowledge for learning and problem solving. Consequently, our study will be based on comparisons between two different systems of multilevel governance of primary care and specialist health services: (a) the new Danish system with a major role for the newly established regions and collaboration with the state and municipalities, and (b) the Norwegian system with state governed specialist care (including state owned regional health authorities and local health enterprises) and primary care governed by the municipalities. A common challenge in Denmark and Norway is to coordinate and govern between mutual dependent democratic levels of governme nt without being able to lean on strong control and command policy instruments within a hierarchical government system. The systemic differences constitute an empirical argument for a comparative study between Denmark and Norway. The first phase of the project will rest on qualitative studies of major policy documents and informant interviews on a) central level, b) regional level, c) local level within specialist health services and d) municipal level. The second phase will be based on comparative in d epth studies where political-administrative coordination are likely to occur. The third phase will be based on nation-wide quantitative surveys.