Coordination agreements, financial incentives and local responses in the governance of Danish and Norwegian health and care services

The project analyses effects of recent reforms and the multilevel governance of Danish and Norwegian health and care services. It is carried out by researchers at IRIS - International Research Institute of Stavanger, Oslo and Akershus University College of Applied Science and the University of Copenhagen. The project is based on qualitative as well as quantitative methods. The researchers have carried out a number of personal and group interviews with central persons in municipalities/regions and health enterprises/hospitals in Denmark and Norway. Interviews include persons involved in negotiations on coordination agreements, members of coordination committees, chief officers, health and care officers, users etc. Surveys have been carried out among local health politicians and members of coordination committees in Denmark and Norway, and health administrators in Norwegian municipalities. A survey among Norwegian patients' organisations will be carried out in the autumn 2017. Preliminary results have been presented in lectures for students and at conferences and workshops (including the Nordic Political Science Association's conferences in Gothenburg, August 2014, and Odense, August 2017). A book, H. Rommetvedt, I.M. Stigen, S. Opedal and K. Vrangbæk (2014): "Hvordan har vi det i dag, da?" on multi level governance and coordination in Norwegian and Danish health policy, has been published by Fagbokforlaget. The book has benefited from the present project, even though it is primarily based on an earlier study funded by the Helseomsorg program. Results have been referred to in Norwegian newspapers.

Kunnskap fra dette prosjektet har dannet grunnlag for utvikling og gjennomføring av flere nye prosjekter med temaer som samhandlingsreformens konsekvenser for kommunale pleie- og omsorgstjenester, øyeblikkelig hjelp-tilbud i kommuner, bruk av velferdsteknologi og "Disease Management Programs". Prosjekterfaringer og resultater er formidlet gjennom en rekke papers og foredrag for relevante brukergrupper. Prosjektet har således bidratt til kompetanseutviklingen i praksisfeltet. Det har også bidratt til å styrke undervisningen på masternivå i styring og ledelse/samhandlingsledelse (OsloMet) og folkesundhedsvidenskab / statskundskab (Københavns universitet). Se resultatrapport for utdyping.

The project focuses on two major instruments in the Norwegian Coordination reform from 2012 and their parallels in the Danish Structural reform from 2007: 1) The statutory establishment of coordination agreements between municipalities and regions/hospit als/health enterprises. 2) The financing systems with municipal co-financing of specialized services and payment for patients who have to stay at hospitals after finalized treatment, covered by block grants from the state, and in the case of Norway earma rked grants for acute help and 24 hours care to be established in the municipalities. The study analyses the implementation and effects of the reforms with regard to: 1) better coordination of services and flows of patients between municipalities and re gions/hospitals/health enterprises, 2) municipalities taking care of a larger share of the health and care services, and 3) reinforcement of the preventive health work of the municipalities. The study is based on: 1) Qualitative, in depth case studies of a) the development and implementation of coordination agreements between a selection of municipalities and hospitals/health enterprises, and b) the activities of committees and other forums for coordination between the same selection of municipalities and hospitals/health enterprises. 2) Qualitative, in depth case studies of the development of new health and care services and activities in selected municipalities. 3) Quantitative analyses of data from nationwide, web based surveys among a) members of coordination committees/forums for representatives from regions/hospitals/health enterprises and municipalities, b) the health directors/administrative leaders of the municipalities' health and care services, c) the local politicians who are members of th e municipal boards responsible for health and care services, and d) users, that is the nationwide organizations for patients and disabled persons.