Manouvring in hybrid health care organizations

Norwegian health care is pervaded with tensions due to conflicting policy aims and dispersed responsibilities. On one hand efforts are made to make the system streamlined, efficient and based on budget units with clear responsibilities. On the other hand efforts are made to make services responsive and coherent for an increasingly diverse population. This project will examine how these efforts are reconciled in the everyday practice of the health care system, in terms of four case studies focusing on diff erent intra-organizational and inter-organizational arenas and on different groups of vulnerable citizens. The first study focuses on disabled people with rare disorders and the way they are diagnosed in general hospitals where state reimbursement is base d on DRG. Do hospitals mobilize external expertise related to these peoples rare disorders? The second study focuses on frail elderly who are about to be discharged from hospitals and the way medical actors from general hospitals and local care agencies n egotiate the responsibility for these patients. The study will particularly look into intermediate rehabilitation wards. The third study draws attention to elderly immigrants (Pakistanis) and to the problems health care staff face in categorizing and diag nosing this patient group. The study will focus on dementia screening in general hospitals, needs assessment in local care agencies, and the problem of non-use among elder Pakistanis. The fourth study will draw attention to the pluralized home care servic e ? a service for ?activist? younger disabled and for elderly cognitively impaired. The study will examine how accountability practices are constructed and experienced by affected parties. The case studies will be carried out by four NOVA researchers in i nterdisciplinary collaboration with other researchers. Results from the case studies will be reported in English-language and Scandinavian-language journals. Results will be synthesized in a Norwegian anthology.