Search results

This paper aims to identify variation in the introduction of New Public Management reforms in healthcare and how this variation is related to country‐specific healthcare states.

The analysis uses the introduction of clinical standards in Britain and Germany as cases. The two countries are characterised by interesting differences in relation to the institutional set‐up of healthcare states and as such present ideal cases to explore the specific ways of how healthcare states filter clinical standards as tools of a generic managerialism.

Both countries have introduced clinical standards but, importantly, the substantive nature of clinical standards differs, reflecting differences in initial institutional conditions. More specifically, in Britain clinical standards have taken the form of two parallel policies, which strengthen hierarchy‐based governing and redefine professional self‐regulation. In Germany, by contrast, clinical standards come in one single policy, which strengthens the hybrid of network‐ and hierarchy‐based governing and to some extent also pure hierarchy‐based forms of governing.

First, with its cross‐country comparative focus, the analysis is able to identify systematic variations across healthcare states and the specific ways in which they impact on the introduction of New Public Management. Second, with its focus on clinical standards, the analysis deals with the governance of medical practice as one of the central areas of healthcare states.

The present paper describes the interplay between the “why” and “how” in co-production based on a case study of community-based healthcare in Denmark involving municipalities and voluntary sports clubs. So far, policy practice and research have focussed on the “why” – the rationales and pre-requisites – of co-production. However, there seems to be a lack of knowledge about the “how” of co-production in the interplay between professionals and volunteers. The paper asks how co-production is being perceived and practised according to existing norms and objectives of public healthcare and civil society, drawing on the theory of institutional logics.

The paper uses a critical case study approach to examine the practice of co-production. The analysis builds on qualitative data from nine semi-structured interviews, two information interviews and project documents. Interviews were recorded, transcribed verbatim and coded.

This paper demonstrates that compatibility of institutional logics was not given, nor did the co-existence of potentially competing logics necessarily result in conflict in co-production. Instead, in this case study co-production emerged as highly contingent, reflecting the dynamic interaction between logics and context-specific management.

This paper makes an original contribution to the conceptual understanding of co-production in emphasising the benefit of paying attention to the network logic when building bridges between public healthcare and civil society – and to unite the seemingly contradictory “why” and “how” of co-production in practice.

The purpose of this paper is to introduce the papers included in this special issue and discuss the theme – shifts in Nordic welfare governance.

The paper discusses the major themes and sets out the structure of the special issue.

The picture emerging is mixed and there is evidence for strong decentralisation where policy instruments allow for considerable local room to manoeuvre. Organisational arrangements for governance are also highly localised, but (over time) oscillate between decentralisation and centralisation. As for the consequences for universalism, the contributions point to three contrasting scenarios. The first, relatively optimistic assessment suggests that while decentralisation challenges territorial equality, in some Nordic countries there seems to be inbuilt self‐correcting mechanisms pulling in the opposite direction. The second scenario is more critical and here it is argued that shifts in welfare governance, such as decentralisation and the introduction of elements of self and market governance, challenge universalism; universalism has become highly contingent on local circumstances and the practice of welfare delivery mixes different types of justice. The final scenario is rather pessimistic about the prospects of universalism and suggests that the shifts in welfare governance challenge universalism on all counts and lead to a wide range of new inequalities among citizens. This echoes the analysis of non‐Nordic countries in Europe where the scope for universalism remains limited.

The contribution of this special issue is twofold. First, using elderly care as a case study, the special issue analyses the complexity of welfare governance by looking at changes in both the vertical and the horizontal dimensions of governing. Second, focusing on Nordic countries, it assesses the substantive implications of shifts in welfare governance, notably in terms of universalism.

The purpose of this paper is to discuss the concept of territorial equality as an indicator of universalism in locally provided care services for older people. The research question explored is how the local organisation of care services impacts on and either strengthens or weakens local universalism.

The analysis is based on case studies in six municipalities in Finland, Norway and Sweden.

The paper shows that three kinds of organisational characteristics are of relevance for local universalism: the explicitness in assignment criteria, the organisational strength of service guarantees and the degree of co‐payments. Local universalism is highly dependent on the specific organisational arrangements at the local level, but in interplay with national level regulations. Of the three investigated kinds of organisational conditions, the local impact is largest on access criteria and the organisational strength of service guarantees.

Although, there has been much work in mapping territorial inequalities in the Nordic as well as in a wider European context, little attention has been given to how universalism should be understood and evaluated at the local level. The study offers an empirical analysis of organisational conditions for local universalism in the Nordic welfare municipalities.

Local welfare governance is approached from the vantage point of informal carers caring for older people. A bottom‐up perspective is used to construct a critical view on welfare provision and governance practices at the local level. The paper aims to discuss the issues.

The data consist of 23 in‐depth interviews with informal carers. Universal access to services and equal treatment of citizens is discussed.

The analysis illustrates how informal carers share care responsibilities with the municipality and gain access to services both as service providers and service users. Informal care comprises a complex mixture of public and private responsibilities that poses a challenge to universalism. There are new inequalities emerging among informal carers, while access to public resources is easier for resource‐rich carers positioned as service providers. Resource‐poor carers identify themselves often as service users in relation to municipality.

The use of original data provides important knowledge on informal carers' dual position in the local welfare governance and contributes to both theoretical and empirical understanding on shifts within Nordic welfare governance. Informal carers' dual position reflects the essence of mixed governance and represents future social policies.

The paper aims to account for the substance of non‐linear governance change by analysing the importance of sector‐specific institutions and the pathways of governing they create.

The analysis uses recent reforms of the governance of medical performance in four European countries as a case, adopting an inductively oriented approach to comparison. The governance of medical performance is a good case as it is both, closely related to redistributive policies, where the influence of institutions tends to be pertinent, and is subject to considerable policy pressures.

The overall thrust of reforms is similar across countries, while there are important differences in relation to how individual forms of governance and the balance between different forms of governance are changing. More specifically, sector‐specific institutions can account for the specific ways in which reforms redefine hierarchy and professional self‐regulation and for the extent to which reforms strengthen hierarchy and affect the balance with other forms of governance.

The recent literature on governance mainly focuses on mapping out the substance of non‐linear change, whereas the development of explanations of the substance of governance change is less systematic. In the present paper, therefore, it is suggested coupling the notion of non‐linear change with an analysis of sector specific institutions inspired by the historical institutionalist tradition to better account for the substance of non‐linear governance change. Further, the analysis offers interesting insights into the complexity of redrawing boundaries between the public and the private in health care.

This paper seeks to identify different medical strategies adopted in relation to the new hospital payment systems in Germany, The Netherlands and England and analyse how the medical strategies have impacted on the emergence of these New Public Management policy tools between 2002 and 2007.

A comparative approach is applied. In addition to secondary sources, the study uses publications in professional journals, official publications of the (national) physician organisations and a (non‐random) expert questionnaire to obtain the views of the medical corporate bodies in the three countries.

The results reveal differences in the medical strategies in the three countries that point towards the significance of institutional and interest configurations. The Dutch corporate medical body was most willing to solve the conflict, while the German and English corporate medical bodies seem to be keen to use a strategy of confrontation. The differences in medical strategies also impact on the ways in which hospital payment systems have emerged in the three countries.

Further research is necessary to study the medical strategies in healthcare reforms from a broader perspective, for instance by including other countries.

The paper gives insights into the interplay between the medical profession and the government in the context of new managerial governance practices in the hospital sector. It adds to the scholarly debates about the role of the medical profession in health policy‐making.

The purpose of this paper is to analyse the changes that have taken place in the central regulation of social care in Finland since the 1970s. The changes in vertical central‐local relations are discussed in the context of economic and welfare state development.

The paper is a case study, applying the concept of “the Nordic welfare municipality” to the case of Finland. With this concept, the author refers to the inherently contradictory character of the Nordic model of welfare governance: to a system that emphasises local self‐government but that, at the same time, perceives regional harmonisation as imperative.

After strong central control during the most intensive construction period of the Finnish welfare state in the 1970s and 1980s, a radical decentralisation reform was implemented in 1993. However, since the early 2000s pressure for centralisation has increased again as emerging regional inequalities in care service provisions came under criticism.

The paper identifies a cycle of decentralisation and recentralisation that reflects the fundamental discrepancy between the maxims of local autonomy and regional equality that are both formative elements of local governance within the Nordic welfare model.

The paper compares the introduction of universal long‐term care schemes and the regulations of migrant care work within the framework of multi‐level governance in Austria and Germany. The aim of the paper is twofold. First, it reveals the characteristics of country‐specific universal policy schemes and second, it explains their designs – the new type of universalism and its completion by regulations of migrant care work within the family framework – by the policy‐making process.

Conceptually, the paper combines approaches within long‐term care research to define dimensions of universalism, as well as on multi‐level governance and new‐institutionalism to examine the policy‐making process. Empirically, Austria and Germany are selected as two cases.

The findings reveal the significant dimensions of the new type of universalist policy design and of policies towards migrant care work. The country differences are explained by the policy‐making process within countries and with cross‐border effects. In particular, the impact of the disability movement in Austria and the coalition between the political parties in Germany resulted in a country‐specific definition of universalism. The integrated approach towards migrant care work in Austria is contrasted with the fragmented approach in Germany. In both countries, the regulations of migrant care work question the idea of universalism.

The impact of societal actors and their ideas on the creation of a new type of universalism and the interrelated regulation of migrant care work has only rarely been examined. The analysis contributes to an understanding of the policy‐making process and its interrelationship with selected policy designs.