Coordinated healthcare, getting the incentives right?

Abstract

The Norwegian government has passed a reform for coordinating the activities of the health sector in the future with the goal of providing cohesive patient pathways. This reform is especially meant for patient groups who rely on assistance from multiple providers in a coordinated and rational manner. The reform measures are intended to facilitate effectively coordinated treatment without patients being burdened with the additional worry of navigating through the healthcare system in order to get adequate help. The policy is designed to facilitate cooperative behavior between service providers in collaboration with patients and their organizations. Since there is no obvious reference to an explicit theory of coordination, this thesis asks what implicit social theory underlines the concept of coordination in the Coordination reform. A document analysis of two public documents namely, NOU 2005:3 and St.meld.nr.47 is the approach adopted for answering this question. The documents are analyzed from the perspective of Habermas or coordination via deliberative decision making, rational choice and a scientific concept of cooperation as proposed by Benkler (2009). The implicit theory behind coordination as it appears in the documents is important because it reveals what assumptions policy makers have about actors and which measures will be effective in facilitating cooperation and coordinated action towards optimal outcomes for patients. Of special interest here is if this policy design makes use of an alternative theory to the standard economic model of rational man as might be expected of a New Public Management reform. The implicit assumptions are vital because proposed measures lay the foundation for an institutional framework that in varying degrees will allow genuine cooperative behavior to flourish.