Spill og strategi i helsesektoren : eksempler fra Østfold

Abstract

"The health sector is a complex and dynamic conglomerate of services at local, regional and national levels. How to balance different considerations between new medical-professional knowledge, controlling expenses and local interests are among the permanent challenges facing political bodies when planning and structuring the services. The book is based upon institutionalist organisation theories, referring back to classic texts as well as present-day analyses. By taking a long-term perspective, and analysing one Norwegian county as a case study, the author addresses questions about how conflicts on hospital structure seemingly have been solved, and how the introduction of new management forms have changed the sector. One of the issues is how, in a 40 years’ perspective, different interest groups have seen their influence over health services and management forms have changed. In contrast to hypotheses that medical doctors would see their influence becoming reduced, the analyses show how medical actors, in an alliance with management consultants, have become more influential when innovations in health work and eventually organisation models are introduced. Regional political bodies and local community interests have lost much of their former role in restructuring processes. At the end of the book, the author makes some hypotheses about how health services will develop in the interface between ideas of a centralised, modern, high tech hospital model on one hand, and local and home based services on the other. These developments will in a nearby future most likely restructure the health sector once more. "