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The Quest for Promoting Integrated Care in the Scandinavian Countries – Recent Reforms, Possibilities and Problems

In Pinheiro, R. Geschwind, L., Ramirez, F., and Vrangbæk, K. (eds). Towards a Comparative Institutionalism: Forms, Dynamics and Logics Across the Organizational Fields of Health Care and Higher Education. Research in the Sociology of Organizations, Emerald: Bingley. 195–213

Abstract

Integration between primary and secondary healthcare services and institutions has been at the core of health policy in Scandinavian countries over the last decade. This paper is based on an explorative case study of recent reforms in the healthcare sector and their outcomes in Denmark, Norway and Sweden. We discuss the possibilities of and problems for integrating the healthcare sector through the coordination mechanisms of hierarchy, market and network. The paper also discusses whether the institutional logic of the healthcare field is moving from a dual logic of ‘cure’ and ‘care’ towards a unifying logic of ‘integrated care’. We find that although the organisational principles that regulate the relationship between actors in the healthcare field in the three countries have changed, the challenge of achieving a mix of coordinative mechanisms that promote, rather than weaken, integration remains. However, the new organisational and regulative arrangements are an arena for increased interaction and collaboration between the actors, and thus a foundation for change towards the institutional logic of integrated health care.