Reforming decentralized integrated health care systems: Theory and the case of the Norwegian reform

.................................................................................................................................................... 2 Introduction............................................................................................................................................... 4 Is there a need for reform? ........................................................................................................................ 4 Changes and reforms in Scandinavia ...................................................................................................... 10 A simple conceptual model..................................................................................................................... 15 theoretical approaches: principal-agent and discrete structural analysis.......................................... 19 Possible destabilizing features of decentralized health care systems ..................................................... 23 the efficiency-equity-free provider choice triangle .......................................................................... 23 elaboration of the fiscal relationships ............................................................................................... 25 Reform strategies .................................................................................................................................... 27 The Norwegian Reform .......................................................................................................................... 28 Weaknesses the reform is expected to correct or contribute significantly to.......................................... 30 Theory and thinking behind the reform .................................................................................................. 32 What can be expected from the reform? ................................................................................................. 37 summary appraisal ............................................................................................................................ 37 principal – agent issues. .................................................................................................................... 38 A transaction cost/discrete structural analysis perspective............................................................... 39 Other issues....................................................................................................................................... 41 Some conclusions and perspectives ........................................................................................................ 43 References ............................................................................................................................................... 47 APPENDIX I........................................................................................................................................... 54 Chronology of changes in the Scandinavian Health Care Systems. ....................................................... 54 changes in Denmark ......................................................................................................................... 54 changes in Norway........................................................................................................................... 55 changes in Finland ............................................................................................................................ 57 changes in Sweden............................................................................................................................ 58