What Frames Quality Registers in Swedish Health Care? – An Institutional Approach

Quality issues strike the classical conflict in a democratic health-care delivery system of different interests among the politicians, the medical profession and public officials. This cannot be studied as a cut-off whiz. Quality registers have developed over the past 40 years. Therefore, this paper puts the innovation of quality registers in an institutional perspective. Two things are essential in this paper. First, this paper reviews the emergence of quality registers in Swedish health care as an effect of institutional arrangements. Second, it analyses the interaction of diverse factors in different institutional settings and logics. The relevant data for the study was collected from official/unofficial policy documents and key actor interviews. The empirical findings show that three different waves of development can be traced in history that has highly affected the development of quality registers. It also shows that medical quality is framed and determined by physicians in line with professional knowledge and by the primary institutional logic of quality in medical care. However, organisational quality in health care is framed by the logic of public equity of access based on a third party payer and the logic of managerial control. These two paths of quality developments are now federating in an institutional logic of transparency. The contribution of this paper is important because it produces insights in different institutional logics, which frames the rise of the two quality paths and the problems they have to face in order to merge. It also enhances the existing knowledge that institutions matter.