Health Care Reforms in Norway, Denmark and United Kingdom: Shifting Balances of Autonomy and Control

This paper focuses on the balance between central governmental control, autonomy for health care institutions and (quasi)-market mechanisms by examining recent health care reforms in Norway, Denmark and United Kingdom. The reforms involve strengthening of overall central government control, simultaneously representing a decentralized system of management and business-like mechanisms to ensure patient choice. The theoretical basis of the study is theories explaining convergence and divergence patterns in health care reform policies. Even though New Public Management (NPM) is still a dominant reform paradigm in our time, culture and political dimensions need to be integrated into the NPM approach to understand health care reforms. A contextualization process that stresses the uniqueness of the national system in general and health systems in particular have to be taken into account. In the empirical section, recent health care reforms in the countries under study are described along three organizational trajectories, decentralization, marketization and centralization showing both convergent and divergent reform patterns.