The end of the decentralised model of healthcare governance? Comparing developments in the Scandinavian hospital sectors

Abstract

Purpose: This paper aims to discuss recent contributions to comparative healthcare systems research, which emphasise decentralisation as a major characteristic of Scandinavian hospital systems. Whether the idea of such a "decentralised Scandinavian model" is appropriate and useful, how and why it was created, and what the alternative is, are central questions approached through a perspective gathered from historical institutionalism.

Design/methodology/approach: The paper employs an analysis of primary and secondary sources on the history of Scandinavian hospital systems, a classification based on historical developments, and an explanatory framework based on historical institutionalism.

Findings: The paper concludes that the idea of a decentralised Scandinavian model for hospital systems has had limited validity, constrained to the years 1970-2000. Historical trajectories and recent developments both indicate that the three systems are more different than commonly assumed, and that recently they seem to be moving in separate directions. The explanation for the developments is found in incremental dynamics, creating institutional change that to a large extent depends on national contexts.

Originality/value: The paper contributes to the current discussion and research relating to classification of health care systems, and aims at developing a more elaborate understanding of the role of the hospital sectors within the Scandinavian welfare states. It challenges the idea that a single model can capture the essence of such diverse systems, and proposes an alternative to such modelling, based on a historical-institutional approach.