The implementation of the Norwegian Coordination Reform : A single-case study of the negotiation process of a contract between municipalities and a hospital

Abstract

The Norwegian Coordination Reform was implemented on January 1st 2012 and it brought along changes for both the primary- and the specialised health care sector. The main changes resulted in a shift in the responsibility of which health care provider was to do which tasks, as well as how the financing of the costs for some treatments in the specialised health care sector would be arranged. In order to make this arrangement more clear for these two parties they were obliged by the government to make legally binding contracts to formalise e.g. how the tasks were to be divided between them and how the two health care sectors were to improve their cooperative patterns in order to ensure more coordinated health care services for the patients. This thesis looks into the negotiation process of coming to terms on these contracts by studying the case of one Norwegian Health Trust and the municipalities in this Health Trust’s catchment area.

The theoretical framework for the thesis consists of negotiation theory, with some subtheories of structure, culture and power regarding negotiations. The thesis is empirically based and a single-case study, and there was conducted in-depth interviews with some of those who were directly involved in the process, from both the municipal side and from the hospital.

The outcome of the process was a success and there ware detected three main success factors in the study; - The importance of participation by the CAO’s in the process. - Municipal alliance. 21 municipalities joined together is a much stronger unity than 21 municipalities negotiating for themselves. - The hospital’s preparation. By recruiting staff with professional experience from the municipalities the hospital was much more prepared for what tfhey could expect in the negotiation process than what the municipalities were.

There were also findings that indicated that there was a superficial disagreement among the parties that was based on their expectations towards each other due to previous experiences. I call the disagreement superficial because it did not seem like the disagreement was based on what they were negotiating over, since they were more coherent in their focus areas and their desired achievements than what they were aware of themselves.

Another interesting finding was that governmental disruption late in the process was not taken well by either of the parties. The Ministry of Health and Care Services tried to intervene in one of the elements negotiated over in the negotiation process. Both parties decided not to follow the Ministry and the parties seemed to have improved their cooperation on the basis of this decision.