In the past decades the health care sector has seen the introduction of measures like competition, purchaser-provider split, privatization, activity-based financing, disaggregation of decision-making power and patient choice. These measures are based upon the logic of markets that has dominated public sector within the OECD since the late 1980s. This public administration reform wave known as New Public Management (NPM) was initially not meant for social services like healthcare. However, it has made its way into most parts of the healthcare system, and it seems like it is here to stay.

Over the past three decades, all the latest major healthcare reforms in Norway have contained, to varying extent, NPM-inspired policies. Most of these reforms, like the introduction of activity-based financing (1997), the hospital ownership reform (2002) and the coordination reform (2012), introduced organizational tools from the private sector to public health care. In this project we address different questions related to the consequences of the NPM policies introduced into the Norwegian health care system through these reforms. Synthesizing knowledge from the consequences of NPM is important for several reasons. 

First, health expenditures in Norway are high and expected to rise even further due to medical and demographical trends that results in people getting older whilst simultaneously demanding complex and expensive medical care. Thus, it is more vital than ever to understand how politics shapes the organization and financing of the health care system which in turn, of course, will affect both public health and the day-to-day operations of the professions themselves.  
Second, several of the NPM measures introduced into the health care sector has been met with skepticism from both patients, professional and politicians. However, more research is needed in order to understand and measure objectively the role on NPM in our health care system. A deeper understanding of the effects of NPM, in both a quantitative and qualitative sense, can help guide policy when shaping the health care system of the future. 

Project work packages

It is important with a varied approach as NPM is a multi-faceted phenomenon across an array of various governmental and institutional levels. The project therefore seeks to analyze the impact of the policies associated with the NPM paradigm on several different fronts, and consists of three working packages:

Work package 1

Investigates the NPM from the perspectives of the professions. Here we ask research questions such as how has the introduction of NPM- inspired reforms, like activity-based financing and the hospital reform, affect working conditions for health care professionals? Also, from a systemic perspective, how has the introduction of the coordination reform affected central quality indicators associated with quality of care?

Work package 2

The second work package takes the perspectives of the population (and thereby the patients). Here we address research questions regarding the association between NPM policy and individual health in a comparative perspective. For instance, how has NPM policies in Scandinavia affected outcomes such as subjective evaluation of health, and are there cross-country differences within the Nordics?

Work package 3

This work package addresses the consequences from the governance perspective and ask questions such as: How has the health trusts responded to the financial and budgetary incentives introduced through the reforms? How has the various NPM-components affected the productivity of the health trusts over time? Who takes the investment decisions in a in a decentralized health care system?