Research project In Swedish health care, a development towards governance has recently been evident through the extensive use of softer policy instruments, such as national agreements. The agreements are reached between the central government and the Swedish Association of Local Authorities and Regions (SALAR). The question is how the agreements affect the status of local self-government, i.e., the autonomy of the subnational governments to make their own decisions on matters of interest for their citizens.
This project aims to investigate national agreements in Swedish health care and their impact on local self-government. The process where the agreements are negotiated between the central government and the Swedish Association of Local Authorities and Regions (SALAR) will be examined as well as how the content of the agreements affects the regions’ discretion in health care. The research questions are answered through interviews with politicians and officers at national and regional levels combined with a systematic analysis of documents.
In recent decades, there has been a development from traditional policy instruments, such as laws and regulations, towards a stronger emphasis on softer policy instruments, such as information, projects, and agreements. This is described in the theoretical literature as a development from government to governance.
In Swedish health care, this development towards governance has been evident through the increased use of national agreements, for example within cancer care, women’s health, and waiting periods. In the case of Sweden, the responsibility of planning and providing health care is decentralized to 21 regions with strong self-government and directly elected regional councils. The agreements are based on voluntariness and cooperation and have been reached between the central government and the Swedish Association of Local Authorities and Regions (SALAR).
In the research on governance, there is a debate if policy instruments such as agreements are soft in practice and thus differ from hard policy instruments regarding, for example, elements of legal sanctions. If not, there might be a conflict between the widespread use of agreements and local self-government.
The project aims to analyse national agreements in Swedish health care and their impact on local self-government. How are the agreements negotiated, especially when it comes to the inclusion of the regions? What is the content of the negotiated agreements in terms of discretion for regions? How are the agreements evaluated and what connection is there to “rewards” and “penalties”?
This issue is important to investigate to achieve a greater understanding of health care governance and organization in a context of multi-level governance, where several different levels have power and responsibility.
The research questions are answered through an empirical study consisting of interviews with politicians and officials at national and regional levels as well as a systematic analysis of documents.
