Introduction

The three Scandinavian countries – Denmark, Norway and Sweden – are characterised by extensive welfare services, cultural similarities and close historical links. The countries also share a continued commitment to public involvement in the financing and delivery of health care. The aim is to support key values of universalism and equal access. Due to the reliance on public financing and universalist ideas, the governance structure is based on democratic decision making at state, regional and municipal levels. The Scandinavian countries are often portrayed as having a high general level of trust within the population, and between citizens and the state. This is often ascribed to a low level of corruption in the public sector and the high level of homogeneity in the population (Rothstein, 2011).

The institutional structure of health care in the three Scandinavian states is important for understanding the regulation of health professionals and the relationship between them and the public. Given the high degree of public involvement and the generally high levels of trust in the public sector, one might expect that conditions for serving the public interest are particularly good in the Scandinavian health systems. Similarly, one might expect that public involvement in regulating and providing health care facilitates a high level of trust between patients and health professionals, as there is little direct economic interaction between the two groups. The aim of this chapter is to explore the evidence about such claims and discuss the reasons behind the results. To facilitate the analysis, we start out by describing key features of the institutional structure of Scandinavian health care systems and the regulation of health professionals.

The institutional structure of Scandinavian health care systems

As Vrangbæk (2017) has noted in terms of the institutional structure of Scandinavian health care systems, traditionally the political culture of such countries has been based on a broad consensus behind the welfare state idea. Consequently, the health systems are based on the principles of universality and equity. All inhabitants have equal rights to public health services, whatever their social status or geographic location. This persistent emphasis on equity has been combined with a tradition of democratic management at the decentralised level, with a key role for regions and municipalities in delivering health care. Regions own and operate almost all of the hospitals in the three countries.