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The interplay between central and sub-central levels: the development of a systemic standard based programme for governing medical performance in Denmark

Published online by Cambridge University Press:  01 July 2009

KARSTEN VRANGBAEK
KARSTEN VRANGBAEK*
Affiliation:
Associate Professor, Department of Political Science, University of Copenhagen, Denmark
*
*Correspondence to: Karsten Vrangbæk, Associate Professor, Department of Political Science, University of Copenhagen, Øster Farimagsgade 5, DK-1353 København K, Denmark. Email: kv@ifs.ku.dk
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Abstract

This paper analyses the introduction of a systemic standards based programme for governing medical performance in Denmark. The programme combines clinical, organisational, and patient related standards and measures, and contains both external evaluation and self-assessment based on standards. The substance of the programme is new compared to the previous decentralised or professionally driven state of affairs that was based on a largely voluntary introduction of clinical standards, combined with a case-by-case evaluation of malpractice incidents. The programme strengthens hierarchy-based forms of governance; these co-exist with salient components of network-based governance as well as some elements of market-based governance. Institutional and contextual factors are important in explaining why a systemic standards based programme emerged as a result of the policy negotiation processes. In particular, the programme reflects stronger governance ambitions from the government in response to claims of a relative decline in the quality of the regional health services. However, the actual design is mediated by institutionalised negotiation processes among the state, decentralised authorities, and health professionals.

Type
Articles
Information
Health Economics, Policy and Law , Volume 4 , Issue 3: Governing Medical Performance: A Comparative Analysis of Pathways of Change , July 2009 , pp. 305 - 327
Copyright
Copyright © Cambridge University Press 2009

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