The paper contributes to the literature of multi-level welfare governance and public accountability in the context of recent European hospital reforms. Focusing on the changing dynamics between regional and central governance of hospitals in Germany, Norway and Denmark, we raise concerns about the reshaping of traditional public accountability mechanisms. We argue that, triggered by growing financial pressures, corporatization and professionalization processes have increasingly removed decisionmaking power from regional political bodies in hospital funding and planning. National governments have tightened their control over the overall trajectory of their hospital systems, but they have also shifted significant responsibility downwards to the hospitallevel. This has reshaped public accountability relationships towards more managerial or professional types of accountability embedded within multi-level forms of governance.
This paper examines a particular performance management instrument in Norway: DRGs used in conjunction with activity‐based funding of hospitals. We ask whether this system creates opportunities for undesirable gaming practices, how accountability arrangements deal with gaming, and how trust and institutional logic may help to explain anomalies and their resolve. From an instrumental and cultural perspective, we examine six Norwegian cases of gaming and two governmental assessments of coding and activity‐based funding. Current solutions do provide gaming opportunities, in a highly complex accountability setting. Accountability arrangements highlight tensions between trust and distrust, rather than resolving the balance between individual goals and collective norms.
Climate change yields both challenges and opportunities. In both cases, costly adaptations and transformations are necessary and desirable, and these must be based on realistic and relevant climate information. However, it is often difficult for climate scientists to communicate this information to decision-makers and stakeholders, and it can be equally difficult for such actors to interpret and put the information to use. In this essay, we discuss experiences and present recommendations for scientists producing climate services. The basis is our work in several climate service projects. One of them aimed to provide local-scale climate data for municipalities in western Norway and to explore how the data were interpreted and implemented. The project was first based solely on climate science expertise, and the participants did not have sufficient competence on coproduction and knowledge about the regulatory and political landscape in which municipalities operate. Initially, we also subscribed to an outdated idea of climate services, where knowledge providers (climate scientists) “deliver” their information to knowledge users (e.g., municipal planners). Increasingly, as stressed in the literature on coproduction of knowledge, we learned that climate service should be an iterative process where actionable information is coproduced through two-way dialogue. On the basis of these and other lessons learned the hard way, we provide a set of concrete recommendations on how to embed the idea of coproduction from the preproposal stage to beyond the end of climate service projects.
Diagnosis Related Groups (DRGs) are used for financial and administrative purposes in hospital systems across the world, and are combined with a series of administrative tools to increase efficiency and effectiveness. Economic dysfunctions of such systems are widely reported, but the organizational basis of this managerial tool and the implications for hospital governance are less explored. This article shows, through eight case studies, how DRGs and waiting list management create opportunities for gaming in Norway and Germany. It argues that whereas these effects are relatively similar, the way they are handled by different accountability types varies considerably between Norway and Germany. Despite similarities in gaming and accountability challenges in the single cases studied, the Norwegian and German systems seem to cope with gaming in different manners, as could be expected: The institutional context creates premises for resolving such issues that vary more with the actual governance setting than with the nature of a given case. Both systems are marked by a certain ambiguity and complexity defined by reforms history, institutional dynamics, and administrative traditions: the German legal‐oriented, Bismarckian system is as ambiguous as the Norwegian consensus‐oriented Beveridge‐type system.
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