Vil reformen med statlige, regionale helseforetak føre til effektivitetsforbedringer i norske sykehus?

Summary
Will the Norwegian hospital reform with state ownership and regional hospital enterprises lead to efficiency and effectiveness improvement in Norwegian hospitals? Predictions from selected theories and experiences so far.

The hospital system was from 1.1.2002 transformed from county ownership to state ownership and hospitals were organized as enterprises. This reform was described by the Ministry of health as a tool to achieve increased efficiency in Norwegian health care system. This article analyses the reform by three theoretical approaches with references to national and foreign experiences. The article also relates the hospital reform to other reforms in the health care sector. The principal-agent approach predicts that because of how the reform has been implemented it will not enhance efficiency. An instrumental perspective predicts that efficiency could have been affected if the reform had led to scale effect by merging hospitals. However, the hospitals mergers have not yet led to profound organizational changes partly due to interference from central political government. Institutional theory would describe the reform as being ambiguous and inconsistent and predicts that the reform would not have practical implications. The overall conclusion is that because how the reform has developed, it would not be followed by an increase in efficiency and effectiveness.