• Mette Udengaard Nors
4. term, Public Administration and Social Science (Master Programme)
The present master thesis is about the Danish Hospital Service (DHS) and its development from the beginning of the seventies until the present day. The idea of a "free choice of hospital service" has been a symptom of this development, and has had a great impact on its future, and it seems that this influence is still going to be seen for some time. This thesis therefore focuses on the major question mark: what has caused the changes, leading to where the DHS is today. This means: appraisal of what, during the past 30-40 years, has happened within the health policy sector, which led to the "free choice of hospital service" and its retrospective development under the motto "history matters". The purpose is, apart from getting an understanding of the mechanisms and causes that have brought us where we are today, to examine which questions this development is raising for the future of the DHS. Of course, the investigation cannot cover the full development, but contributes to explaining how and why we now have the "free choice of hospital service", its retrospective development as well as the consequences and possibilities which this development may entail for the future DHS. As mentioned, this thesis is based on the assumption that history and the past course of events play a great part in the development up to and from the first law of the "free choice of hospital service". And of course, it is natural to choose the theory of historical institutionalism. Apart from helping to understand the development of the "free choice of hospital service" this theory shows some of the tools and basic knowledge used to obtain a qualified guess as to how the development of the "free choice of hospital service" will affect the future of the DHS. Furthermore, this thesis is especially based on the study of existing documents and my own interviews with central people involved. The thesis shows that the development within "the free choice of hospital service" may have two issues: partly some prominent problems - boundary problems and waiting lists - and partly historical institutional mechanisms. Therefore, it appears that the "free choice of hospital service" has resulted in a change of path within the organisation of the DHS. First of all, the thoughts of the DHS has been changed, from seeing the DHS as something that should be a pure public mission, to the involvement of the private sector. The involvement of the private sector is a breach of the original idea that hospital services must be a pure public mission. Secondly, the "free choice of hospital" makes the political control within the counties, and later on regions, difficult, which means a restriction in the political margin of manoeuvre. The transition from counties to regions has emphasized this restriction. This has therefore breached with the thought of hospital services should be decentralized into full-function units, based on the principles of proximity and economic viability. This raises questions about the future of hospital services. Will this development result in the privatisation of hospital services? Will this development affect the free and equal access to hospital services? What about health insurance policies - can they emphasise the present development? And what about the present economic situation - what impact will it have? The answers lay in the future.
Publication date2008
Publishing institutionPolitik og Administration
ID: 16056921