The healthcare agreements between the regions and municipalities in Denmark have been in
place since 2007, during which no studies of the agreements and their development has been
conducted. This thesis therefore examines how the management of the healthcare agreements
has developed since 2007 and until 2019. The ambition is to deduce what influence the
management has had on the chosen organisation and format for the health agreement in the
northern region of Denmark (Region Nord). The thesis’ empirical data is based on interviews
with administrative and political informants from Region Nord and Thisted Municipality. The
interviews are supplemented with a two-part document analysis. The first part examines how
the governance form has evolved since 2007, which is done by comparing the Danish health
authority's initial guidance, with the current guidance on the healthcare agreement. The
second part analyses how the organization, format and follow up have changed through the
different generation of health agreements.

The analysis illustrated how the Danish Health Authority initially operated with a very strict
management of both the content and the format of the Healthcare Agreements between the
regions and municipalities. This resulted in agreements that reduced the flexibility of how it
could be implemented and thereby stifled innovation in the healthcare sector.

The Danish Health Authority's strict management has been decreasing since 2015, to the
point of no longer having any mandatory; focus-areas, format, or content. Initially, there was
a looser framework for the follow-up and evaluation of the agreements, however today the
objectives have shifted to primarily concern the impact and the quality.

The analysis concluded that a “political steering group” for each municipality was
established at the political level from the beginning. This changed with the third generation,
when the “Municipal cluster structure” was adopted. This led to the establishment of four
“political embedded groups” in line with the “cluster structure”. The organizational changes
continue during the upcoming Healthcare Agreement, where a cross-sectoral political forum
called "Health Policy Session" will be established. On the composition of the different
forums, it should be emphasized that an increased participation from clinical personnel, could
optimize cooperation in certain situations. The composition of forums should therefore be
considered during the upcoming Healthcare Agreement, as Region Nord gets more time and
freedom to create its own framework and initiatives for healthcare in Region Nord.