title: Norwegian home care in transition - heading for accountability, off-loading responsibilities.
abstract: In Norway, home-based care forms part of the universal welfare model in that services are offered to and used by all groups of citizens. An infrastructure of in-home services has evolved within a multi-level government characterised by a combination of local autonomy and strong integration between central and local levels. In the mid-1980s and early 1990s, home care was typically organised in teams characterised by collegiality and flexible organisation. Over the past two decades, this framework has been challenged by new modes of governance introduced under the banner of transparency and accountability. This paper focuses on how this new trend in governance has been justified and put into practice. Against the backdrop of the institutional history of home care, the paper demonstrates how accountability arrangements became entangled with ongoing effort of local authorities to control costs. Drawing on existing case studies conducted at different points in time, the paper reveals how these arrangements have reshaped home care organisations in a way that also contributes to splitting up and curtailing responsibilities. It is argued that steps taken to make home care services more transparent and reliable have made them less sensitive to the particular needs of individual service recipients. Although no firm conclusion can be drawn from a limited number of case studies, the paper concludes by arguing that accountability arrangements in home care have enhanced the predictability and reliability of service delivery. However, as off-loading responsibilities may be disempowering for those who do not have additional coping resources, institutional changes may also serve to undermine the enabling role of home care services. These findings suggest a need to address the dilemma inherent in the rationing of home care services and to rethink how a contextual and situated approach to care can be better balanced against the requirement of due process.
authors.affiliation: NOVA - Norwegian Social Research, Elisenberg, Oslo, Norway. mia.vabo@nova.no
authors.forename: Mia
authors.initials: M
authors.lastname: Vabø
mesh_terms: D000368:Aged; D003363:Cost Control; D015276:Health Care Rationing; D006699:Home Care Services / Q000191:economics* / Q000639:trends; D006801:Humans; D009664:Norway; D013222:State Medicine; D019472:Universal Health Insurance