Samhandlingsreformen og fastlegene – et avstandsforhold?

Abstract

The role of regular general practitioners in The Coordination Reform – a distance relationship? Expectations for regular General practitioners (GPs) stronger horizontal and vertical integration in The Norwegian Coordination Reform is relatively clear. Given three different perspectives, the article analyzes whether these expectations are met. The policy perspective, which is based on analysis of policy documents and changes in GPs regulation, shows that the reform has barely challenged GPs autonomous role in the municipality. The new service agreement system contains neither good structures nor mechanisms to ensure vertical and horizontal integration. The municipal perspective, supported by qualitative and quantitative data from municipalities, shows that it is difficult for the municipality to control GPs via service agreements and regulations. The respondents in our material show much willingness and interest to collaborate with GPs in line with the reform ambitions. At the same time they express disappointment over GPs lack of engagement, and it seems largely to be accepted that GPs’ are “outside” the municipal health care system. The GP perspective, where we have analyzed data from GPs, matches the image of the GP’s role with a certain distance to instruments in the reform.