NOVA - Norwegian Social Research, Elisenberg, Oslo, Norway.
Health Soc Care Community. 2012 May;20(3):283-91. doi: 10.1111/j.1365-2524.2012.01058.x. Epub 2012 Feb 22.
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.
在挪威，居家护理是普遍福利模式的一部分，因为服务面向所有公民群体提供并被所有公民群体使用。在具有地方自治和中央与地方层级紧密整合特点的多层次政府框架内，发展出了居家服务基础设施。20 世纪 80 年代中期和 90 年代初期，居家护理通常以团队形式组织，具有合作和灵活的组织特点。在过去的二十年中，这种模式受到了以透明度和问责制为旗帜引入的新治理模式的挑战。本文重点关注这种新治理趋势是如何得到证明和付诸实践的。本文以居家护理的制度历史为背景，展示了问责制安排是如何与地方当局控制成本的持续努力纠缠在一起的。利用在不同时间点进行的现有案例研究，本文揭示了这些安排如何以一种也有助于分裂和限制责任的方式重塑居家护理组织。有人认为，为使居家护理服务更加透明和可靠而采取的措施降低了它们对个别服务接受者特殊需求的敏感性。尽管从有限数量的案例研究中无法得出确凿的结论，但本文的结论是，居家护理中的问责制安排提高了服务提供的可预测性和可靠性。然而，由于卸责可能会使那些没有额外应对资源的人失去权力，制度变革也可能破坏居家护理服务的赋权作用。这些发现表明，需要解决居家护理服务配给中固有的困境，并重新思考如何更好地平衡以情境为导向的护理方法与正当程序的要求。
