A soft policy instrument with a hard content? An analysis of national agreements in Swedish multi-level healthcare.

PURPOSE

In Sweden, a decentralized unitary state, the 21 self-governing regions are responsible for healthcare. A governing tool in the relations between the central government and the regions is the use of "national agreements". The literature describes agreements as soft policy instruments, meaning they are voluntary, non-binding and lack detail. Our purpose is to analyse the content of national agreements in Swedish healthcare to explore their characteristics.

DESIGN/METHODOLOGY/APPROACH: We use document analysis to investigate whether the content of the national agreements in Swedish healthcare is primarily general or specific in terms of stated goals, measures, disbursement and review. The analysis includes eight agreements from 2022.

FINDINGS

The content varies in specificity and detail across agreements in healthcare, some being specific while others are more general and broadly formulated. An important conclusion is that agreements within the same policy area can have different characteristics. Agreements are inherently "soft", but with potential variations in their application and consequences.

ORIGINALITY/VALUE: Due to their high level of detail and scope, agreements may pose a challenge to the principle of regional self-government. This could limit the regions' discretion to set their own priorities and make necessary adjustments, ultimately impacting both efficiency and accountability within healthcare.