Introduction There are several, and multi-layered, prioritisation challenges both within long-term care (LTC) and between LTC and other municipal sectors. This issue is set on the agenda with a new green paper report from 2018 (Blankholmutvalget). Our aim was to examine the ways in which ideas, challenges and organisation at the policy and administrative level shape prioritisations in municipal long-term care. First we wanted to explore significant conditions and processes behind prioritisations, and, secondly to identify the ruling (operationalisations of) principles of prioritisations in the municipalities.
Material and Methods Fieldwork and interviews were conducted in three municipalities in different regions of Norway. The interview subjects included a range of municipal employees and municipal actors such as mayors, opposition politicians, chief municipal executives/chief administrative officer (rådmenn), health and social care officers/top administrative leaders of the municipal health and care services and department (kommunalsjef helse- og omsorg), heads of home care, nursing homes and purchase units.
Results We found a distinct perception of an increasing central governmental control regime and a master narrative of increased financial pressure. For the two largest municipalities this had led to a continuous efficiency-, change- and economic adjustment policy, with benchmarking as a new, measurable and decisive policy instrument. This seemed to give shape to an increased acceptance of service provision at a minimum level but not necessarily of good quality.
Conclusions Based on findings, we argue that a resource criterion appears to be a ruling principle for prioritisation at this level in municipal LTC, and for a general narrowing of the local scope of opportunity for prioritisation.
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