Health Care Integration in Practice: An Institutionalized Dilemma

摘要

Integration in health care is a normative goal, but the legal regulation of government operations across sectors is complex. Many values must be safeguarded and they are therefore legally protected. Interoperability can, however, create value conflicts and there is little empirical research into the constructive attempts to resolve such deep-rooted conflicts. This paper addresses this gap by an in-depth study of how values are institutionalized in laws and government organizations. Data was collected by means of participant observation and narrative interviews. The study showed that value conflicts constitute barriers to integration that were difficult to resolve. One major problem was that the necessary discussion about how the conflicts should be handled could not be held because there was no such arena. Different authorities were governed by different values that were deeply institutionalized; while services were to be integrated, the legal regulating bodies were not.