In conflict with local self-government? National agreements in Swedish health care

In Swedish health care, a development towards governance has been evident in recent decades through an extensive use of softer policy instruments, such as negotiated agreements.

The agreements have been reached between the national government and the Swedish Association of Local Authorities and Regions.

The question is how the agreements affect the status of local self-government, i.e. the autonomy of the subnational governments to make their own decisions on matter of interest for their citizens. In the research on governance, there is a debate if policy instruments such as agreements are soft in practice.

If not, there might be a conflict between a widespread use of agreements and local self-government.

The aim of the project is therefore to analyse negotiated agreements in Swedish health care and their impact on local self-government. How are the agreements negotiated, especially when it comes to the inclusion of subnational government? What is the content of the negotiated agreements in terms of discretion for subnational government?

How are the agreements evaluated and what connection is there to “rewards” and “penalties”?

The project consists of an empirical study with interviews and systematic analysis of documents, such as the agreements.

Our contribution is to connect the discussions on soft and hard policy instruments with the literature on central-local government relations in health care.