Geografiske ulikheter i tilbudet av polikliniske tjenester til barn og unge ved norske sykehus

Abstract

Background: National surveys have identified major geographical inequalities in offers of secondary healthcare for children and adolescents inNorway.Inequalities vary fromthree-foldtofive-foldfordifferent illnesscategories. These inequalities cannot be explained by differences in morbidity. Health policy objectives of geographical equality suggest reducingthese differences.Themaingoal of thispaper istoexplorewhygeographicalinequalitiesinsecondaryhealth-care for children and adolescents occur. Material and method: Individual in-depth interviews based on a semi-structured interview-guide with 17 chief physicians and six office managers in six different pediatric departments divided between all Norwegian health regions. All interviews were coded and thematically classified using the software NVivo, and thereafter qualitatively interpreted. Resultsand conclusion: Geographical inequalities in secondary healthcare for children and adolescents appear to be created through a complex interaction between formal and informal structures involving political, organizational, managerial, medical and cultural factors. Health-policy instruments introduced to create more efficient resource utilization, such as function-sharing between hospitals and task shifts between providers, might contribute to the observed geographical inequalities. Because priority-settings are culturally contingent, geographical equality cannot be obtained through formal structures alone. Building culture through professional networks could secure legitimacy and professional anchoring of negotiated national standards.