Deals and value measuring in interactive health-care services

This paper aims to investigate the role of value measuring (VM) as an integrated part of a deal introduced to govern the cross-boundary relationship of state specialist- and primary care providers in the Norwegian health sector.

Drawing on a longitudinal ethnographic case study, this study explores the role of payment for dischargeable patients (PDP), an incentive arrangement introduced as a mechanism of value appropriation intended to create stability in the relationship and support improved patient flows between care providers. The fieldwork took place over approximately 18 months, consisting of intensive participant observations, interviews and document studies.

The VM integrated in the PDP deal between the hospital and municipality, on the surface level, appears simple. The VM, however, rests on a very complex practice of information sharing where accounts on patient status, procedures and activities form the basis of the integrated VM. The deal and its VM, despite its ambitious aims, were not able to fulfill the expectations of a smooth appropriation of value through the management of monetary flows or supporting information sharing for value creation. The VM of the PDP deal aimed at bringing the parties closer together, rather created a distance where money matters became a source of tension.

This study investigates the interconnections of deals and VM in a public sector service context, showing aspects of deals different from that of prior studies into private sector deals.