Legitimation in allocation of municipal health and care services

Project summary

This postdoc project investigates legitimation strategies and processes in the allocation of municipal health and care services in Norway. The aim is to generate knowledge on how municipal decision-makers justify service allocation decisions, and to explore implications of their legitimation practices for upholding liberal democratic principles such as ensuring equal treatment of citizens and maintaining neutrality in addressing citizens' needs. Through ethnographic fieldwork that includes observations and interviews, and analysis of written decisions from three strategically selected municipalities, practices within both "traditional" and "new" allocation models are examined, especially in the context of the shift towards "early intervention." The project analyses how key concepts such as "need," "justice," and "adequacy/prudence" are operationalized in decision-making processes, and how understandings of these concepts influence service allocation. Particular attention is given to employees’ perspectives, including their understanding of their roles, competencies, and discretionary judgments when evaluating applications and citizens' needs. The study highlights challenges related to municipal autonomy and state governance, and explores how municipalities balance these factors with professional competence. The research framework addresses how supranational rights and Norwegian legislation shape local decision-making processes. The overarching research questions are: "How do decision-makers in health and care services in (three) Norwegian municipalities legitimise decisions regarding services and benefits? What are the consequences of these decision-making practices, as exercises of delegated state authority, on employees' perceptions of their roles and legitimation practices? What implications do the justifications of these decisions have for municipalities' adherence to the state’s liberal democratic principles of equality and neutrality?" The study provides new knowledge about how municipal allocation practices are shaped—and can be perceived—as legitimate or illegitimate by employees (and citizens), with implications for democratic accountability and equitable service provision in the health and care sector.