Heading for health policy reform: transforming regions of care from geographical place into governance object

Abstract

This article analyses how regional actors and national authorities shape and transform ‘the region’ from a geographical place into an object of governance for organising and delivering older person care. Drawing on an extensive ethnographic research project in the Netherlands, our findings show that these actors in interaction constitute the region through three practices: consistently creating urgency to foreground regional problems and solutions; renegotiating regulatory policies to facilitate regional care provision; and reconstructing care infrastructures to materialise regional care provision. Actors use and obtain power from co-existing and interacting institutional arrangements to develop new regional care arrangements. This evokes new interdependencies that reconfigure existing governance arrangements. Studying governance objects in-the-making reveals the required iterations, reconsiderations, and adjustments as processes within a given (ambiguous) institutional context, and which lead to institutional change. As regional organisation policies are increasingly scrutinised, this article provides an interesting and important contribution to this field.