The struggle between welfare state models and prevailing healthcare policy in Scandinavian healthcare legislative documents

Abstract

PurposeThe paper aims to compare and discuss the findings of discursive constructions of patients in legal texts from the three Scandinavian countries. Since traditional welfare state systems in Scandinavia are being challenged by new governance systems, new questions are being raised about patient positions and agency, carrying with them potential ethical dilemmas for healthcare professionals.Design/methodology/approachThe methodology of the paper is inspired by critical discourse analysis. Comprehensively analysing the findings of previous discourse studies on how “the patient” is constructed in central policy texts, this study compares the position of the patient in Norway, Sweden and Denmark.FindingsThe paper reveals ideological struggles across the Scandinavian countries, operating at a political level, a legislative level and a healthcare level. It is shown that national governance systems still exert hegemonic power by strongly influencing patients' degree of choice and autonomy. The discursive struggle between welfare state governance and other governance systems in Scandinavia indicates a shift towards a commercial healthcare market although a traditional welfare model is advocated by professionals and researchers.Research limitations/implicationsBecause of the specific conditions of Scandinavian healthcare policy, the findings lack generalisability. The research approach should therefore be explored further in additional contexts.Practical implicationsThe findings of this study can inform policymakers, professionals and patients of the ideological values underlying seemingly objective shifts in national policy.Originality/valueA comparative critical discourse analysis can expose patterns in the Scandinavian approaches to patient rights.