The entrance of "the economic man" in Health Care Quality - a Danish case study

Inspired by New Public Management and global meta discourse, such as democratisation and commodity (Fairclough, 1992), Performance Measurements has made its entry into the Danish health sector. As a result considerable changes have been made within the health structure with a new health reform in 2004. The keywords during this change have been efficiency and service. Efficiency is conceived as a specific means to service. The level of service a hospital is able to give is manifested in how efficient the hospital is. To be able to measure the efficiency of hospitals, the focus has changed from qualitative to quantitative outputs. The output measures form the foundation for a number of decisions such as allocation of human resources and funding. The purpose of this paper is to show how performance measurements have had a dominant impact on different stakeholders and their influences, which furthermore has had an impact on the perceived concept of service and service quality. The following research questions will be addressed: Is there a change in the relative power construction of stakeholders within the Danish health care system over the period of 2002-2008? If so, what effect has this change of relative power had on the concept of service quality?

Using Politt et al (1995) framework for the concept of service quality along with Lukes (1974/2005) third dimensional power concept, news media text is analysed in order to identify the dominant discursive power represented and its effect on the concept of service quality. This is further supported by using Fairclough's (1992/1995/2001) critical discourse analysis as a tool to identify micro elements in the texts which are influenced by the macro societal structures. It is found that the economic discourse is the most dominant. The economic discourse influences the other discourses and the text written on health care. The economic focus on numbers and quantitative output seems to have a large effect on the concept of service quality from being qualitative to becoming quantitative. This seems to work against the initial aim of restructuring the health sector, which was to offer patients treatment and care on a high professional level. However, the aim and focus has become on giving the patient the most efficient treatment as in the quickest and cheapest.