Public/private ownership and quality of care: Evidence from Danish nursing homes.

The involvement of private for-profit (FP) and not-for-profit (NFP) providers in the otherwise public delivery of welfare services is gradually changing the Nordic welfare state towards a more market-oriented mode of service delivery. This article examines the relationship between ownership and quality of care in public and private FP and NFP nursing homes in Denmark. The analysis draws on original survey data and administrative registry data (quality inspection reports) for the full population of almost 1000 nursing homes in Denmark. Quality is measured in terms of structural quality, process quality and outcome quality. We find that public nursing homes have a higher structural quality (in terms of, for instance, staffing), while FP providers perform better in terms of process quality (e.g. in the form of individualised care). NFP providers perform well in terms of structural criteria such as employment of full-time staff and receive fewer critical comments in the inspection reports. However, the results depend to some extent upon the method of data collection, which underlines the benefits of using multiple data sources to examine the relationship between ownership and the quality of care.

Can inequality be tamed through boundary work? A qualitative study of health promotion aimed at reducing health inequalities.

This paper examines the organisational dynamics that arise in health promotion aimed at reducing health inequalities. The paper draws on ethnographic fieldwork among public health officers in Danish municipalities and qualitative interviews from an evaluation of health promotion programmes targeting homeless and other marginalised citizens. Analytically, we focus on 'boundary work', i.e. the ways in which social and symbolic boundaries are established, maintained, transgressed and negotiated, both at the administrative level and among frontline professionals. The paper discusses three types of boundary work: (i) demarcating professional domains; (ii) setting the boundaries of the task itself; and (iii) managing administrative boundaries. The main argument is that the production, maintenance and transgression of these three types of boundaries constitute central and time-consuming aspects of the practices of public health professionals, and that boundary work constitutes an important element in professional practices seeking to 'tame a wicked problem', such as social inequalities in health. A cross-cutting feature of the three types of boundary work is the management of the divide between health and social issues, which the professionals seemingly seek to uphold and transgress at the same time. The paper thus contributes to ongoing discussions of intersectoral action to address health inequalities. Furthermore, it extends the scope and application of the concept of boundary work in the sociology of public health by suggesting that the focus in previous research on professional demarcation be broadened in order to capture other types of boundaries that shape, and are shaped by, professional practices.

Consumers' purchase of organic food products. A matter of convenience and reflexive practices.

The aim of this study was to gain insight into the purchase of organic food products by consumers and to explore the main factors driving this process. This paper uses evidence from 16 in-depth interviews with consumers in Denmark carried out in 2008-2009. On the basis of the analysis two broad concepts are suggested: convenience behaviours and reflexive practices. Convenience behaviours are characteristic of pragmatic organic consumers. This type of shopping behaviour requires organic foods to be available in the local supermarket, they have to be clearly visible (preferably with an eco-label), and the price differential vis-à-vis conventional products have to be minimal. The analysis also showed that politically/ethically minded consumers have reflexive practices when purchasing organic food products: health considerations, ethical considerations (animal welfare), political considerations (environmentalism) and quality considerations (taste) play an important part for these consumers. Reflexive shopping practices can be sparked by life events (e.g. having children), "shocking" news about conventional food products and similar events, and news capable of creating a "cognitive dissonance" among consumers. The Danish case illustrates that the government needs to actively implement reforms and promote activities which make organic products a convenient choice for the pragmatic oriented consumer if their market share is to increase substantially.

Motivation to take part in integrated care-an assessment of follow-up home visits to elderly persons.

OBJECTIVES: The aim of follow-up visits by the general practitioner and district nurse (within a week after discharge from hospital) is to reduce hospital readmissions and improve the overall wellbeing of the patient. There is strong evidence that these programmes are effective, but are difficult to implement because of a number of organizational obstacles, including co-ordination between the organizations involved in the process. In this paper we look at the factors that affect motivation to participate in a cross-sectoral programme in Copenhagen, Denmark, implementing follow-up home visits to elderly persons. THEORY AND METHODS: The analysis is based on inter-organizational network theory in an attempt to explain the role of motivation in network formation between organizational systems. The empirical findings are based on focus groups and in-depth interviews with hospital staff, general practitioners, and district nurses. RESULTS: Care providers are motivated to collaborate by a number of factors. The focus of collaboration needs to be clearly defined and agreed upon, there needs to be a high degree of equality between the professionals involved, and there has to be a will to co-operate based on a shared understanding of values and learning potentials. CONCLUSIONS: The study concludes that we need to focus on specific care fields and actors to reduce complexity in the area and more fully understand what motivates care providers to participate in cross-sectoral activities, such as a follow-up home visit programme. One lesson for current policy is that motivational factors need to be addressed in future collaborative programmes in order to fully exploit the potential health benefits.