61 Rethinking local government: Essays on municipal reform - VATT

Local Government in Denmark and the 2007municipal reformLocal-regional coordination of health care and specialized socialserviceBefore the 2007 reform municipalities and regional <strong>government</strong>s, thecounties did not need to coordinate their activities to any great extent.The <strong>government</strong>’s ambition when dividing tasks across tiers in thepublic sector was to create the clearest possible division in order tomake both financial and political responsibility as clear as possible tocitizens. Of course, this ideal could not be completely achieved. Thehospital sector organized at the regional level has always had a needto cooperate with the old age care systems organized at the <strong>local</strong> level;the primary school systems organized by the municipalities havealways had to cooperate with the secondary educational institutionsorganized at the regional level; and the specialized social institutionsorganized at the regional level have always had to cooperate with thegeneral social service system at the <strong>local</strong> level. But the ambition wasto have clear and separate functional responsibilities.This ambition was given up in 2007 when the municipalities tookover responsibility for all social services, also the hitherto specializedregional functions and part of the regional health care system. Inthese areas municipalities and regions now have to cooperate andcoordinate their activities to an unprecedented extent.As noted above, in the area of specialized social services, themunicipalities were given the choice whether to take over the oldcounty institutions or let them be transferred to the new regions. Inthe end they took over almost all the counties’ old special institutions,and many municipalities ended up with institutions for which theydid not have enough clients of their own. This created a market wheremunicipalities sell and buy places in specialized social institutions.As a consequence, two coordination challenges have arisen. Not onlydo municipalities and regions need to coordinate activity levels in themunicipal institutions and the few remaining regional institutions.They also need to coordinate activities in relation to one anothersince many municipalities have clients placed in institutions run byother municipalities.68