Abstract
■ BACKGROUND
In 2004, the responsibilities for all substance abuse treatment and rehabilitation services in Norway were transferred from the county level to the state owned regional healthcare enterprises.
■ AIM
This reform, as many other European health reforms, was inspired by the same ideological and expert policy prescriptions for organizing public services. The aim of this paper is to analyze how these organizational principles influence the probability of services meeting the conditions of recognized prerequisites for a high quality of care.
■ DATA
The paper builds on data from one national and two regional evaluations of the reform.
■ RESULTS
The new organization principles have created a system of fragmented, linear transfer of responsibilities from one agency to the next, preventing the realization of fundamental preconditions for effective treatments of substance abuse. Initiatives of bottom-up organization are seen as attempts to counteract these consequences.
■ CONCLUSIONS
There seems to be an inherent contradiction between the overall organization of healthcare and social services for substance abusers in Norway, and recognized preconditions for a high quality of care. Bottom-up organization is, to some degree an effective counteract in alleviating the consequences of this contradiction. Top-down and bottom-up organizing seems to have been established as two parallel forms of organizational development in the Norwegian substance treatment system.