Överenskommelser med SKR, ett vårdpolitiskt styrmedel

Sammanfattning: Agreements with SKR (Swedish Association of Local Authorities and Regions) have emerged as a significant steering instrument for the Ministry of Health and Social Affairs (MHSA). The agreements define activities for the Local Authorities to carry out and nearly always include earmarked grants. No study has yet explained why agreements are utilized as a steering instrument. Therefore, this study seeks to explain why by applying governance theory, where agreements are conceptualized as a steering instrument belonging to governance, as opposed to government. The study conducts multiple interviews with local officials, civil servants and officials at MHSA. The interviews are analyzed with reference to the function of the agreements, motives for choosing agreements as a steering instrument and the negotiation that precedes the agreements. The study shows that use of agreements can be explained by enabling the MHSA to use SKR as an informational channel and utilize SKR´s ability of coordination. Agreements are also assumed to lead to greater ownership, and SKR is assessed to have a better ability to coordinate than government agencies. It is also shown how agreement is negotiated “in the shadow of the hierarchy”, which may explain why SKR accepts agreements that limits local discretion. The results imply that the agreements are primarily explained as a means of delegation.