Analysing boundaries of health and social care in policy and media reform narratives

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Abstract

Collaboration has become an imperative of many new healthcare policies; however, little attention has been paid to how system-level narratives in both policy documents and the media create boundaries that shape implementation processes. By using boundary work as a theoretical lens, this article critically analyses the discourse found in both policy documents and the media surrounding the 2015 Dutch LTC reform. This discourse analysis contributes, first, by revealing two separate narratives – one epic, one tragic – which we argue represent different rhetorical styles used to (de-)legitimise symbolic boundaries. Second, we contribute by unravelling boundary work in both the social and symbolic dimensions to show how the design of the 2015 reform led to a tension-ridden position for local actors: symbolic boundaries demanded integration, while social boundaries imposed differentiation. These findings have implications for literature on boundary work as well as for policy design and its local implementation.
Original languageEnglish
Pages (from-to)568–586
Number of pages19
JournalPolicy & Politics
Volume50
Issue number4
Early online date9 Feb 2022
DOIs
Publication statusPublished - 2022

Funding

The authors are grateful to Sierk Ybema, Frans Kamsteeg, and the members of the Talma Institute for their insightful comments which helped develop this article’s argument. We also thank the two anonymous reviewers for their constructive feedback. This work was supported by the Ministry of Health,Welfare, and Sport.

FundersFunder number
Talma Institute
Ministerie van Volksgezondheid, Welzijn en Sport

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