Health care policy at a crossroads? A Discursive Study of Patient Agency in National Health Quality Strategies between 1993 and 2015.

The Danish health care sector currently undergoes changes that imply a gradual transition from an evidence based activity model to a value based quality model centred on patient involvement and value-based governance (Mainz, Kristensen and Bartels 2015; Porter 2010; Rostgaard 2015). The patient naturally occupies a central position in health care, and the transition therefore raises important questions about health care quality and how successive national health quality strategies value quality and ascribe roles and agency to patients. To explore the complexity of these quality strategies, we analyse and discuss how political discourse moments (Rancière 1999; Gamson 1992; Carvalho 2008) influence the contents of the national health quality strategies and how variation in the construal of patient roles and agency indicate discursive struggle in Danish national health care policy. Underlying theoretical concepts are informed by New Public Management, the welfare state, health communication and discourse theory. Our analytical approach is inspired by Critical Discourse Analysis (Fairclough 1995; 2003; 2015) and combines content analysis with linguistic analysis.