Artikkelen setter søkelys på forholdet mellom rettslig regulering og medisinskfaglig skjønnsutøvelse ved prioritering av spesialisthelsetjenester i Norge. På bakgrunn av en surveyundersøkelse blant 449 sykehusleger diskuteres det hvorvidt skriftlige prioriteringsveiledere ansvarliggjør sykehuslegene når det gjelder overordnede prioriteringshensyn. Med utgangspunkt i et analytisk skille mellom epistemiske og strukturelle ansvarliggjøringsmekanismer diskuteres det hvorvidt veilederne kan fungere demokratisk-rettslig og/eller profesjonelt ansvarliggjørende. Artikkelen viser at en kombinasjon av god kjennskap til prioriteringsveilederen og en positiv vurdering av den forutgående revisjonens konsekvenser for veiledernes relevans har avgjørende betydning for i hvilken grad veilederne får innvirkning på legenes prioriteringspraksis. Nøkkelord rettslig regulering, faglig skjønnsutøvelse, spesialisthelsetjenesten, prioritering, ansvarliggjøring
This article investigates factors that contributed to the successful introduction of 33 priority guidelines for Norwegian specialist health care from 2008 to 2012. The guidelines constituted an important step in changing the regulation of clinical priority setting from largely self-regulation by medical professionals to a more centralised and hierarchical form, and therefore, resistance from the medical profession was expected. My focus is on organisational factors within the project that developed the guidelines, using policy documents and project documents as the main source of data. I find that the project was characterised by a high level of autonomy in terms of how it was organised and the actors included, with significant capacity for action in terms of both structure and personnel, and a broad inclusion of affected actors. The priority guideline project was dominated by medical professionals, and its organisation did not represent a radical break with established traditions of medical professional self-regulation. Although organisational autonomy, action capacity and broad inclusion were clearly of importance, the project's compliance with historical traditions and norms of medical governance stands out as the key factor in understanding the successful establishment of the priority guidelines.
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