In healthcare, as in other public sectors, the work of policy is commonly described differently depending on whom you are asking. The divergence can be explained by different ways of conceptualising the policy process; as an authoritative choice, as a structured interaction and as a social construction. What is more, the divergence does not need to be seen as a problem which has to be eliminated, rather seen as a tension that policy workers are managing (Colebatch 2006). This paper explores the different descriptions of policy work that are given in the same policy process in the context of rationing and fairness in Swedish health care. The policy context comprises, among other things, distributive conflicts, ethical controversies and organisational complexity. No matter how much resources are allocated to health care it is impossible to satisfy every citizen’s need and demand. Thus, rationing and limit-setting are unavoidable. What is more, exclusion of health services may have crucial consequences for citizen’s life and health. Therefore, rationing entails ethical controversies. In the context of Sweden, where 21 county councils are the main providers of health services, the responsibility for rationing is shared by locally elected politicians, non-elected officials and different medical professionals. All these different stakeholders have their ideas and logics of how the policy work with rationing should and has to be done. The ‘blurriness’ of responsibility implies certain risk for conflicts and legitimacy problem. This paper looks at the work of the policy for provision of assistive technologies (AT) in two county councils, where both have the ambition to make the policy more ‘fair’. The aim is to understand how officials and prescribers of AT describe the policy work and further to understand how they manage to handle different and many times tough situations.
