Establishing Individual Care Plans for Rehabilitation Patients: Traces of Self-Targeting in the Norwegian Universal Welfare State

Abstract

Several countries have introduced devices for coordination of complicated individual cases across care, health and welfare services. This study examined one such device: the individual care plan (ICP), introduced in Norway in 2001 to enhance user involve­ment and coordination across sectors and service providers. Despite strong political imperatives, however, ICPs have remained significantly underused. To understand why, this study investigated the experiences with ICPs among staff in municipal coordinating units, tasked with organising rehabili­ta­tion efforts and case­workers in local labour and welfare services. In focus groups, participants discussed the fictitious vignette of a patient with traumatic brain injury, a person clearly within the ICP target group. They praised ICPs for advancing the rehabilitation process but acknowledged that they were applied too rarely. Through abductive-retroductive recontextualisation, this study identified a practice of de-facto self-targeting: in some municipalities, patients had to request ICPs themselves. We argue that this mechanism may have emerged from ambiguous propensities of rehabilitation, simultaneously emphasising needs and potentials, and ultimately from ambiguities in the Norwegian welfare model balancing universalism and local autonomy.