Table 2 Examples of a completed signature matrix for two initial frames: Citizens’ best” and “Fire fighting”

Metaphors

“Shopping around in the market place of health care and social services”; “Choosing services as one chooses the toppings for one’s pizza”

A municipality as a “fire fighter” extinguishing fires here and there

Exemplars

Municipality: Enabling choice and citizen involvement; taking care of citizens; creating continuity of care Private providers: Providing something more than the public sector; meeting diverse citizen needs; enabling choice and personalised services

Municipality: Trying to ensure the availability of services; object rather than active subject Private providers: Able to meet the acute needs of the municipality e.g. delivering workforce.

Catchphrases

Citizens’ right to choose their own provider and make their own decisions; representing the will of the citizens; individually tailor-made services; taking care of our citizens; continuity of care

Physician shortage; Shortage of facilities

Depictions

The decisions are based on the citizens’ best. Privatizing provides citizens with better opportunities to choose their provider and with a more diverse selection of providers. On the other hand, the decision not to privatize is based on a notion that public sector needs to take care of citizens and that market forces endanger equity and equality.

The decision to privatize is argued with acute needs e.g. acute physician shortage. The decisions are made on a case-by-case basis.

Roots

Public choice; Paternalism; Individualism

Physician shortage; lack of monetary resources; service needs

Consequences

Positive: Citizens get what they want; tailor-made services Negative: Failed monitoring may endanger the quality; patient safety may suffer if private providers employ staff that is not familiar with the area and local conditions

Positive: Availability of services & better accessNegative: Short-term improvements only, privatization as an emergency solution

Appeals to principle

The goal is to work for the best of the citizens: increased private provision enhances the ability to make choices

The goal is to ensure that the services are available even though there is a shortage of resources etc.