Interplay between efficiency and quality in contracting: a case of responses to policy changes in public hearing-aid service

This article provides a study of supply-side responses to contracting out hearing aid services and products in the Danish public sector. Drawing on the theory of social mechanisms, we show how service quality is reconfigured as a response to the contracting changes and argue that efficiency and quality concerns are always interrelated. We conclude that micro level action-formation components will likely transform the effects of the situational policy changes at the macro level. Therefore, simultaneous management of efficiency and quality is an essential and ongoing effort that requires responsiveness to the non-contractible dimensions of quality.