Allocation models and prioritising practices in long-term care services in the nordic countries: An integrative systematic review

The Nordic countries are experiencing an increasing demand for long-term care services, primarily due to an ageing population and a declining ratio of working-age individuals to older adults. This development places growing pressure on municipal care services and intensifies challenges related to service allocation and prioritisation. Care managers responsible for service allocation operate at the intersection of quality expectations, legal obligations, and constrained resources, highlighting the need for greater insight into how prioritisation decisions are made in practice. This integrative systematic review synthesises and conceptualises how allocation and prioritisation have been examined in Nordic research. The review focuses on decision-making processes and identifies key priorities, challenges and organisational responses across different allocation models. The review was based on comprehensive searches of major databases and resulted in 24 articles. The studies included were analysed using a thematic synthesis approach. The review identifies two main analytically derived models for organising service allocation: (1) a purchaser–provider split model and (2) self-managing teams combining allocation and service provision. Across both models, the literature describes similar challenges, including ethical tensions, time and resource constraints, economic pressures and prioritisation dilemmas. Allocation care managers are shown to play a central role in translating policy expectations and individual needs into concrete allocation decisions. Despite strong universalistic ambitions, services tend to be prioritised for individuals with rehabilitation potential and people living with dementia.