Wellbeing services counties in Finland: Tracing public values of a new level of government

Abstract Introduction Public values are fundamental principles guiding public administration, shaping governance, rights, and obligations in the society. In public sector reforms, particularly in health systems, these values play a central role creating tensions that reflect broader societal goals. Understanding public values is essential for analyzing health system reforms, as those direct public organizations in fulfilling tasks, managing resources, and meeting societal expectations. Methods This study examines these dynamics through qualitative interviews with 17 Wellbeing Services County (WSC) CEOs and 18 leading WSC politicians. Data were analyzed using abductive content analysis, applying Tina Nabatchi's (2018) public values typology: political, legal, organizational, and market frames. The study explores how WSC roles are perceived, and which value frames are emphasized. Findings Politically, transparency and accountability are central, highlighting democratic representation and trust, but challenged by practical implementation. Legally, WSCs navigate between autonomy and regulatory compliance, creating friction between local control and state mandates. Organizational values split between state-level focus, policy alignment and equity, and internal priorities like coordination, staff well-being, and strategic management. Market values stress financial sustainability, emphasizing cost-control within state funding frameworks, often in tension with service quality and equity. Conclusions The findings reveal how WSCs embody complex value constellations shaped by overlapping public and professional norms and external constraints. Health system reform thus involves reconciling diverse, sometimes conflicting, public values in a regulated and politically charged context.