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  • 1.
    Werntoft, Elisabet
    et al.
    Department of Health Sciences, Division of Nursing, Lund University.
    Edberg, Anna-Karin
    Department of Health Sciences, Division of Nursing, Lund University.
    Decision makers' experiences of prioritisation and views about how to finance healthcare costs2009In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 92, no 2-3, p. 259-267Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Prioritisation in healthcare is an issue of growing importance due to scarcity of resources. The aims of this study were firstly to describe decision makers' experience of prioritisation and their views concerning willingness to pay and how to finance healthcare costs. An additional aim was to compare the views of politicians and physicians.

    METHODS: The study was a cross-sectional study based on a questionnaire administered to 700 Swedish politicians and physicians. This was analysed using both quantitative and qualitative methods.

    RESULTS: A majority of the decision makers (55%) suggested that increasing costs should be financed through higher taxation but more physicians than politicians thought that higher patient fees, private health insurance and a reduction in social expenditure were better alternatives. Prioritisation aroused anxiety; politicians were afraid of displeasing voters while physicians were afraid of making medically incorrect decisions.

    CONCLUSIONS: This study do not answer the question about how to make prioritisation in health care but the result highlights the different ways that the decision makers view the subject and thereby elicit that publicly elected politicians and physicians perhaps not always work with the same goal ahead. There are needs for more research but also more media focus on the subject so the citizens will be aware and take part in the debate.

  • 2.
    Åhgren, Bengt
    Nordic School of Public Health.
    Competition and integration in Swedish health care2010In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 96, no 2, p. 91-97Article in journal (Refereed)
    Abstract [en]

    Despite of an insignificant track record of quasi-market models in Sweden, new models of this kind have recently been introduced in health care; commonly referred to as "choice of care". This time citizens act as purchasers; choosing the primary care centre or family physician they want to be treated by, which, in turn, generates a capitation payment to the chosen unit. Policy makers believe that such systems will be self-remedial, that is, as a result of competition the strong providers survive while unprofitable ones will be eliminated. Because of negative consequences of the fragmented health care delivery, policy makers at the same time also promote different forms of integrated health care arrangements. One example is "local health care", which could be described as an upgraded community-oriented primary care, supported by adaptable hospital services, fitting the needs of a local population. This article reviews if it is possible to combine this kind of integrated care system with a competition driven model of governance, or if they are incompatible. The findings indicate that some choice of care schemes could hamper the development of integration in local health care. However, geographical monopolies like local health care, enclosed in a noncompetitive context, lack the stimulus of competition that possibly improves performance. Thus, it could be argued that if choice of care and local health care should be combined, patients ought to choose between integrated health care arrangements and not among individual health professionals. (C) 2010 Elsevier Ireland Ltd. All rights reserved.

  • 3.
    Åhgren, Bengt
    Nordic School of Public Health.
    Is it better to be big? The reconfiguration of 21st century hospitals: Responses to a hospital merger in Sweden2008In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 87, no 1, p. 92-99Article in journal (Refereed)
    Abstract [en]

    Objectives: Swedish hospital mergers seem to stem from a conviction among policy makers that bigger hospitals lead to lower average costs and improved clinical outcomes. The effects of mergers in the form of multisited hospitals have not been systematically evaluated. The purpose of this article is to contribute to this area of knowledge by exploring responses to the merger of Blekinge Hospital.

    Methods: The evaluation was guided by the philosophy of triangulation. A questionnaire was sent to 597 randomly selected employees, that is 24% of the health care staff. Four hundred ninety-eight employees answered the questionnaire, giving a response rate of 83%. Furthermore, interviews of different groups of stakeholders were conducted.

    Results: A moderate increase of quality was assessed, which, a low proportion of the employees perceived had decisively or largely to do with the merger. The majority perceives economical incentives as the drivers of change, but, at the same time, only 10% of this group believes this target was reached completely or to a large extent.

    Conclusions: The employees believe the merger has neither generated economy of scale advantages nor substantial quality improvement. Instead, it seems more rewarding to promote cross-functional collaboration together with clinical specialisation. Needs for both integration and differentiation could thereby be fulfilled. (c) 2008 Elsevier Ireland Ltd. All rights reserved.

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