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  • 1.
    Åhgren, Bengt
    et al.
    Nordic School of Public Health.
    Axelsson, Runo
    Determinants of integrated health care development: chains of care in Sweden2007In: International Journal of Health Planning and Management, ISSN 0749-6753, E-ISSN 1099-1751, Vol. 22, no 2, p. 145-157Article in journal (Refereed)
    Abstract [en]

    Local health care in Sweden is an emerging form of integrated care, linked together by chains of care. Experiences show, however, that the development of chains of care is making slow progress. In order to study the factors behind this development, an embedded multiple-case study design was chosen. The study compared six health authorities in Sweden, three with successful and three with unsuccessful chain of care development. Three major determinants of integrated health care development were identified: professional dedication, legitimacy and confidence. In more detail, space for prime movers and trust between participants were crucial success factors, while top-down approaches targeting at the same time a change of management systems were negative for the development of chains of care. Resistance from the body of physicians was a serious obstacle to such a development. Local health care depends on developed chains of care, but it seems that health care managers do not have the management systems necessary to run these clinical networks, mainly due to a lack of acceptance from the medical profession. This is an impossible situation in the long run, since the number of chains of care is likely to increase as a result of the emerging local health care. Copyright (c) 2007 John Wiley & Sons, Ltd.

  • 2.
    Åhgren, Bengt
    et al.
    Nordic School of Public Health, Göteborg, Sweden.
    Nordgren, Lars
    Lunds universitet.
    Is choice of care compatible with integrated health care?: an exploratory study in Sweden2012In: International Journal of Health Planning and Management, ISSN 0749-6753, E-ISSN 1099-1751, Vol. 27, no 3, p. e162-e172Article in journal (Refereed)
    Abstract [en]

    Competitive and integrative policy actions are simultaneously being promoted in Swedish primary care; citizens' choice of care is launched while primary care is expected to integrate its activities with other providers for the creation of ‘local health care’. Competition tends, however, to fragment the provision of services. The aim of this study is, accordingly, to explore whether or not these policies are compatible in practice. For this purpose, strategically designed group interviews were conducted with citizens. When citizens make active choices, they are under the influence of self-perceived conditions: that is, the accessibility of the care, its continuity and the treatment offered by the care provider, conditions which, in turn, have a lot in common with the guiding principles of local health care. On the other hand, citizens who choose passively, because of not being in contact with primary care, have no difficulties in being disloyal to the chosen unit when becoming patients. In doing so, they also contribute to the fragmentation of local health care. Making entirely free choices when it comes to primary care seems to be incompatible with local health care. However, choice of care only partly equals the conditions of free choice. Choice of care and local health care would thus seem to be compatible, in practice, for the majority of patients.

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