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  • 1.
    Werntoft, Elisabet
    et al.
    Lunds universitet.
    Edberg, Anna-Karin
    Kristianstad University, Research Platform for Collaboration for Health. Lunds universitet.
    Swedish politicians’ view of obstacles when dealing with priority settings in health care2015In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 29, no 4, p. 532-542Article in journal (Refereed)
    Abstract [en]

    Purpose

    The purpose of this paper is to identify and describe main obstacles for politicians when dealing with healthcare priority setting.

    Design/methodology/approach

    The study had an exploratory descriptive design based on interviews with 18 politicians from two different county councils in Sweden. The interviews were analyzed using inductive qualitative content analysis.

    Findings

    The politicians highlighted the importance of, and difficulties in, communicate political missions; the politicians in this study saw the media as not always being fair watchdogs, implying that possibly important but unpopular prioritizing decisions were not made because of the risks of being badly reported and therefore not re-elected. Breaking up established structures in care practice is difficult and change takes time, partly because of existing higher level financing and rules and the system’s traditional separation of facilities and services. Although the politicians highlighted their limited power to influence and control resource allocation they could give small and “lower profile”, low-prioritized disciplines control of their own budgets and base payments on the results the disciplines accomplished.

    Originality/value

    This study highlights the difficulties that politicians experience, for example, having to take unpleasant decisions and thereby run the risk of being scrutinized by media, which in turn could influence how effectively tax money is being used.

  • 2.
    Werntoft, Elisabet
    et al.
    Lunds universitet.
    Edberg, Anna-Karin
    Lunds universitet.
    The views of physicians and politicians concerning age-related prioritisation in healthcare.2009In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 23, no 1, p. 38-52Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The aim of this study is to describe the view of age-related prioritisation in health care among physicians and healthcare politicians and to compare their views regarding gender and age.

    DESIGN/METHODOLOGY/APPROACH: Swedish physicians (n=390) and politicians (n=310), mean age 52 years, answered an electronic questionnaire concerning age-related priority setting in healthcare. The questionnaire had fixed response alternatives with possibility of adding comments.

    FINDINGS: A majority of the participants thought that age should not influence prioritisation, although more physicians than politicians thought that younger patients should be prioritised. There were also significant differences concerning their views on lifestyle-related diseases and on who should make decisions concerning both vertical and horizontal prioritisation. The comments indicated that the politicians referred to ethical principles as a basis for their standpoints while the physicians often referred to the importance of biological rather than chronological age.

    RESEARCH LIMITATIONS/IMPLICATIONS: Web-based surveys as a method has its limitations as biased samples and biased returns could cause major problems, such as limited control over the drop-outs. The sample in this study was, however, judged to be representative.

    PRACTICAL IMPLICATIONS: The results indicate that supplementary guiding principles concerning prioritisation in healthcare are needed in order to facilitate decision-making concerning resource allocation on a local level.

    ORIGINALITY/VALUE: This paper adds important knowledge about decision makers' views on age-related priorities in healthcare, thus contributing to scientific base for prioritisation in healthcare and the ongoing debate in society.

  • 3.
    Åhgren, Bengt
    Nordic School of Public Health.
    Mutualism and antagonism within organisations of integrated health care2010In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 24, no 4, p. 396-411Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The purpose of this paper is to explore the concepts of Swedish integrated health care, their state of development and interdependence, and, furthermore, evaluate whether the theoretical framework used improves the comprehension of why integrated health care arrangements endure or cease.

    DESIGN/METHODOLOGY/APPROACH: The study is founded on descriptive data gathered from a literature search on integrated health care in Sweden. With inspiration from ecology theory, these data were analysed guided by a theoretical model based on a continuum of symbiotic effects, from antagonism to mutualism.

    FINDINGS: The era of Swedish integrated health care started in the 1990s, when a kind of clinical network called chains of care was launched. At the beginning the chain of care development was predominantly surrounded by non-integrative conditions, which had a restraining effect on these efforts. Even so, it seems that chains of care are here to stay. This faith in chains of care can to some extent be explained by the crucial role they have as connectors in the emerging local health care systems. Thus, these systems need chains of care to evolve and chains of care seem to require the integrative framework of local health care to progress and endure. Integrated health care performance could be troublesome, unless such mutualistic conditions are in place. States of commensalism may also be promoted, but the advantages are unilateral and therefore there is a risk of disloyalty by the unaffected part, which, in turn, can create a breeding-ground for an antagonistic liaison.

    ORIGINALITY/VALUE: A theoretical approach founded on what may be called "Health Care System Ecology" appears to enhance the understanding of the complex logic of integrated health care.

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