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| 42. |
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| 43. |
- Åhgren, Bengt
(författare)
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Competition and integration in Swedish health care
- 2010
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Ingår i: Health Policy. - 0168-8510 .- 1872-6054. ; 96:2, s. 91-97
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 44. |
- Åhgren, Bengt, 1950-
(författare)
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Competition-exposed integration : an impossible composition?
- 2013
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Ingår i: What healthcare can we afford?. ; , s. 106-
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- ContextSwedish health care, like many other health care systems, is in a constant development mode to meet never-ending demands for improved efficiency and quality. Competitive and integrative policies are for example concurrently introduced in Swedish primary care; citizens‘ choice of primary care is launched while primary care is expected to integrate its activities with other providers for the creation of =local health care‘. Competition has though a tendency fragment the provision of services. The aim of this study is therefore to explore whether or not these two strategies are compatible in practice.MethodsGroup interviews were conducted at four locations in Sweden. The groups included persons aged between 20 and 45 years, 46 and 64 years and 65 years or over. The interviewees were living either in a big town or in a small community. Altogether, 21 randomly selected individuals participated in the group interviews. A deductive approach was chosen: six question topics were formulated with guidance from a theoretical framework about choice of care. The group interviews were thus semistructured without any predetermined codes. Each group interview took between 1 and 1.5 h to complete. Moreover, the conversations were recorded and transcribed as verbatim reports. As a consequence of the deductive approach, directed content analysis was chosen for the analysis of the group conversations.ResultsChoice of care is executed from the perspectives of being a prospective or current patient, which, in practice, imply choices are performed passive and active respectively. If the later group perceive interpersonal continuity, accessibility and demeanour of health professionals as favourable, they remain faithful to their actively chosen provider. The only condition that seems to trigger this group of patients to reconsider their choices is if they been the subject of bad manners. Those executing passive choices are less faithful to their original choice. When these former prospective patients, often younger persons, are in need of primary care they often disregard their choice if waiting times are shorter at other providers. This group generally prefer accessible service and seldom consider where it is provided. The group of passive choices also include citizens accepting suggestions presented by the authorities, founded on the conviction that ―they know what is best for me.DiscussionMany patients that have made active choices are thus faithful to their choices. This is rare in a consumer-market, which is characterized by high degree of exchangeability of providers; a condition which by and large corresponds with the attitude of those making passive choices. Nevertheless, a majority of patients stay with their choice of provider, often selected among a limited number of options. Moreover, health care providers and patients have long-term relationships, which is typical of a producer-market. In other words, if politicians strive for a competition-exposed primary care, the competition concept ought not to be founded on the theories of a consumer-market. The principles of a producer-market seem instead to be more applicable, which imply that providers will be competitive if they are able to build stable relations with their patients, which, in turn, facilitate for integrative arrangements among health care providers.
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| 45. |
- Åhgren, Bengt
(författare)
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Creating Integrated Care : Evaluation and Management of Local Care in Sweden
- 2007
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Ingår i: Journal of Integrated Care. - 1476-9018. ; 15:6, s. 14-21
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Tidskriftsartikel (refereegranskat)abstract
- It seems impossible to create a comprehensive evaluation model which fully takes into account the multi-dimensional context of integrated health and social care. Clinical integration, as a prerequisite for efficient outcomes of integration, must nonetheless get special attention. For more extensive evaluations, a quality chain matrix, including co-operating acts by different providers, has proven to be useful. Examples of evaluated services in Sweden are given, and the management benefits of the use of evaluation data are highlighted.
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| 46. |
- Åhgren, Bengt, 1950-
(författare)
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Creating integrated health care
- 2007
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Ingår i: International Journal of Integrated Care. - 1568-4156 .- 1568-4156. ; 7:Oct-Dec, s. e38-
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 47. |
- Åhgren, Bengt, et al.
(författare)
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Determinants of integrated health care development : chains of care in Sweden
- 2007
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Ingår i: International Journal of Health Planning and Management. - 0749-6753 .- 1099-1751. ; 22:2, s. 145-157
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 48. |
- Åhgren, Bengt
(författare)
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Dissolving the Patient Bermuda Triangle
- 2010
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Ingår i: International Journal of Care Coordination. - 2053-4354. ; 14:4, s. 137-141
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Tidskriftsartikel (refereegranskat)abstract
- The differentiation of roles, tasks and responsibilities in health care has gradually increased because of efforts to decentralize, specialize and professionalize our health-care systems. These development approaches can on the one hand be regarded as successful, although there is also a negative flipside. Increased differentiation has concurrently fragmented the delivery of health care, which, in turn, can be divided into structural, clinical and cultural fragmentation. Patients are lost as a result of these conditions of fragmentation. This phenomenon can metaphorically be described as a ‘Patient Bermuda Triangle’. Actions to dissolve the Patient Bermuda Triangles are commonly termed ‘Integrated health care’, a global buzzword that includes integrated care pathway as well as other integrated health-care strategies. Moreover, integrated care is a means to an end: improved patient outcome. To achieve this, it is crucial to have necessary prerequisites in place: both functional and interactional conditions. This procedure seems to be an organic process where the stakeholders go through gradual changes until the optimum level of integration, as well as mutualistic interactions, is established. If these conditions are concealed or impossible to achieve, developmental work should be ended to avoid the evolvement of antagonistic relations between the stakeholders concerned. This state will likely establish a Patient Bermuda Triangle or reinforce an existing one.
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| 49. |
- Åhgren, Bengt, et al.
(författare)
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Evaluating integrated health care : a model for measurement
- 2005
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Ingår i: International journal of integrated care. - 1568-4156. ; 5:Jul-Sep, s. e01-
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: In the development of integrated care, there is an increasing need for knowledge about the actual degree of integration between different providers of health services. The purpose of this article is to describe the conceptualisation and validation of a practical model for measurement, which can be used by managers to implement and sustain integrated care.THEORY: The model is based on a continuum of integration, extending from full segregation through intermediate forms of linkage, coordination and cooperation to full integration.METHODS: The continuum was operationalised into a ratio scale of functional clinical integration. This scale was used in an explorative study of a local health authority in Sweden. Data on integration were collected in self-assessment forms together with estimated ranks of optimum integration between the different units of the health authority. The data were processed with statistical methods and the results were discussed with the managers concerned.RESULTS: Judging from this explorative study, it seems that the model of measurement collects reliable and valid data of functional clinical integration in local health care. The model was also regarded as a useful instrument for managers of integrated care.DISCUSSION: One of the main advantages with the model is that it includes optimum ranks of integration beside actual ranks. The optimum integration rank between two units is depending on the needs of both differentiation and integration.
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| 50. |
- Åhgren, Bengt, et al.
(författare)
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Evaluating intersectoral collaboration : a model for assessment by service users
- 2009
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Ingår i: International journal of integrated care. - 1568-4156. ; 9, s. e03-
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: DELTA was launched as a project in 1997 to improve intersectoral collaboration in the rehabilitation field. In 2005 DELTA was transformed into a local association for financial co-ordination between the institutions involved. Based on a study of the DELTA service users, the purpose of this article is to develop and to validate a model that can be used to assess the integration of welfare services from the perspective of the service users.THEORY: The foundation of integration is a well functioning structure of integration. Without such structural conditions, it is difficult to develop a process of integration that combines the resources and competences of the collaborating organisations to create services advantageous for the service users. In this way, both the structure and the process will contribute to the outcome of integration.METHOD: The study was carried out as a retrospective cross-sectional survey during two weeks, including all the current service users of DELTA. The questionnaire contained 32 questions, which were derived from the theoretical framework and research on service users, capturing perceptions of integration structure, process and outcome. Ordinal scales and open questions where used for the assessment.RESULTS: The survey had a response rate of 82% and no serious biases of the results were detected. The study shows that the users of the rehabilitation services perceived the services as well integrated, relevant and adapted to their needs. The assessment model was tested for reliability and validity and a few modifications were suggested. Some key measurement themes were derived from the study.CONCLUSION: The model developed in this study is an important step towards an assessment of service integration from the perspective of the service users. It needs to be further refined, however, before it can be used in other evaluations of collaboration in the provision of integrated welfare services.
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