| 1. |
- Arvidsson, Eva, 1959-, et al.
(författare)
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Vägen framåt
- 2013
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Ingår i: Att välja rättvist. - Lund : Studentlitteratur AB. ; , s. 207-214
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Som vi visat har utvecklingen av metoder och strukturer för öppna prioriteringar i Sverige kommit långt. Många frågor återstår likväl. Under vårt arbete med denna bok har vi identifierat ett antal förbättringsområden och utmaningar som vi avslutningsvis vill lyfta fram. Det rör sig om vilka som ska delta i prioriteringarna, tydliggörande av värdegrunden, behov av bättre kunskap, baserad på både vetenskaplig metod och erfarenhet, och fortsatt utveckling av prioriteringsprocesser på olika nivåer och i olika sammanhang. Även om vi i Sverige skulle nå en god enighet kring principer och kriterier för prioriteringar så kommer vi alltid finna många olika sätt att praktiskt lösa specifika prioriteringsproblem.
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| 2. |
- Arvizu, Dan, et al.
(författare)
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Summary for Policy Makers: Intergovernmental Panel on Climate Change Special Report Renewable Energy Sources (SRREN)
- 2011
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- The Working Group III Special Report on Renewable Energy Sources and Climate Change Mitigation (SRREN) presents an assessment of the literature on the scientific, technological, environmental, economic and social aspects of the contribution of six renewable energy (RE) sources to the mitigation of climate change. It is intended to provide policy relevant information to governments, intergovernmental processes and other interested parties. This Summary for Policymakers provides an overview of the SRREN, summarizing the essential findings. The SRREN consists of 11 chapters. Chapter 1 sets the context for RE and climate change; Chapters 2 through 7 provide information on six RE technologies, and Chapters 8 through 11 address integrative issues.
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| 3. |
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Att välja rättvist : prioriteringar i hälso- och sjukvården
- 2013
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Samlingsverk (redaktörskap) (övrigt vetenskapligt/konstnärligt)abstract
- Hälso- och sjukvårdens resurser räcker inte till alla behov och önskemål från patienter och medborgare, vilket gör att personal och beslutsfattare hamnar i svåra situationer. Hur ska vi veta att det är rätt patienter som tvingas stå tillbaka? Att välja rättvist tar upp centrala begrepp och etiska principer kring prioriteringar. Boken beskriver även metoder för att göra prioriteringar på ett systematiskt sätt och erfarenheter av såväl nationella som internationella prioriteringar.Prioriteringsbeslut fattas på alla nivåer och kan gälla fördelning av resurser till olika verksamheter, behandlingsbeslut av enskilda patienter eller investeringar i nya medicinska metoder. Boken ger förslag på hur beslutsunderlagen kan förbättras. Här ges anvisningar om hur man mäter behov och nytta hos patientgrupper och i befolkningen, hur kostnadseffektivitet beräknas och hur man skapar ett kunskapsunderlag. På så sätt får läsaren inte bara ta del av prioriteringarnas teori utan även av deras praktik, inte minst genom konkreta exempel på hur öppna prioriteringar i dag tillämpas i svensk hälso- och sjukvård.Boken är avsedd för dig som arbetar kliniskt eller planerar att arbeta med prioriteringar – nationellt, i landsting eller i kommuner. Boken ger även en värdefull inblick för dig som vill lära mer om hur vårdens svåra val ska kunna hanteras i framtiden.
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| 4. |
- Carlsson, Per, 1951-, et al.
(författare)
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Öppna prioriteringar i hälso- och sjukvården
- 2013. - 1:1
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Ingår i: Att välja rättvist. - Lund. - 9789144083933 ; , s. 17-33
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- I detta inledande kapitel redovisar vi syftet med och motivet till boken. Därefter redovisar vi framväxten av prioriteringar i andra länder och introducerar den svenska prioriteringsutredningen och förändringen av hälso- och sjukvårdslagen år 1997. Vi ger också förklaringar till varför prioriteringar är nödvändiga i alla hälso- och sjukvårdssystem med offentlig finansiering och varför mer öppna prioriteringar är eftersträvansvärda.
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| 5. |
- Lindholm, Lars, et al.
(författare)
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Att mäta hälsobehov, vårdbehov och patientnytta
- 2013. - 1
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Ingår i: Att välja rättvist. - Lund. - 9789144083933 ; , s. 65-76
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- I det här kapitlet beskriver vi hur hälso- och vårdbehov kan kategoriseras, kvantifieras och mätas. Det gör vi genom att beskriva ICF, WHO:s klassifikation av funktionstillstånd, funktionshinder och hälsa, samt redovisar hur måttet QALY, kvalitetsjusterade levnadsår, konstrueras. Med dess hjälp kan man mäta både hälsoförlust vid sjukdom och hälsovinst eller patientnyttan till följd av interventioner. QALY kan därför också användas som ett mått på vårdbehov. Måttet är också ett vanligt förekommande effektmått i kostnadseffektanalyser, vilket vi återkommer till i nästa kapitel.
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| 6. |
- Lindström, Håkan, et al.
(författare)
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Ethically acceptable prioritisation of childless couples and treatment rationing : "accountability for reasonableness"
- 2008
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Ingår i: European Journal of Obstetrics, Gynecology, and Reproductive Biology. - : Elsevier BV. - 0301-2115 .- 1872-7654. ; 139:2, s. 176-186
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: With in vitro fertilisation serving as a specific case, an intervention was aimed at investigating the potential for applying prioritisation theories and methods in a real-life situation to form an evidence-based proposal that met the standards of the "Accountability for Reasonableness" Model. In turn, this case would serve as a basis for public decision on rationalisation, prioritisation and rationing, whereby given resources are allocated with respect to the ethical template of the Swedish Parliament's decision on priorities in health care. STUDY DESIGN: Management representatives of the overall county council as well as the gynaecologic-obstetric department levels, infertility treatment professionals and a patients' organisation representative worked together to create guidelines building on the ethical principles of human dignity, needs/solidarity and cost-effectiveness, on evidence of treatment effect, epidemiology and economic resources availability. Also quality improvement techniques were used. RESULTS: Due to new guidelines for priority setting, it is expected that more childless couples in the studied health care region will get publicly financed IVF treatment. IVF treatment outcome is expected to be more cost-effective in terms of pregnancies for a given amount of resources. A balance between needs - as defined by the guidelines' criteria - and resources is expected and thus waiting lists are expected to vanish. The patients' organisations representative accepted the guidelines. They were also accepted by all obstetric clinics and formally agreed upon by the political boards of all county councils in the region. CONCLUSION: Use of a deliberative decisions model, structured quality improvement methodology and an accepted model for prioritisation helped create a system for legitimate prioritisation of couples and rationing of treatment regarding a group of patients where differentiation has been considered difficult.
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| 7. |
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| 8. |
- Waldau, Susanne
(författare)
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Bottom-up priority setting revised : a second evaluation of an institutional intervention in a Swedish health care organisation
- 2015
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Ingår i: Health Policy. - : Elsevier. - 0168-8510 .- 1872-6054. ; 119:9, s. 1226-1236
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Tidskriftsartikel (refereegranskat)abstract
- Background: Transparent priority setting in health care based on specific ethical principles is requested by the Swedish Parliament since 1997. Implementation has been limited. In this case, transparent priority setting was performed for a second time round and engaged an entire health care organisation. Aims: Objectives were to refine a bottom-up priority setting process, reach a political decision on service limits to make reallocation towards higher prioritised services possible, and raise systems knowledge. Methods: An action research approach was chosen. The national model for priority setting was used with addition of dimensions costs, volumes, gender distribution and feasibility. The intervention included a three step process and specific procedures for each step which were created, revised and evaluated regarding factual and functional aspects. Evaluations methods included analyses of documents, recordings and surveys. Results: Vertical and horizontal priority setting occurred and resources were reallocated. Participants' attitudes remained positive, however less so than in the first priority setting round. Identifying low-priority services was perceived difficult, causing resentment and strategic behaviour. The horizontal stage served to raise quality of the knowledge base, level out differences in ranking of services and raise systems knowledge. Conclusions: Existing health care management systems do not meet institutional requirements for transparent priority setting. Introducing transparent priority setting constitutes a complex institutional reform, which needs to be driven by management/administration. Strong managerial commitment is required.
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| 9. |
- Waldau, Susanne, 1954-
(författare)
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Creating organisational capacity for priority setting in health care : using a bottom-up approach to implement a top-down policy decision
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In this thesis, priority setting to the form of the Swedish parliamental decision on priority setting, 1997, is considered an innovation for implementation in health care. The features of this innovation are investigated. The practical implications of implementation are identified by investigating the user organisation, ie, Swedish health care organisations and management systems. Also, a case of a three-stage process for macro-level priority setting that engaged the entire organisation in the Västerbotten County Council (VCC) is presented. This is done against a background of preceding implementation efforts in the VCC. Four specific research efforts and papers are presented. In Paper I, priority setting is operationalised into a multi-dimensional resource allocation task. On that basis, with the help of interviews (1998) and surveys (2002 and 2005) primarily of VCC health care managers, the impact of implementation is measured by prioritisation structures, processes and decisions. Survey response rates were low. Results were used as qualitative data, internally compared, and interpreted as: a) responses reflected mainly “early adopters’” opinions; b) priority setting is an ambiguous concept; c) indicating limited overall implementation; d) reinterpretation of the prioritisation task occurred over time among respondents; and, e) this group took increasingly personal responsibility as stakeholders in priority setting. Paper II reports a case study intervention of explicit, departmental level priority setting with the aim of improving cost-effectiveness in in vitro fertilization resource use and a rationing of services perceived legitimate by all stakeholders. The intervention combined priority setting and structured quality improvement techniques. Results were: a) improved operational efficiency of diagnostic procedures that allowed resources to be reallocated to treatment; and b) patients were prioritized and treatment resources were rationed based on evidence of treatment effect among subgroups. Evaluation showed that the procedure met stated criteria for legitimacy. In Paper III, a full-format test of the macro level prioritisation process is described and evaluated by participants with the help of surveys after each completed stage. Participants report the need for improvement of elements in the overall process and of procedural specifics. However, overall there was a strong commitment to the initiative and satisfaction with the process and the resulting decisions. In Paper IV, procedural specifics of the prioritisation process are evaluated. They are also compared to the Program Budgeting and Marginal Analysis (PBMA) framework when used for macro level purposes. Procedures provided intended results such as vertical and horizontal priority setting and a consistent process. However, economic targets were not fully achieved in any of the stages. Conclusions include that health care management systems are not prepared for priority setting and need profound restructuring and that the prioritisation process described in Papers III and IV was successful because: a) the process satisfied politicians’ directives; b) participants were satisfied with the procedures and perceived the subsequent reallocation decisions as legitimate; and, c) methods resulted in the intended outcome. Factors suggested as the basis of success include: long-term overall preparations; broad and deep participation; a readiness for change among participants; a stage for horizontal priority setting that added to the quality, feasibility and perceived validity of the knowledge base; a strong process leadership; and politicians determined to protect the process from opportunistic disturbances.
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| 10. |
- Waldau, Susanne, 1954-
(författare)
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Local prioritisation work in health care : assessment of an implementation process
- 2007
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Ingår i: Health Policy. - : Elsevier BV. - 0168-8510 .- 1872-6054. ; 81:2-3, s. 133-145
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Tidskriftsartikel (refereegranskat)abstract
- Political, horizontal prioritisation requires knowledge on local health care resource use on unit or patient group level. This in turn requires unit level structures (meeting forums) and processes for creation of knowledge and continuous, open decision-making on prioritisation. Ideally, for decisions to be legitimate, such procedures should meet the "Accountability for reasonableness"-criteria of Daniels and Sabin [Daniels N. Accountability for reasonableness. Establishing a fair process for priority setting is easier than agreeing on principles. British Medical Journal 2000;321:1300-1]. A strategy, aiming at shaping such an organisational culture, was developed and set to work within a regional health care organisation, responsible for around 250000 inhabitants. This pilot study regarding topic and methodology assesses the changes of knowledge in open prioritisation as well as structures, processes for and results of such work on unit level in that organisation 1998 through early 2005. Initial interviews and two consecutive surveys were analysed. Results indicate that only early adopters respond to the surveys and among them a growing knowledge in priority setting, acceptance of personal leadership for local priority setting work and recognition of a need for adequate structures and processes. Among respondents, one could note a development: A tentative model expressing different positions towards prioritisation was developed.
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