| 1. |
- Bergstedt, Emma, 1983-, et al.
(författare)
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Consolidating political leadership in healthcare : a mediating institution for priority-setting as a political strategy in a local health system
- 2024
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Ingår i: Health Economics, Policy and Law. - : Cambridge University Press. - 1744-1331 .- 1744-134X.
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Tidskriftsartikel (refereegranskat)abstract
- The allocation of resources is a crucial part of political decision-making in healthcare, but explicit priorities are rarely set when resources are distributed. Two areas that have received some attention in research about legitimacy and priority-setting decisions in healthcare are the role of technical expert agencies as mediating institutions and the role of elected politicians. This paper investigates a political priority-setting advisory committee within a regional authority in Sweden. The aim is to explore how a political body can serve as a mediating institution for priority-setting in healthcare by disentangling the arrangements of its work in terms of what role it performs in the organisation and what it should do. The findings illustrate that promoting the notion of explicit priority-setting and the political aspects inherent in priority-setting in political healthcare management can contribute to consolidating political governance and leadership. There is, however, a complex tension between stability and conflicting values which has implications for the role of politicians as citizens' democratic representatives. This paper enhances our understanding of the role of mediating institutions and political properties of healthcare priority-setting, as well as our understanding of political and democratic healthcare governance in local self-government.
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| 2. |
- Ewert, Benjamin, et al.
(författare)
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Any lessons to learn? : Pathways and impasses towards health system resilience in post-pandemic times
- 2023
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Ingår i: Health Economics, Policy and Law. - : CAMBRIDGE UNIV PRESS. - 1744-1331 .- 1744-134X. ; 18:1, s. 66-81
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Tidskriftsartikel (refereegranskat)abstract
- The COVID-19 pandemic has been an ultimate challenge for health systems as a whole rather than just single sectors (e.g. hospital care). Particularly, interface management between health system sectors and cooperation among stakeholders turned out to be crucial for an adequate crisis response. Dealing with such interfaces, it is argued in the literature, demands from health care systems to become resilient. One way to analyse this is to focus on the ways in which bottlenecks in health systems are dealt with during the pandemic. This paper investigates six bottlenecks, including overburdened public health agencies, neglected nursing homes and insufficient testing capacities that have been encountered in the health systems of Germany, Sweden and the Netherlands during the pandemic. Based on empirical findings we identify and critically discuss preliminary lessons in terms of health system resilience, an increasingly popular theoretical concept that frames crises as an opportunity for health system renewal. We argue that in practice health system resilience is hindered by path dependencies of national health systems and, owed to the crisis, interim policies that lack ambition for broader reforms.
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| 3. |
- Fredriksson, Mio, 1976-, et al.
(författare)
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Getting involved : the extent and impact of patient and public involvement in the Swedish health system
- 2020
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Ingår i: Health Economics, Policy and Law. - 1744-1331 .- 1744-134X. ; 15:3, s. 325-340
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Tidskriftsartikel (refereegranskat)abstract
- Patient and public involvement (PPI) is framed as beneficial for individuals and for the health system. However, little is known about the extent of involvement, or of its impact. Based on data from Sweden, we show that apart from voting in regional elections (76%), more people reported involvement as individual patients (23%) than part of collective activities (5%) or activities relating to a citizen perspective (4%). There was no correlation between how many people participated and the estimated impact - which was generally low. More extensive involvement is thus not linked to the potential to influence decisions. We argue that to achieve the benefits associated with PPI it is crucial to understand more about people's motivation for being involved and what underlies low estimates of impact. This requires a more systematic approach to involvement, how it is evaluated and its results communicated to participants and the society. We also argue that a future challenge for the Swedish health system, and for other similar health systems, is to support long-term collective involvement in the midst of growing individualization of health services and involvement opportunities primarily intended for patients.
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| 4. |
- Hoffstedt, Caroline, et al.
(författare)
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When do people choose to be informed? : Predictors of information-seeking in the choice of primary care provider in Sweden
- 2020
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Ingår i: Health Economics, Policy and Law. - Cambridge : Cambridge University Press. - 1744-1331 .- 1744-134X. ; 15:2, s. 210-224
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Tidskriftsartikel (refereegranskat)abstract
- Improving the ability of patients to make informed choices of health care provider can give providers more incentive to compete based on quality. Still, it is not evident to what extent and when people search for information when choosing a provider. The aim of this study is to identify under what circumstances individuals seek information when choosing a primary care provider. Research to date has mostly focused on individuals’ demographic and socio-economic characteristics and the poor availability of information as barriers to information-seeking and use. Our results highlight the importance of taking individuals’ personal motivations and situational context into account when studying information-seeking behavior. Overall, these results suggest that not even individuals who are likely to search for information since they switched or considered switching primary care provider, do so to any greater extent. However, those motivated to change providers by internal factors such as dissatisfaction or a belief that other providers may provide superior services actively sought out information to a greater extent than those motivated by external factors such as the closure of their current provider, or by moving house. Gender, employment status, place of residence and education level was also significantly associated with information-seeking.
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| 5. |
- Hoffstedt, C., et al.
(författare)
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When do people choose to be informed? Predictors of information-seeking in the choice of primary care provider in Sweden
- 2020
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Ingår i: Health Economics Policy and Law. - : Cambridge University Press (CUP). - 1744-1331 .- 1744-134X. ; 15:2, s. 210-224
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Tidskriftsartikel (refereegranskat)abstract
- Improving the ability of patients to make informed choices of health care provider can give providers more incentive to compete based on quality. Still, it is not evident to what extent and when people search for information when choosing a provider. The aim of this study is to identify under what circumstances individuals seek information when choosing a primary care provider. Research to date has mostly focused on individuals' demographic and socio-economic characteristics and the poor availability of information as barriers to information-seeking and use. Our results highlight the importance of taking individuals' personal motivations and situational context into account when studying information-seeking behavior. Overall, these results suggest that not even individuals who are likely to search for information since they switched or considered switching primary care provider, do so to any greater extent. However, those motivated to change providers by internal factors such as dissatisfaction or a belief that other providers may provide superior services actively sought out information to a greater extent than those motivated by external factors such as the closure of their current provider, or by moving house. Gender, employment status, place of residence and education level was also significantly associated with information-seeking.
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| 6. |
- Kullberg, Linn, et al.
(författare)
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Does voluntary health insurance reduce the use of and the willingness to finance public health care in Sweden?
- 2022
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Ingår i: Health Economics, Policy and Law. - : Cambridge University Press. - 1744-1331 .- 1744-134X. ; 17:4, s. 380-397
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Tidskriftsartikel (refereegranskat)abstract
- Voluntary private health insurance (VHI) has generally been of limited importance in national health service-type health care systems, especially in the Nordic countries. During the last decades however, an increase in VHI uptake has taken place in the region. Critics of this development argue that voluntary health insurance can undermine support for public health care, while proponents contend that increased private funding for health services could relieve strained public health care systems. Using data from Sweden, this study investigates empirically how voluntary health insurance affects the public health care system. The results of the study indicate that the public Swedish health care system is fairly resilient to the impact of voluntary health insurance with regards to support for the tax-based funding. No difference between insurance holders and non-holders was found in willingness to finance public health care through taxes. A slight unburdening effect on public health care use was observed as VHI holders appeared to use public health care to a lesser extent than those without an insurance. However, a majority of the insurance holders continued to use the public health care system, indicating only a modest substitution effect.
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| 7. |
- Lehto, Juhani, et al.
(författare)
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The reactions to macro-economic crisis in Nordic health system policies : Denmark, Finland and Sweden, 1980-2013
- 2015
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Ingår i: Health Economics, Policy and Law. - 1744-1331 .- 1744-134X. ; 10:1, s. 61-81
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Tidskriftsartikel (refereegranskat)abstract
- Denmark, Finland and Sweden have experienced two major recessions during the last 25 years. The adjustments to the earlier crisis in the late 1980s (Denmark) and early 1990s (Finland and Sweden) resembled the policies in many other European countries during the present crisis. The analysis of relationship of deep economic crises and growth period between them to the health system policies and institutions in the three countries from the 1980s to 2013 is based on a categorisation of reactions to external shocks as path conforming or path breaking. The results of the empirical long-term trends show that the reactions to deep recessions have been mainly temporary adjustments and acceleration of changes already prepared before economic crisis. The economic crisis in the three countries has not been ‘good enough’ to enable paradigmatic changes in the Nordic public, decentralised and equity-oriented health systems. Changes such as the slow privatisation in care funding and production and the adoption of new management practices indicate an ongoing paradigmatic change related to longer-term societal, ideological and political developments rather than directly to economic crises or growth.
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| 8. |
- Or, Zeynep, et al.
(författare)
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Are health problems systemic? : Politics of access and choice under Beveridge and Bismarck systems
- 2010
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Ingår i: Health Economics, Policy and Law. - 1744-1331 .- 1744-134X. - 9782878123548 ; 5:3, s. 269-293
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Tidskriftsartikel (refereegranskat)abstract
- Industrialised countries face similar challenges for improving the performance of their health system. Nevertheless, the nature and intensity of the reforms required are largely determined by each country’s basic social security model. Most reforms in Beveridge-type systems have sought to increase choice and reduce waiting times while those in major Bismarck-type systems have focused on cost control by constraining the choice of providers. This paper looks at the main differences in performance of five countries and reviews their recent reform experience, focusing on three questions: Are there systematic differences in performance of Beveridge and Bismarck-type systems? What are the key parameters of healthcare system, which underlie these differences? Have recent reforms been effective?Our results do not suggest that one system-type performs consistently better than the other. In part, this may be explained by the heterogeneity in organisational design and governance both within and across these systems. Insufficient attention to those structural differences may explain the limited success of a number of recent reforms. Thus, while countries may share similar problems in terms of improving healthcare performance, adopting a ‘copy-and-paste’ approach to healthcare reform is likely to be ineffective.
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| 9. |
- Sandberg, Johanna, 1981-, et al.
(författare)
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The dilemma of knowledge use in political decision-making : National Guidelines in a Swedish priority-setting context
- 2019
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Ingår i: Health Economics, Policy and Law. - : Cambridge University Press. - 1744-1331 .- 1744-134X. ; 14:4, s. 425-442
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Tidskriftsartikel (refereegranskat)abstract
- There is a growing recognition of the importance of evidence to support allocative policy decisions in health care. This study is based on interviews with politicians in four regional health authorities in Sweden. Drawing on theories of strategic use of knowledge, the article analyses how politicians perceive and make use of expert knowledge represented by the National Guidelines, embracing both a scientific and a political rationale. As health care is an organisation with a dual basis for legitimacy – at the same time a political and an action organisation – it affects knowledge use. We investigate how the context of health care priority setting influences the conditions for knowledge use among regional politicians. Our findings illustrate the dilemma of political decision-makers and how they prefer to use expert knowledge. The politicians use this policy instrument in a legitimising fashion, as it will fit into the current political debate on more equal care. As an instrument for resource allocation the politicians noted that ‘facts’ per se could not provide them with a sufficient basis for legitimising their governing of health care. The dualistic organisational context makes knowledge important as a political weapon in negotiations with the medical profession.
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| 10. |
- Tinghög, Gustav, 1979-, et al.
(författare)
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Individual responsibility for what? : A conceptual framework for exploring the suitability of private financing in a publicly funded health-care system
- 2010
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Ingår i: Health Economics, Policy and Law. - : Cambridge University Press. - 1744-1331 .- 1744-134X. ; 5:2, s. 201-223
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Tidskriftsartikel (refereegranskat)abstract
- Policymakers in publicly funded health-care systems are frequently required to make intricate decisions on which health-care services to include or exclude from the basic health-care package. Although it seems likely that the concept of individual responsibility is an essential feature of such decisions, it is rarely explicitly articulated or evaluated in health policy. This paper presents a tentative conceptual framwork for exploring when health-care services contain characteristics that facilitate individual responsibility through private financing. Six attributes for exploring the suitability of private financing for specific health-care commodities are identified: (i) it should enable individuals to value the need and quality both before and after utilization; (ii) it should be targeted toward individuals with a reasonable level of individual autonomy; (iii) it should be associated with low levels of positive externalities; (iv) it should be associated with a demand sufficient to generate a private market; (v) it should be associated with payments affordable for most individuals; and finally, (vi) it should be associated with 'lifestyle enhancements' rather than 'medical necessities'. The tentative framework enables exploration of individual responsibility connected to health care as a heterogeneous group of commodities, and allows policymakers to make decisions on rationing by design rather than default.
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