| 1. |
- Dong, Hengjin, et al.
(författare)
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A description of outpatient drug use in rural China : evidence of differences due to insurance coverage
- 1999
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Ingår i: International Journal of Health Planning and Management. - 0749-6753 .- 1099-1751. ; 14:1, s. 41-56
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Tidskriftsartikel (refereegranskat)abstract
- This paper describes the effects of health financing systems (insurance) on outpatient drug use in rural China. 1320 outpatients were interviewed (exit interview) in the randomly selected county, township and village health care facilities in five counties in three provinces of central China. The interview was face to face. Questions were asked by a trained interviewer and were answered by patient him/herself. The main finding was that health insurance appeared to influence drug use in outpatient services. The average number of drugs per visit was 2.56 and drug expenditures per visit was 16.9 yuan. Between insured and uninsured (out-of-pocket) groups, there were significant differences in the number of drugs and drug expenditures per visit. The insured had a lower number of drugs and a higher drug expenditure per visit than the uninsured, implying the use of more expensive drugs per visit than the uninsured. There were also significant differences in the number of drugs and drug expenditures per visit between the types of insurance. One third of the drugs were anti-infectives, most of which were penicillin, gentamycin, and sulfonamides. The results imply that uninsured patients do not receive the same care as the insured do even if they have the same needs. The fee-for-service financing for hospitals and health insurance have changed health providers' and consumers' behaviour and resulted in the increase of medical expenditure.
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| 2. |
- Ahgren, Bengt, et al.
(författare)
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Is choice of care compatible with integrated health care? An exploratory study in Sweden
- 2012
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Ingår i: International Journal of Health Planning and Management. - : Wiley. - 1099-1751 .- 0749-6753. ; 27:3, s. 162-172
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Tidskriftsartikel (refereegranskat)abstract
- 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. Copyright (c) 2012 John Wiley & Sons, Ltd.
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| 3. |
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| 4. |
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| 5. |
- Berlin, Johan, 1975-, et al.
(författare)
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Cultural camouflage : a critical study of how artefacts are camouflaged and mental health policy subverted
- 2015
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Ingår i: International Journal of Health Planning and Management. - : Wiley. - 0749-6753 .- 1099-1751. ; 30:2, s. 111-126
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Tidskriftsartikel (refereegranskat)abstract
- This study identifies hidden artefacts in a public organisation. In contrast to earlier studies, itfocuses on artefacts as concealing rather than conveying meaning. Negligent behaviour causedby an unpopular culture was recognised in five psychiatric wards at a Swedish universityhospital. Data comprising observations (87 h) and interviews (n = 60) were collected over aperiod of 48months (2008–2011). Four different items used in everyday work representing adeeper meaning of the organisation were identified during the observations. The items selectedwere work attire, nametags, keys and restraint beds. These were considered particularly promisingwhen it came to the aim of the study, namely, to find out how artefacts are camouflaged. Theobservations and the interviews revealed that these were controversial and contested artefacts inthe organisation. The study uses the term ‘cultural camouflage’ for behaviour that ignores andconsciously conceals symbols that have negative values. This concept contrasts with previousresearch that shows how artefacts are emphasised and how they contribute to the character ofthe activity in a transparent way. Conservative and backward-looking behaviour among staffprovided one explanation as to why artefacts were concealed. Another was the need to establishharmonious internal interactions.
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| 6. |
- Bukachi, Salome A, et al.
(författare)
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Healthcare priority setting in Kenya : a gap analysis applying the accountability for reasonableness framework
- 2014
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Ingår i: International Journal of Health Planning and Management. - : Wiley. - 0749-6753 .- 1099-1751. ; 29:4, s. 342-361
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Tidskriftsartikel (refereegranskat)abstract
- In resource-poor settings, the accountability for reasonableness (A4R) has been identified as an important advance in priority setting that helps to operationalize fair priority setting in specific contexts. The four conditions of A4R are backed by theory, not evidence, that conformance with them improves the priority setting decisions. This paper describes the healthcare priority setting processes in Malindi district, Kenya, prior to the implementation of A4R in 2008 and evaluates the process for its conformance with the conditions for A4R. In-depth interviews and focus group discussions with key players in the Malindi district health system and a review of key policy documents and national guidelines show that the priority setting process in the district relies heavily on guidelines from the national level, making it more of a vertical, top-down orientation. Multilateral and donor agencies, national government, budgetary requirements, traditions and local culture influence the process. The four conditions of A4R are present within the priority setting process, albeit to varying degrees and referred to by different terms. There exists an opportunity for A4R to provide a guiding approach within which its four conditions can be strengthened and assessed to establish whether conformance helps improve on the priority setting process.
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| 7. |
- Carlström, Eric, 1957, et al.
(författare)
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The unannounced patient in the corridor - trust, friction and person centered care.
- 2017
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Ingår i: International Journal of Health Planning and Management. - : Wiley. - 0749-6753 .- 1099-1751. ; 32:1
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Tidskriftsartikel (refereegranskat)abstract
- In this study, a Swedish cancer clinic was studied where three to four unscheduled patients sought support from the hospital on a daily basis for pain and nutrition problems. The clinic was neither staffed nor had a budget to handle such return visits. In order to offer the patients a better service and decrease the workload of the staff in addition to their everyday activities, a multidisciplinary team was established to address the unscheduled return visits. The team was supposed to involve the patient, build trust, decrease the friction, and contribute to a successful rehabilitation process. Data were collected from the patients and the staff. Patients who encountered the team (intervention) and patients who encountered the regular ad hoc type of organization (control) answered a questionnaire measuring trust and friction. Nurses in the control group spent 35% of their full‐time employment, and the intervention group staffed with nurses spent 30% of their full‐time employment in addressing the needs of these return patients. The patients perceived that trust between them and the staff was high. In summary, it was measured as being 4.48 [standard deviation (SD) = 0.82] in the intervention group and 4.41 (SD = 0.79) in the control group using the 5‐point Likert scale. The data indicate that using a multidisciplinary team is a promising way to handle the problems of unannounced visits from patients. Having a team made it cost effective for the clinic and provided a better service than the traditional ad hoc organization.
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| 8. |
- Carson, Dean B., 1970-, et al.
(författare)
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Addressing the workforce crisis in (rural) social care : a scoping review
- 2024
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Ingår i: International Journal of Health Planning and Management. - : John Wiley & Sons. - 0749-6753 .- 1099-1751. ; 39:3, s. 806-823
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Forskningsöversikt (refereegranskat)abstract
- Background: This scoping review identifies strategies potentially addressing the ‘workforce crisis’ in rural social care. The increasing global demand for social care has been coupled with widely recognised challenges in recruiting and retaining sufficient staff to provide this care. While the social care workforce crisis is a global phenomenon, it is particularly acute in rural areas.Methods: The review identified 75 papers which (i) had been published since 2017, (ii) were peer reviewed, (iii) concerned social care, (iv) were relevant to rural settings, (v) referenced workforce shortages, and (vi) made recommendations for ways to address those shortages. Thematic synthesis was used to derive three analytical themes with a combined 17 sub-themes applying to recommended strategies and evidence supporting those strategies.Results: The most common strategies for addressing social care workforce shortages were to improve recruitment and retention (‘recruit and retain’) processes without materially changing the workforce composition or service models. Further strategies involved ‘revitalising’ the social care workforce through redeploying existing staff or identifying new sources of labour. A small number of strategies involved ‘re-thinking’ social care service models more fundamentally. Very few papers specifically considered how these strategies might apply to rural contexts, and evidence for the effectiveness of strategies was sparse.Conclusion: The review identifies a significant gap in the literature in relation to workforce innovation and placed-based studies in rural social care systems. It is unlikely that the social care workforce crisis can be addressed through continuing attempts to recruit and retain workers within existing service models.
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| 9. |
- Dong, Hengjin, et al.
(författare)
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The impact of expanded health system reform on governmental contributions and individual copayments in the new Chinese rural cooperative medical system
- 2016
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Ingår i: International Journal of Health Planning and Management. - : Wiley. - 0749-6753 .- 1099-1751. ; 31:1, s. 36-48
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Tidskriftsartikel (refereegranskat)abstract
- In 2002, the Chinese central government created a new rural cooperative medical system (NCMS), ensuring that both central and local governments partner with rural residents to reduce their copayments, thus making healthcare more affordable. Yet, significant gaps in health status and healthcare utilization persisted between urban and rural communities. Therefore, in 2009, healthcare reform was expanded, with (i) increased government financing and (ii) sharply reduced individual copayments for outpatient and inpatient care. Analyzing data from China's Ministry of Health, the Rural Cooperative Information Network, and Statistical Yearbooks, our findings suggest that healthcare reform has reached its preliminary objectives-government financing has grown significantly in most rural provinces, especially those in poorer western and central China, and copayments in most rural provinces have been reduced. Significant intraprovincial inequality of support remains. The central government contributes more money for poor provinces than for rich ones; however, NCMS schemes operate at the county level, which vary significantly in their level of economic development and per capital gross domestic products (GDP) within a province. Data reveal that the compensation ratios for both outpatient and inpatient care are not adjusted to compensate for a rural county's level of economic development or per capita GDP. Consequently, a greater financial burden for healthcare persists among persons in the poorest rural regions. A recommendation for next step in healthcare reform is to pool resources at prefectural/municipal level and also adjust central government contributions according to the GDP level at prefectural/municipal level.
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| 10. |
- Eriksson, Thérèse, et al.
(författare)
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The introduction of a value-based reimbursement programme - Alignment and resistance among healthcare providers
- 2023
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Ingår i: International Journal of Health Planning and Management. - : Wiley. - 0749-6753 .- 1099-1751. ; 38:1, s. 129-148
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Tidskriftsartikel (refereegranskat)abstract
- Reimbursement programmes are used to manage care through financial incentives. However, their effects are mixed and the programmes can motivate behaviour that goes against professional values. Value-based reimbursement programmes may better align professional values with financial incentives. The aim of this study is to analyse if and how healthcare providers adapt their practices to a value-based reimbursement programme that combines bundled payment with performance-based payment. Forty-one semi-structured interviews were conducted with representatives from healthcare providers within spine surgery in Sweden. Data were analysed using thematic analysis with an abductive approach and a conceptual framework based on neo-institutional theory. Healthcare providers were positive to the idea of a value-based reimbursement programme. However, during its introduction it became evident that some aspects were easier to adapt to than others. The bundled payment provided a more comprehensive picture of the patients needs but to an increased administrative burden. Due to the financial impact of the bundled payment, healthcare providers tried to decrease the amount of post-discharge care. The performance-based payment was appreciated. However, the lack of financial impact and transparency in how the payment was calculated caused providers to neglect it. Healthcare providers adapted their practices to, but also resisted aspects of the value-based reimbursement programme. Resistance was mainly caused by lack of understanding of how to interpret and act on new information. Providers had to face unfamiliar situations, which they did not know how to handle. Better IT-facilitation and clearer definition of related care is needed to strengthen the value-based reimbursement programme among healthcare providers. A value-based reimbursement programme seems to better align professional values with financial incentives.
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| 11. |
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| 12. |
- Friedman, James M., et al.
(författare)
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Distance to hospital and utilization of surgical services in Haiti: do children, delivering mothers, and patients with emergent surgical conditions experience greater geographical barriers to surgical care?
- 2013
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Ingår i: International Journal of Health Planning and Management. - : Wiley. - 1099-1751 .- 0749-6753. ; 28:3, s. 248-256
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Tidskriftsartikel (refereegranskat)abstract
- Background An inverse relationship between healthcare utilization and distance to care has been previously described. The purpose of this study was to evaluate this effect related to emergency and essential surgical care in central Haiti. Methods We conducted a retrospective review of operative logbooks from the Clinique Bon Sauveur in Cange, Haiti, from 2008 to 2010. We used Geographic Information Systems to map the home locations of all patients. Spearman's correlation was used to determine the relationship between surgical utilization and distance, and a multivariate linear regression model identified characteristics associated with differences in distances traveled to care. Results The highest annual surgical utilization rate was 184 operations/100 000 inhabitants. We found a significant inverse correlation between surgical utilization rate and distance from residence to hospital (r(s) = -0.68, p = 0.02). The median distance from residence to hospital was 55.9 km. Pediatric patients lived 10.1% closer to the hospital than adults (p<0.01), and distance from residence to hospital was not significantly different between men and women (p = 0.25). Patients who received obstetric or gynecologic surgery originated 7.8% closer to the hospital than patients seeking other operations (p<0.01), and patients who received emergent surgical care originated 24.8% closer to the hospital than patients who received elective surgery (p<0.01). Copyright (C) 2012 John Wiley & Sons, Ltd. Conclusions Utilization of surgical services was low and inversely related to distance from residence to hospital in rural areas of central Haiti. Children and patients receiving obstetric, gynecologic or emergent surgery lived significantly closer to the hospital, and these groups may need special attention to ensure adequate access to surgical care. Copyright (C) 2012 John Wiley & Sons, Ltd.
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| 13. |
- Fältholm, Ylva, et al.
(författare)
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The implementation of process orientation at a Swedish hospital
- 2008
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Ingår i: International Journal of Health Planning and Management. - : Wiley. - 0749-6753 .- 1099-1751. ; 23:3, s. 219-233
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Tidskriftsartikel (refereegranskat)abstract
- During the last decade, as a response to the need for inter- as well as intra-organizational integration, management models initially developed for industry have been spread to health care organizations. Based on 62 in-depth interviews, this qualitative study aims at describing and analyzing the limited success of implementation of process orientation at a Swedish hospital and in doing so, the traditional and the critical approaches are combined. Applying a traditional approach, the limited success of the implementation of process orientation is explained in terms of difficulties to challenge deeply institutionalized organizational routines and the inter-disciplinary boundaries. This might be condensed to the dilemma of how to maintain and develop the specialization of the medical profession while focusing process rather than function and how to enhance inter-organizational integration without hampering intra-organizational collaboration. Applying a critical approach, the limited success is explained in terms of a differentiated translation process and in terms of separation of talk and practice. This means that process orientation, notwithstanding that it might be an efficient tool for the type of integration needed, might be regarded as part of a change discourse, aiming at conveying a picture of an efficient and modern organization.
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| 14. |
- Granström, Emma, et al.
(författare)
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Enhancing policy implementation to improve healthcare practices : The role and strategies of hybrid national-local support structures
- 2018
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Ingår i: International Journal of Health Planning and Management. - : John Wiley & Sons. - 0749-6753 .- 1099-1751. ; 33:4, s. E1262-E1278
-
Tidskriftsartikel (refereegranskat)abstract
- Background In this study, we followed a national initiative to enhance the use of quality indicators gathered in national quality registries (NQRs) for improvement of clinical practices in Swedish healthcare, more specifically by investigating the support strategies of regional support centers with national and local missions. The aim was to increase knowledge on the role, challenges, and strategies of support structures with mixed and complex missions in the healthcare system. Methods Documents and 25 semistructured interviews with staff at 6 regional support centers, ie, quality registry centers, formed this multiple case study. Data were analyzed using conventional content analysis. Results The centers' strategies varied from developing the NQRs to become more suitable for improvement to supporting healthcare's use of NQRs, from the use of task to process-oriented support strategies, and from taking on national responsibilities to responding to local initiatives. All quality registry centers engaged in initiatives inspired by the Breakthrough Series approach. Some used preexisting change concepts or collaborated with local development units. A main challenge was to overcome a lack of formal mandate to act in the healthcare organizations they served. Conclusions Support functions with mixed and complex missions have to use a variation of strategies to reach relevant actors and achieve changes. This study provides valuable input for policy and decision-makers on the support strategies used and challenges of support functions with complex missions situated in-between national and local levels of the healthcare system, here denoted hybrid national-local support structures.
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| 15. |
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| 16. |
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| 17. |
- Jensen, Christian, 1963, et al.
(författare)
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The project organization as a policy tool in implementing welfare reforms in the public sector
- 2013
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Ingår i: International Journal of Health Planning and Management. - : Wiley. - 0749-6753 .- 1099-1751. ; 28:1, s. 122-137
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Tidskriftsartikel (refereegranskat)abstract
- Organizational design is considered in policy literature as a forceful policy tool to put policy to action. However, previous research has not analyzed the project organization as a specific form of organizational design and, hence, has not given much attention to such organizations as a strategic choice when selecting policy tools. The purpose of the article is to investigate the project as a policy tool; how do such temporary organizations function as a specific form of organization when public policy is implemented? The article is based on a framework of policy implementation and is illustrated with two welfare reforms in the Swedish public sector, which were organized and implemented as project organizations. The case studies and the analysis show that it is crucial that a project organization fits into the overall governance structure when used as a policy tool. If not, the project will remain encapsulated and will not have sufficient impact on the permanent organizational structure. The concept of encapsulation indicates a need to protect the project from a potential hostile environment. The implication of this is that organizational design as a policy tool is a matter that deserves more attention in the strategic discussion on implementing public policies and on the suitability of using certain policy tools. Copyright © 2012 John Wiley & Sons, Ltd.
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| 18. |
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| 19. |
- Khorram-Manesh, Amir, 1958, et al.
(författare)
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Reasons for longer LOS at the emergency departments: Practical, patient‐centred, medical, or cultural?
- 2020
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Ingår i: International Journal of Health Planning and Management. - : Wiley. - 0749-6753 .- 1099-1751. ; 34:4
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Tidskriftsartikel (refereegranskat)abstract
- Emergency department (ED) overcrowding is caused by external and/or internal factors. One critical internal factor, leading to longer length of stay (LOS) at ED (eg, frequent ED users), is the physician's uncertainty in management of patients with unclear diagnosis and or complex medical history. The aim of this study was to identify whether the causes of physicians' uncertainty was practical, patient‐centred, medical, or cultural. Using earlier published dimensions of uncertainty, 18 physicians were asked to reply to a template by choosing a relevant dimension that causes a delay in assessment of a known complex patient. This stage was completed by interviews through which participants had an opportunity to express their concerns and critical thoughts, if any. The data obtained from the template were collected and analysed. The interviews were recorded and transcribed verbatim. The results of the template indicated medical dimension as the main factor in delayed assessment of a complex patient. However, this finding was challenged by the results of the interviews, which indicated higher impact of personal/routines/cultural dimension (eg, being afraid of criticism, reprimand, and gossip or feelings of guilt). Although medical, patient‐centred, and practical issues are important causes of longer LOS at ED, physicians' working and professional environment may have a higher impact than previously perceived. The uncertainty caused by interpersonal, organisational, and cultural issues within a clinic/hospital seems to influence the physician's ability to make decisions and thus a patient's medical outcome.
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| 20. |
- Korlén, S., et al.
(författare)
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Exploring staff experience of economic efficiency requirements in health care : A mixed method study
- 2019
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Ingår i: International Journal of Health Planning and Management. - : Wiley. - 0749-6753 .- 1099-1751. ; 34:4, s. 1439-1455
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Tidskriftsartikel (refereegranskat)abstract
- Background: Economic resources are limited in health care, and governance strategies are used to push provider organizations to use resources efficiently. Although studies show that hybrid managers are successful in reconciling economic efficiency requirements with professional values to meet patient needs, surprisingly few studies focus on staff. The aim of this study is to explore staff members' experience of economic efficiency requirements. Methods: A mixed method design was applied, targeting multi-professional staff in the Department of Rehabilitation Medicine in a Swedish university hospital. Survey data was collected (n = 93), followed by focus-group interviews to support the understanding of the quantitative findings. Findings: The findings show that health care staff is knowledgeable and intrinsically motivated to consider efficiency requirements, albeit it should not dominate clinical decisions. However, staff experiences little influence over resource allocation and identifies limitations in the system's abilities to meet patient needs. Staff experience incorporates a local unit and a system perspective. Conclusion: Staff members are aware of economic efficiency requirements and will behave accordingly if patients are not at risk. However, their engagement seems to rely on how economic efficiency requirements are handled at multiple system levels and their trust in the system to fairly support patient needs.
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| 21. |
- Kullén Engström, Agneta, et al.
(författare)
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The concept of effectiveness--a blind alley? A study of different interpretations in a Swedish county council
- 2001
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Ingår i: International Journal of Health Planning and Management. - : John Wiley & Sons Ltd.. - 0749-6753 .- 1099-1751. ; 16:1, s. 61-71
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Tidskriftsartikel (refereegranskat)abstract
- Swedish health care organizations are experiencing pressure to make ever greater efforts to rationalize and to increase effectiveness in the way they plan and provide services. In order to gain a better understanding of the current practice of the three groups of key actors in Swedish health care—politicians, senior civil servants and operational managers—and their perception of effectiveness, a study was carried out in a Swedish county council using both qualitative and quantitative methods. While in general the concept of effectiveness is thought of as crucial, it is not clearly or uniformly defined within the organization. Each of the three groups defines the concept in a way that reflects their own function, which may lead efforts to achieve effectiveness into a blind alley.
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| 22. |
- Kullén Engström, Agneta, et al.
(författare)
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The double spiral of change : experiences of privatization in a Swedish hospital
- 2010
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Ingår i: International Journal of Health Planning and Management. - : John Wiley & Sons Ltd.. - 0749-6753 .- 1099-1751. ; 25:2, s. 156-168
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesPrivatization is a trend in countries with a public health system. It involves organizational change, a cultural transformation and changes for the employees as well as a more strictly controlled work. The objective of this study is to describe, analyse and interpret how privatization is perceived by the employees of a health care organization in Sweden. Methodology In-depth interviews have been performed with physicians, paramedics, secretaries, nurses, assistant nurses and local managers, in all 14 respondents, after a private entrepreneur had taken over the management of a hospital. The interviews were tape-recorded and have been analysed and interpreted following a grounded theory approach. Findings The transcribed interviews show that trust is a core category and linked with emotions, commitment and security. The analysis shows that employees' experience of privatization within a health care organization differs and is full of nuances and complexities. Conclusion A simultaneous virtuous and a vicious circle of experiences and reactions may describe how employees experience privatization. It can also be concluded that leadership is an important factor in the success of organizational change.
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| 23. |
- Larsson, Lena Gunvor, et al.
(författare)
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A national study on collaboration in care planning for patients with complex needs
- 2019
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Ingår i: International Journal of Health Planning and Management. - : Wiley. - 0749-6753 .- 1099-1751. ; 34:1, s. E646-E660
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: The purpose of this study was to investigate inter-organisational collaboration on care planning for patients with complex care needs. Internationally, and in Sweden where the data for this study was collected, difficulties in care planning and transition of patients between the main health care providers, hospitals, municipal care, and primary care are well known.METHOD: A survey of a total population of care managers in hospitals, municipalities, and primary care in Sweden was conducted. The study assessed accessibility, willingness, trustworthiness, and collaboration between health care providers. Data were analysed with descriptive statistics, bivariate, and multivariate regressions.RESULTS: The results indicate that Swedish health care providers show strong self-awareness, but they describe each other's ability to collaborate as weak. Primary care stands out, displaying the highest discrepancy between self-awareness and displayed accessibility, willingness, trustworthiness, and collaboration.CONCLUSION: Inability to collaborate in patient care planning may be due to shortcomings in terms of trust between caregivers in the health care organisation at a national level. Organisations that experience difficulties in collaboration tend to defend themselves with arguments about their own excellence and insufficiency of others.
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| 24. |
- Lindgren, Åsa, 1979, et al.
(författare)
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Why risk professional fulfilment: a grounded theory of physician engagement in healthcare development
- 2013
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Ingår i: International Journal of Health Planning and Management. - : Wiley. - 0749-6753 .- 1099-1751. ; 28:2
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Tidskriftsartikel (refereegranskat)abstract
- The need for trans-professional collaboration when developing healthcare has been stressed by practitioners and researchers. Because physicians have considerable impact on this process, their willingness to become involved is central to this issue.
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| 25. |
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| 26. |
- Löfström, Mikael
(författare)
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Inter-organizational collaboration projects in the public sector : a balance between integration and demarcation
- 2010
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Ingår i: International Journal of Health Planning and Management. - : John Wiley & Sons, Ltd. - 0749-6753 .- 1099-1751. ; 25:2
-
Tidskriftsartikel (refereegranskat)abstract
- For several years, the development of the Swedish public sector has been accompanied by a discussion about inter-organizational collaboration, which has been examined in several national experiments. The experience, however, indicates significant difficulties in implementing collaboration in local authorities’ regular activities. This article argues that organizing inter-organizational collaboration in projects tends to be counterproductive, since the purpose of this collaboration is to increase the integration of local authorities. This article is based on case studies of three different collaboration projects. Each project is analyzed in relation to the way collaboration is organized within the project and how the relationship to the local authorities’ activities is designed. The outcome of these studies shows that while collaboration projects increase integration between the responsible authorities, the integration stays within the projects. This is due to the fact that the projects were designed as units separate from the responsible authorities. As a result, the collaboration that occurs in the projects is not implemented in the local authorities’ activities, and the viability of the increased integration of different responsible authorities does not extend beyond the projects.
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| 27. |
- Mæhle, Per Magnus, et al.
(författare)
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Exploring the triggering process of a cancer care reform in three Scandinavian countries
- 2021
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Ingår i: International Journal of Health Planning and Management. - : John Wiley & Sons. - 0749-6753 .- 1099-1751. ; 36:6, s. 2231-2247
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Tidskriftsartikel (refereegranskat)abstract
- Cancer incidence is increasing, and cancer is a leading cause of death in the Scandinavian countries, and at the same time more efficient but very expensive new treatment options are available. Based on the increasing demand, high expectations and limited resources, crises in public legitimacy of cancer care evolved in the three Scandinavian countries. Similar cancer care reforms were introduced in the period 2007-2015 to address the crisis. In this article we explore processes triggering these reforms in countries with similar and well-developed health care systems. The common objective was the need to reduce time from referral to start treatment, and the tool introduced to accomplish this was integrated care pathways for cancer diagnosis, that is Cancer Patient Pathways. This study investigates the process by drawing on interviews with key actors and public documents. We identified three main logics in play; the economic-administrative, the medical and the patient-related logic and explored how institutional entrepreneurs skillfully aligned these logics. The article contributes by describing the triggering processes on politically initiated similar reforms in the three countries studied and also contributes to a better understanding on the orchestrating of politically initiated health care reforms with the intention to change medical practice in hospitals.
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| 28. |
- Maluka, Stephen Oswald, 1978-, et al.
(författare)
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Decentralization and health care prioritization process in Tanzania : from national rhetoric to local reality
- 2011
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Ingår i: International Journal of Health Planning and Management. - : Wiley. - 0749-6753 .- 1099-1751. ; 26:2, s. e102-e120
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Tidskriftsartikel (refereegranskat)abstract
- During the 1990s, Tanzania like many other developing countries adopted health sector reforms. The most common policy change under the health sector reforms has been decentralization, which involves the transfer of power and authority from the central level to local authorities. Based on the case study of Mbarali district in Tanzania, this paper uses a policy analysis approach to analyse the implementation of decentralized health care priority setting. Specifically, the paper examines the process, actors and contextual factors shaping decentralized health care priority setting processes. The analysis and conclusion are based on a review of documents, key informant interviews, focus group discussion, and notes from non-participant observation. The findings of the study indicate that local institutional contexts and power asymmetries among actors have a greater influence on the prioritization process at the local level than expected and intended. The paper underlines the essentially political character of the decentralization process and reiterates the need for policy analysts to pay attention to processes, institutional contexts, and the role of policy actors in shaping the implementation of the decentralization process at the district level. Copyright (c) 2010 John Wiley & Sons, Ltd.
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| 29. |
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| 30. |
- Meng, Xiangli, et al.
(författare)
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How do administrative borders affect accessibility to hospitals? The case of Sweden
- 2018
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Ingår i: International Journal of Health Planning and Management. - : Wiley. - 0749-6753 .- 1099-1751. ; 33:3
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Tidskriftsartikel (refereegranskat)abstract
- An administrative border might hinder the optimal allocation of a given set of resources by restricting the flow of goods, services, and people. In this paper, we address the question: Do administrative borders lead to poor accessibility to public service? In answering the question, we have examined the case of Sweden and its regional administrative borders and hospital accessibility. We have used detailed data on the Swedish road network, its hospitals, and its geo-coded population. We have assessed the population's spatial accessibility to Swedish hospitals by computing the inhabitants' distance to the nearest hospital. We have also elaborated several scenarios ranging from strongly confining regional borders to no confinements of borders and recomputed the accessibility. Our findings imply that administrative borders are only marginally worsening the accessibility.
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| 31. |
- Mosquera Mendez, Paola A, et al.
(författare)
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Challenges of implementing a primary health care strategy in a context of a market-oriented health care system : the experience of Bogota, Colombia
- 2014
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Ingår i: International Journal of Health Planning and Management. - : Wiley-Blackwell. - 0749-6753 .- 1099-1751. ; 29:4, s. E347-E367
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Although Colombia has a health system based on market and neoliberal principles, in 2004, the government of the capital-Bogota-took the decision to formulate a health policy that included the implementation of a comprehensive primary health care (PHC) strategy. This study aims to identify the enablers and barriers to the PHC implementation in Bogota. METHODS: The study used a qualitative multiple case study methodology. Seven Bogota's localities were included. Eighteen semi-structured interviews with key informants (decision-makers at each locality and members of the District Health Secretariat) and fourteen FGDs (one focus group with staff members and one with community members) were carried out. Data were analysed using a thematic analysis approach. RESULTS: The main enablers found across the district and local levels showed a similar pattern, all were related to the good will and commitment of actors at different levels. Barriers included the approach of the national policies and a health system based on neoliberal principles, the lack of a stable funding source, the confusing and rigid guidelines, the high turnover of human resources, the lack of competencies among health workers regarding family focus and community orientation, and the limited involvement of institutions outside the health sector in generating intersectoral responses and promoting community participation. CONCLUSION: Significant efforts are required to overcome the market approach of the national health system. Interventions must be designed to include well-trained and motivated human resources, as well as to establish available and stable financial resources for the PHC strategy.
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| 32. |
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| 33. |
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| 34. |
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| 35. |
- Tolestam Heyman, Ellen, 1969, et al.
(författare)
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Likelihood of admission to hospital from the emergency department is not universally associated with hospital bed occupancy at the time of admission
- 2021
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Ingår i: International Journal of Health Planning and Management. - : Wiley. - 0749-6753 .- 1099-1751. ; 36:2, s. 353-363
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Tidskriftsartikel (refereegranskat)abstract
- Background The decision to admit into the hospital from the emergency department (ED) is considered to be important and challenging. The aim was to assess whether previously published results suggesting an association between hospital bed occupancy and likelihood of hospital admission from the ED can be reproduced in a different study population. Methods A retrospective cohort study of attendances at two Swedish EDs in 2015 was performed. Admission to hospital was assessed in relation to hospital bed occupancy together with other clinically relevant variables. Hospital bed occupancy was categorized and univariate and multivariate logistic regression were performed. Results In total 89,503 patient attendances were included in the final analysis. Of those, 29.1% resulted in admission within 24 h. The mean hospital bed occupancy by the hour of the two hospitals was 87.1% (SD 7.6). In both the univariate and multivariate analysis, odds ratio for admission within 24 h from the ED did not decrease significantly with an increasing hospital bed occupancy. Conclusions A negative association between admission to hospital and occupancy level, as reported elsewhere, was not replicated. This suggests that the previously shown association might not be universal but may vary across sites due to setting specific circumstances.
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| 36. |
- Wennman, Ingela, et al.
(författare)
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Urgent care centre in Sweden-the integration of teams and perceived effects.
- 2019
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Ingår i: The International journal of health planning and management. - : Wiley. - 1099-1751 .- 0749-6753.
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Tidskriftsartikel (refereegranskat)abstract
- An urgent care centre (UCC) is an upcoming trend in Swedish health care. Although UCCs have been established in other countries, their effectiveness and value have not yet been studied in Sweden. The aim of this study was to investigate the interaction between the UCC and emergency department (ED) by using validated evaluation models. One adult ED (AED) and one child ED (CED), together with a newly established UCC nearby, were included in this study. The interaction between the UCC team and the ED teams was studied by using two evaluation models: one for evaluation of integration and the other one for the evaluation of the effects, in terms of perceived relief of the ED after the establishment of the UCC. It was evident that integration was achieved early on in the course of the follow-up. However, the perception of integration varied between low (EDs) and high collaboration (UCC). All respondents of the EDs indicated relief, in terms of pace and pressure on the ED since the UCC was established. This study indicates that the grade of integration and collaboration between UCC and ED can be achieved automatically and very early during the establishment. It also shows that UCCs can be a competent complement to EDs and alleviate some of the heavy pressure placed on EDs due to ED overcrowding.
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| 37. |
- Wihlman, Ulla, et al.
(författare)
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Organizing vocational rehabilitation through interorganizational integration : a case study in Sweden
- 2011
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Ingår i: International Journal of Health Planning and Management. - : Wiley. - 0749-6753 .- 1099-1751. ; 26:3, s. E169-E185
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Tidskriftsartikel (refereegranskat)abstract
- This study describes and analysis five years of experiences from organising an interorganisational project on vocational rehabilitation. A qualitative case study approach was used based on interviews, focus group discussions and documents. The aim was to analyse how and why the project was organised in the way it was in relation to theories of integration, organisational change and learning. The results show that the vocational rehabilitation project was initiated mainly for financial reasons. It was organised as a mechanistic system with the aim of producing different activities, where financial control and support from all the levels of the organisations involved was important. A new bureaucracy between the different authorities involved was built up, where the vertical (top-down) integration was more important than the horizontal. The result was scattered islands of interprofessional work in different teams, but without contacts between them. The project did not influence the processes or workflows of the organisations involved in the project, which would be important from a service-user perspective. It may therefore be questionnable to organise the development of interorganisational integration for vocational rehabilitation in a separate project organisation. Instead, interorganisational networks with focus on interconnections of processes and workflows may be more flexible and adaptable. Copyright (C) 2010 John Wiley & Sons, Ltd.
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| 38. |
- Zhang, Luying, et al.
(författare)
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Balancing the funds in the New Cooperative Medical Scheme in rural China : determinants and influencing factors in two provinces
- 2010
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Ingår i: International Journal of Health Planning and Management. - 0749-6753 .- 1099-1751. ; 25:2, s. 96-118
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Tidskriftsartikel (refereegranskat)abstract
- In recent years, the central government in China has been leading the re-establishment of itsrural health insurance system, but local government institutions have considerable flexibility inthe specific design and management of schemes. Maintaining a reasonable balance of funds iscritical to ensure that the schemes are sustainable and effective in offering financial protectionto members. This paper explores the financial management of the NCMS in China through acase study of the balance of funds and the factors influencing this, in six counties in twoChinese provinces. The main data source is NCMS management data from each county from2003 to 2005, supplemented by: a household questionnaire survey, qualitative interviews andfocus group discussions with all local stakeholders and policy document analysis. The studyfound that five out of six counties held a large fund surplus, whilst enrolees obtained onlypartial financial protection. However, in one county greater risk pooling for enrolees wasaccompanied by relatively high utilisation levels, resulting in a fund deficit. The opportunitiesto sustainably increase the financial protection offered to NCMS enrolees are limited by thefinancial pressures on local government, specific political incentives and low technicalcapacities at the county level and below. Our analysis suggests that in the short term, effortsshould be made to improve the management of the current NCMS design, which shouldbe supported through capacity building for NCMS offices. However, further medium-terminitiatives may be required including changes to the design of the schemes.
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| 39. |
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| 40. |
- 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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| 41. |
- Åhgren, Bengt, et al.
(författare)
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Is choice of care compatible with integrated health care? : an exploratory study in Sweden
- 2012
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Ingår i: International Journal of Health Planning and Management. - 0749-6753 .- 1099-1751. ; 27:3, s. e162-e172
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Tidskriftsartikel (refereegranskat)abstract
- 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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| 42. |
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| 43. |
- Gerdtham, UG, et al.
(författare)
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Redistributive effects of Swedish health care finance
- 1998
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Ingår i: International Journal of Health Planning and Management. - : JOHN WILEY & SONS LTD. - 0749-6753. ; 13:4, s. 289-306
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Tidskriftsartikel (refereegranskat)abstract
- This paper investigates the redistributive effects of the Swedish health care financing system in 1980 and 1990 for four different financial sources: county council taxes, payroll taxes, direct payments and state grants. The redistributive effects are dec
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| 44. |
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| 45. |
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| 46. |
- Ovretveit, J
(författare)
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Nordic privatization and private healthcare
- 2003
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Ingår i: The International journal of health planning and management. - : Wiley. - 0749-6753. ; 18:3, s. 233-246
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Tidskriftsartikel (refereegranskat)
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| 47. |
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| 48. |
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| 49. |
- Lindström-Sandahl, Hanna, 1979-, et al.
(författare)
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Effects of a phonics intervention in a randomized controlled study in Swedish second-grade students at risk of reading difficulties
- 2023
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Ingår i: Dyslexia. - : John Wiley & Sons. - 1076-9242 .- 1099-0909. ; 29:4, s. 290-311
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Tidskriftsartikel (refereegranskat)abstract
- Teaching phoneme awareness to children at risk for early reading difficulties has been recognized as successful in several studies. In this randomized controlled trial (RCT)-study, we add to this research by optimizing core procedural as well as teaching components in a phonics-directed intervention and extend the RCT reading intervention research into a semi-transparent language context. The aim of the present study was to evaluate the effects of a novel Swedish intensive phonics program. This randomized controlled pre-test and post-test intervention study targeted second-grade students with early reading difficulties. Students were identified by a repeated screening procedure and allocated to intervention (n = 34) and control (n = 34) conditions. A 9-week intensive phonics-based program was administrated one-to-one, by special education teachers in Swedish mainstream elementary schools. Results show an improvement in the intervention group, compared with the controls on all outcome measures. Findings indicate that the supplementary phonics program, delivered with high intensity, can significantly increase word reading skills and reading comprehension in second-grade students with early reading difficulties.
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