Anna Hallberg, Ulrika Winblad and Mio Fredriksson
The build-up of large-scale COVID-19 testing required an unprecedented effort of coordination within decentralized healthcare systems around the world. The aim of the study was to…
Abstract
Purpose
The build-up of large-scale COVID-19 testing required an unprecedented effort of coordination within decentralized healthcare systems around the world. The aim of the study was to elucidate the challenges of vertical policy coordination between non-political actors at the national and regional levels regarding this policy issue, using Sweden as our case.
Design/methodology/approach
Interviews with key actors at the national and regional levels were analyzed using an adapted version of a conceptualization by Adam et al. (2019), depicting barriers to vertical policy coordination.
Findings
Our results show that the main issues in the Swedish context were related to parallel sovereignty and a vagueness regarding responsibilities and mandates as well as complex governmental structures and that this was exacerbated by the unfamiliarity and uncertainty of the policy issue. We conclude that understanding the interaction between the comprehensiveness and complexity of the policy issue and the institutional context is crucial to achieving effective vertical policy coordination.
Originality/value
Many studies have focused on countries’ overall pandemic responses, but in order to improve the outcome of future pandemics, it is also important to learn from more specific response measures.
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Sofie Vengberg, Mio Fredriksson, Bo Burström, Kristina Burström and Ulrika Winblad
Payments to healthcare providers create incentives that can influence provider behaviour. Research on unit-level incentives in primary care is, however, scarce. This paper…
Abstract
Purpose
Payments to healthcare providers create incentives that can influence provider behaviour. Research on unit-level incentives in primary care is, however, scarce. This paper examines how managers and salaried physicians at Swedish primary healthcare centres perceive that payment incentives directed towards the healthcare centre affect their work.
Design/methodology/approach
An interview study was conducted with 24 respondents at 13 primary healthcare centres in two cities, located in regions with different payment systems. One had a mixed system comprised of fee-for-service and risk-adjusted capitation payments, and the other a mainly risk-adjusted capitation system.
Findings
Findings suggested that both managers and salaried physicians were aware of and adapted to unit-level payment incentives, albeit the latter sometimes to a lesser extent. Respondents perceived fee-for-service payments to stimulate production of shorter visits, up-coding of visits and skimming of healthier patients. Results also suggested that differentiated rates for patient visits affected horizontal prioritisations between physician and nurse visits. Respondents perceived that risk-adjustments for diagnoses led to a focus on registering diagnosis codes, and to some extent, also up-coding of secondary diagnoses.
Practical implications
Policymakers and responsible authorities need to design payment systems carefully, balancing different incentives and considering how and from where data used to calculate payments are retrieved, not relying too heavily on data supplied by providers.
Originality/value
This study contributes evidence on unit-level payment incentives in primary care, a scarcely researched topic, especially using qualitative methods.
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Inga-Britt Gustafsson, Lars Wallin, Ulrika Winblad and Mio Fredriksson
A local healthcare organisation providing healthcare to 288,000 residents in Sweden struggled with a longstanding budget deficit. Several attempts to overcome the demanding…
Abstract
Purpose
A local healthcare organisation providing healthcare to 288,000 residents in Sweden struggled with a longstanding budget deficit. Several attempts to overcome the demanding financial situation have failed. A decommissioning programme was launched, and two years later, an evaluation indicated positive outcomes. The aim of this study was to explore factors politicians and public servants perceived as enablers to the successful implementation of the programme.
Design/methodology/approach
A deductive content analysis approach using a framework of factors facilitating successful implementation of decommissioning decisions was applied to analyse interviews with 18 informants.
Findings
Important factors were: (1) a review report contributing to the clarity of evidence, which (2) made the clarity of the rationale for change undeniable and (3) strengthened the political support for change. Additional factors were: (4) the strength of executive leadership, (5) the strength of clinical leadership supported by (6) the quality of project management and (7) a cultural and behavioural change seen as an important outcome for the path forward. A way to maximise the potential for a successful implementation of a large-scale decommissioning programme is to build a shared vision and a collaboration grounded in convincing evidence. Include public servants with a clinical background in the executive leadership team to contribute with legitimacy, competence, and trust in the decommissioning programme’s intention.
Originality/value
The paper addresses the limited knowledge of best practices in decommissioning processes and contributes empirical knowledge from a successful case.
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Ulrika Winblad, Karsten Vrangbæk and Katarina Östergren
This paper aims to analyse waiting‐time guarantees in the three Scandinavian countries (Denmark, Norway, and Sweden) and to assess whether their current policy designs have…
Abstract
Purpose
This paper aims to analyse waiting‐time guarantees in the three Scandinavian countries (Denmark, Norway, and Sweden) and to assess whether their current policy designs have strengthened the role of patients in their healthcare systems.
Design/methodology/approach
The paper compares official documents and legislation in the three countries. The main findings are that waiting‐time guarantees have generally empowered patients in the Scandinavian health systems. This empowerment is stronger in Denmark and Norway, where formal waiting‐time guarantee rules are applied, than in Sweden, where the guarantee is based on the “softer” regulatory instrument of agreements. While patients are formally empowered in all three countries, and care providers are gradually adjusting to this situation, it is also clear that the practical conditions for empowering patients are not fully in place. The issue of information dissemination is particularly important.
Research limitations/implications
Assessments are based on current regulatory configurations in the three countries, where the process of adapting and implementing the policies is ongoing. These assessments are based on a comparative analysis of the institutional designs. There is no detailed information on how patients use the waiting‐time guarantee.
Practical implications
It is important to consider carefully the information that patients have available in exercising their right to choose healthcare as well as the incentives for providing such information to them.
Originality/value
This is the first systematic comparison of waiting‐time guarantees in the three countries. It is a starting‐point for further research on the introduction of waiting‐time guarantees in public health systems.
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The purpose of this paper is to outline the conditions for a new service system in healthcare, which will be able to match the available capacity in and between healthcare units…
Abstract
Purpose
The purpose of this paper is to outline the conditions for a new service system in healthcare, which will be able to match the available capacity in and between healthcare units, in order to match the need of care for the patients.
Design/methodology/approach
By drawing on statements from patients, experiences from similar services (a literature review), empirical research into the effects of the reforms on free choice and the care guarantee and a theoretically informed discussion drawing on value‐creation and service productivity, it is claimed that a matching system is needed to be developed.
Findings
As healthcare lacks incentives and structures of matching capacity between various care providers, and for coordinating episodes of care for the patient, the result is management of capacity that is difficult and uncertain for patients. Continuity and coordination during all the healthcare process are seen as important values by patients. It is valuable for patients to be matched in the coordination of contacts with providers and specialists.
Practical implications
Healthcare matching generates the supportive data for innovative service research. For management, it could be applicable in different organisational areas, for patients in their choices of provider and for the providers, when matching the needs for patients. In further research, it would be of value to discuss the barriers of matching.
Originality/value
Outlining the conditions for a service system, healthcare matching, has not been done before.