Still ‘skiing their own race’ on New Public Management implementation? Patient choice and policy change in the Finnish and Swedish health-care systems

Abstract

This article applies an agenda-setting approach to the impact of New Public Management on health-care reform in Sweden and Finland (1993–2016). A system-level view of agenda setting and New Public Management implementation is used to order the historical data derived from literature reviews of each health reform process. New Public Management is viewed as a hybrid concept rooted in the search for efficiency gains and cost containment but, here, generating system preservation and system change strategies, characterised as ‘public competition’ and ‘choice and marketisation’. Sweden and Finland are viewed as ‘pragmatic modernisers’ in the public management literature. Health-care system reform in each country was based on similar problems and similar policy ‘solutions’, and was promoted by similar actors, while the implementation of choice and marketisation again saw windows of opportunity open in a similar manner in each. Policy divergence nevertheless occurred. We identify three key reasons for this, relating to the site and pervasiveness of conflict, the impact of party systems, and administrative openness to outside ideas. Sweden’s conflictual politics produced stalemate while consensual Finland produced radical policy change. Point for practitioners • Finland and Sweden wanted to modernise rather than overturn the traditional welfare settlement with New Public Management implementation. • Similar policy problems emerged and similar solutions were forwarded, often by similar actors and for similar reasons. • In both countries, powerful centre-right government correlates with the promotion of fundamental ‘choice and marketisation’ policies. • National differences in New Public Management implementation remain.

Patient education in the hospital-at-home care context

“…Fragmented or unsatisfactory education can also result in misunderstandings, extra care visits or calls to healthcare staff, severe complications, rising healthcare service costs, or worse; all of which are contrary to the aims underlying social-and healthcare reforms. 1,7…”

“…Economic constraints, demographic ageing, and the rising cost of healthcare services have led globally to the need for social-and healthcare reforms in many countries. 1 The trend toward caring for somatic, psychiatric and palliative care patients in their homes, when possible, has emerged in Northern Europe, North America and other parts of world during the past two decades. Hospital-at-home (HAH) care, through which patients of all ages and life situations receive care, requires systematic patient education.…”

How does the distribution of work tasks among home care personnel relate to workload and health-related quality of life?

“…In Sweden, political reforms since the 1990s have resulted in a choice-based health and welfare system with both public- and private-sector providers. Based on the principles of New Public Management, these reforms were intended to move the labour market in a more service-oriented direction (Smith and Rauhut 2019 ), presumably leading to more cost-effective health and social care (Andersson and Kvist 2015 ). As a consequence of the community care reform of 1992 (commonly known as Ädelreformen ) (Szebehely and Trydegård 2012 ), there has been a notable shift from hospital-based healthcare towards care provided in patients’ own homes.…”