The reorientation of market-oriented reforms in Swedish health-care

Harrison, Michael I.; Calltorp, J

doi:10.1016/s0168-8510(99)00060-3

Cited by 54 publications

(55 citation statements)

References 19 publications

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“…Hospital mergers were popular in the mid1990s [17]. At the same time, negotiations to merge county councils started in the south and west of Sweden.…”

Section: Changes In the Organisation And Funding Of The Systemmentioning

confidence: 99%

Swedish healthcare under pressure

Anell

2005

Health Econ.

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Swedish health care, run by local governments at both the regional (county) and the municipal levels, has been under pressure during the last 15 years, following increased scrutiny of performance and demand for cost-containment. Health-care expenditures per capita and levels of resource inputs have grown, but more slowly than in other EU countries. At the same time, the number of elderly people has increased, as have options for medical treatment. In the late 1980s, several local governments referred to long waiting-lists for elective treatment and anecdotal evidence of inefficiency and poor responsiveness when arguing for market-oriented reforms. A purchaser-provider split followed, and so did changes in the payment systems for health-care providers. According to the available evidence, these reforms yielded an increased volume of services in the short run; but traditional hierarchical management soon replaced the new incentives. Moreover, evidence suggests that changes introduced by the national government, and the deteriorating funding conditions together with a continued use of new medical technology, have had more far-reaching effects on health-care output and outcome than local-government reforms.

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“…Hospital mergers were popular in the mid1990s [17]. At the same time, negotiations to merge county councils started in the south and west of Sweden.…”

Section: Changes In the Organisation And Funding Of The Systemmentioning

confidence: 99%

Swedish healthcare under pressure

Anell

2005

Health Econ.

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“…Several counties, however, chose to keep the changed arrangements already in place, and even to continue further implementation. 35,43 A.2. The Current Reform Starting in 2007, five separate county councils sought to strengthen their primary care system by introducing increased patient choice of private as well as publicly managed primary care providers, 40 adopting an organizational approach that was broadly consistent with Reform model/pattern #3 above.…”

Section: Two Provider-side Cases Studiesmentioning

confidence: 99%

Governance, Government, and the Search for New Provider Models

Saltman

Antonio²

2015

Int J Health Policy Manag

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A central problem in designing effective models of provider governance in health systems has been to ensure an appropriate balance between the concerns of public sector and/or government decision-makers, on the one hand, and of non-governmental health services actors in civil society and private life, on the other. In tax-funded European health systems up to the 1980s, the state and other public sector decision-makers played a dominant role over health service provision, typically operating hospitals through national or regional governments on a command-and-control basis. In a number of countries, however, this state role has started to change, with governments first stepping out of direct service provision and now de facto pushed to focus more on steering provider organizations rather than on direct public management. In this new approach to provider governance, the state has pulled back into a regulatory role that introduces market-like incentives and management structures, which then apply to both public and private sector providers alike. This article examines some of the main operational complexities in implementing this new governance reality/strategy, specifically from a service provision (as opposed to mostly a financing or even regulatory) perspective. After briefly reviewing some of the key theoretical dilemmas, the paper presents two case studies where this new approach was put into practice: primary care in Sweden and hospitals in Spain. The article concludes that good governance today needs to reflect practical operational realities if it is to have the desired effect on health sector reform outcome.

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“…Artikel I och II tar upp landstingens politiska reformer och kvalitetsmodeller som utvecklades i en strävan mot mål-och resultatstyrning. Detta innebar att nya styrningsprinciper i enlighet med den förvaltningspoli-tiska idéströmning som samlas i begreppet "New Public Management" (NPM) successivt infördes i hälso-och sjukvården (Christensen & Laegreid, 2001;Blomqvist & Rothstein, 2000;Harrison & Calltorp, 2000). Nu möttes den medicinska professionen av nya styrningsideal dominerade av ett ekonomiskt språkbruk, vilket förstärkte den underliggande spänningen mellan politik och profession.…”

Section: Managementidéer Får Genomslagunclassified

Mellan kunskap och politik : Kvalitetssystem och offentlig kunskapsstyrning i hälso- och sjukvården

Örnerheim¹

2016

Linköping Studies in Arts and Sciences

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The reorientation of market-oriented reforms in Swedish health-care

Cited by 54 publications

References 19 publications

Swedish healthcare under pressure

Swedish healthcare under pressure

Governance, Government, and the Search for New Provider Models

Mellan kunskap och politik : Kvalitetssystem och offentlig kunskapsstyrning i hälso- och sjukvården

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