Effektivitet och Kvalitet
Nedan presenterar vi ett antal forskningsprojekt och publikationer som bedrivs av forskare eller forskningsinstitutioner knutna till Forum för Health Policys forskarnätverk.
Making decisions in health care: policy and preferences in Sweden and England
Uppsala University, Department of Public Health and Caring Sciences (Mio Fredriksson)
Who wants to be involved in health care decisions? Comparing preferences for individual and collective involvement in England and Sweden
Författare: Mio Fredriksson, Max Eriksson, Jonathan Tritter (2017)
Short summary: This paper is on patient and public involvement (PPI). We investigated whether preferences for PPI differed between two countries with Beveridge type health systems – Sweden and England. An effective health system that ensures public health must integrate an effective approach to PPI both in individual treatment decisions and shaping local health and social care priorities. To be effective, involvement activities must take into account the variation in the desire for involvement and the implications that this has for equity.
‘Involvement that makes an impact on healthcare: Perceptions of the Swedish public’
Författare: Mio Fredriksson, Max Eriksson, Jonathan Tritter (2017)
Short summary: ‘Participation and influence in society’ is the first of 11 objective domains in Swedish public health policy. The aim of this article is to investigate the views of the Swedish general population on the impact of a range of health participation activities, and whether these views were associated with sociodemographic characteristics. The results suggest people have more confidence in the impact of participating as individual patients rather than collectively and as citizens.
The role of information in choice of provider systems
Uppsala University, Department of Public Health and Caring Sciences (Caroline Hoffstedt)
‘When do people choose to be informed? Predictors of information-seeking in the choice of primary care provider in Sweden’
Författare: Caroline Hoffstedt, Magnus Fredriksson, Håkan Lenhoff and Ulrika Winblad (2018)
Short summary: The aim of this study is to identify under what circumstances individuals seek information when choosing a primary care provider. Overall, the 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. Gender, employment status, place of residence and education level was also significantly associated with information-seeking.
How does the design of the reimbursement systems affect the behavior of primary care providers?
Uppsala University, Department of Public Health and Caring Sciences (David Isaksson)
‘Risk selection in primary care: a cross-sectional fixed effect analysis of Swedish individual data’
Författare: David Isaksson, Paula Blomqvist, Ronnie Pingel, Ulrika Winblad (2017)
Short summary: The aim of this study was to assess socioeconomic differences between patients registered with private and public primary healthcare centres. The results show that there are notable differences in registration patterns, indicating a skewed distribution of patients and health risks between private and public primary healthcare providers. This suggests that risk selection behaviour occurs in the reformed Swedish primary healthcare system, foremost through location patterns.
‘Privatization of social care delivery – how can contracts be specified?’
Författare: David Isaksson, Paula Blomqvist, Ulrika Winblad (2017)
Short summary: In the study, 1,005 quality requirements from public procurements of nursing homes were categorized, and their degree of monitorability assessed. The analysis showed that quality requirements related to ‘soft’ areas such as social activities typically were non-monitorable. The requirements were written in an imprecise, vague manner, thus making it difficult for the local governments to determine whether or not they were met.
‘Market-orienting reforms in rural health care in Sweden: how can equity in access be preserved?’
Författare: Linn Kullberg, Paula Blomqvist och Ulrika Winblad (2018)
Short summary: In this paper, we explore the effects of marketization policies on rural health care provision. The findings demonstrate the difficulties involved in introducing market dynamics in health care provision in rural areas, as these reforms not only undermined existing resource allocation systems based on health needs but also undercut attempts by local policy makers to arrange for care provision in remote locations through planning and coordination.
”Exploring Digital Time Measurement in the Public Sector: Labor Productivity and Service Quality in Home Care”
Författare: Henrik Jordahl and Lovisa Persson (2018)
Short summary: We measure labor productivity in home care using new data from the recent introduction of digital time measurement in Swedish municipalities. By measuring worker utilization (delivered hours as a share of worked hours) we avoid several problems that have plagued previous studies of public sector productivity. The time use measure exposes substantial variation in productivity between home care units, suggesting room for improvement. More productive units deliver a larger share of the hours approved by care managers and have equally satisfied users.
Standardized outcome measures for pregnancy and childbirth, an ICHOM proposal
Författare: Isis Amer-Wåhlin et. al (2018)
Short summary: Value-based health care aims to optimize the balance of patient outcomes and health care costs. To improve value in perinatal care using this strategy, standard outcomes must first be defined. The objective of this work was to define a minimum, internationally appropriate set of outcome measures for evaluating and improving perinatal care with a focus on outcomes that matter to women and their families. We propose a set of outcome measures for evaluating the care that women and infants receive during pregnancy and the postpartum period. While validation and refinement via pilot implementation projects are needed, we view this as an important initial step towards value-based improvements in care.
”Management Practices and the Quality of Primary Care”
Författare: Jannis Angelis, Anna Häger Glenngård and Henrik Jordahl (2017)
Short summary: Using the World Management Survey method, we map and analyse management quality in Swedish primary care centres. On average, private providers have higher management quality than public ones. We also find that centres with a high overall social deprivation among enrolled patients tend to have higher management quality. Regarding quality of care, we find that management quality is positively associated with accessibility, but not with patient reported experience.