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Isaksson, David
Publications (10 of 14) Show all publications
Isaksson, D., Blomqvist, P. & Winblad, U. (2018). Privatization of social care delivery –: how can contracts be specified?. Public Management Review, 20(11), 1643-1662
Open this publication in new window or tab >>Privatization of social care delivery –: how can contracts be specified?
2018 (English)In: Public Management Review, ISSN 1471-9037, E-ISSN 1471-9045, Vol. 20, no 11, p. 1643-1662Article in journal (Refereed) Published
Abstract [en]

ABSTRACT

When contracting out services to private actors, public authorities must be able to ensure that the quality of services provided is satisfactory. Therefore, it is important to formulate precise quality requirements, thus making them possible to monitor. 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.

KEYWORDS: Contracting, public procurement, elder care, quality, social services

National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-354473 (URN)10.1080/14719037.2017.1417465 (DOI)
Available from: 2018-06-20 Created: 2018-06-20 Last updated: 2018-09-26Bibliographically approved
Isaksson, D. (2018). Steering health and social care through quasi-markets. (Doctoral dissertation). Uppsala: Acta Universitatis Upsaliensis
Open this publication in new window or tab >>Steering health and social care through quasi-markets
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Municipalities and county councils try a multitude of different strategies when they design and steer health and social care markets to ensure that goals such as quality and equity are met. Depending on the strategies used, different problems arise. The aim of this thesis is to examine how local authorities can design quasi-markets in a way that achieves public goals such as equity and high quality. To answer the aim, four empirical studies were carried out.

The studies show that when designing a market by contracting-out through public procurement, the issues lay primarily at specifying and defining what is meant by quality before a service is privatized. This is especially difficult to do concerning soft areas such as elder- and healthcare. If this is not done properly, it can lead to crucial issues for monitoring quality since the contracting authority cannot hold the provider responsible for delivering an aspect of a service if that aspect is not specified in the contract.

When a market is designed as in the patient choice systems in primary care, it creates a whole other set of difficulties for the local governments. Here, it is not as important to specify quality beforehand in the contracts since quality monitoring is done retrospectively by both the counties themselves as well as the patients who with their choices can monitor quality by punishing providers with poor quality by registering with another provider. Instead, the crucial problem is how to design reimbursement system that will lead to an equal access to health care. In this respect, the county councils utilize different methods. However, despite these measures, the primary care choice reform have led to inequity, both geographical inequity in regards to where new private primary health care centres are located but also, to a larger degree, socio-economic inequity relating to what kind of socio-economic groups of individuals are registered with private PHCCs. In other words, county councils do not manage to fully counteract risk selection behaviour by the design of their reimbursement system which could imply issues with unequal access to health care.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 52
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1473
Keywords
patient choice, contracting, equity, health policy, public procurement, quasi-markets
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Public Administration Studies
Research subject
Health Care Research
Identifiers
urn:nbn:se:uu:diva-354476 (URN)978-91-513-0368-0 (ISBN)
Public defence
2018-09-07, B21, BMC, Husargatan 3, Uppsala, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2018-08-17 Created: 2018-06-20 Last updated: 2018-08-27Bibliographically approved
Isaksson, D., Blomqvist, P. & Winblad, U. (2016). Free establishment of primary health care providers: effects on geographical equity. BMC Health Services Research, 16, Article ID 28.
Open this publication in new window or tab >>Free establishment of primary health care providers: effects on geographical equity
2016 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 16, article id 28Article in journal (Refereed) Published
Abstract [en]

Background

A reform in 2010 in Swedish primary care made it possible for private primary care providers to establish themselves freely in the country. In the former, publicly planned system, location was strictly regulated by local authorities. The goal of the new reform was to increase access and quality of health care. Critical arguments were raised that the reform could have detrimental effects on equity if the new primary health care providers chose to establish foremost in socioeconomically prosperous areas.

The aim of this study is to examine how the primary care choice reform has affected geographical equity by analysing patterns of establishment on the part of new private providers.

Methods

The basis of the design was to analyse socio-economic data on individuals who reside in the same electoral areas in which the 1411 primary health care centres in Sweden are established. Since the primary health care centres are located within 21 different county councils with different reimbursement schemes, we controlled for possible cluster effects utilizing generalized estimating equations modelling. The empirical material used in the analysis is a cross-sectional data set containing socio-economic data of the geographical areas in which all primary health care centres are established.

Results

When controlling for the effects of the county council regulation, primary health care centres established after the primary care choice reform were found to be located in areas with significantly fewer older adults living alone as well as fewer single parents – groups which generally have lower socio-economic status and high health care needs. However, no significant effects were observed for other socio-economic variables such as mean income, percentage of immigrants, education, unemployment, and children <5 years.

Conclusions

The primary care choice reform seems to have had some negative effects on geographical equity, even though these seem relatively minor.

Keywords
Patient choice; Equity; Marketization; Sweden; Primary health care; Geographic location
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-274995 (URN)10.1186/s12913-016-1259-z (DOI)000368550800001 ()26803298 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2016-01-27 Created: 2016-01-27 Last updated: 2018-06-28Bibliographically approved
Winblad, U., Isaksson, D., Josefsson, K. & Olsson, F. (2014). Kvalitetskrav i valfrihetssystem – en analys av förfrågningsunderlagen: en analys av förfrågningsunderlagen. Stockholm: Sveriges kommuner och landsting
Open this publication in new window or tab >>Kvalitetskrav i valfrihetssystem – en analys av förfrågningsunderlagen: en analys av förfrågningsunderlagen
2014 (Swedish)Report (Other academic)
Place, publisher, year, edition, pages
Stockholm: Sveriges kommuner och landsting, 2014. p. 38
Keywords
hemtjänst, förfrågningsunderlag, LOV, lagen om valfrihet, privata utförare
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Public Administration Studies
Research subject
Health Care Research
Identifiers
urn:nbn:se:uu:diva-220682 (URN)
Funder
Swedish Association of Local Authorities and Regions
Available from: 2014-03-19 Created: 2014-03-19 Last updated: 2015-01-07
Winblad, U., Isaksson, D., Josefsson, K. & Olsson, F. (2014). Kvalitetskrav i valfrihetssystem: en analys av förfrågningsunderlag för hemtjänst.
Open this publication in new window or tab >>Kvalitetskrav i valfrihetssystem: en analys av förfrågningsunderlag för hemtjänst
2014 (Swedish)Report (Other academic)
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-270572 (URN)978-91-7585-100-6 (ISBN)
Available from: 2015-12-30 Created: 2015-12-30 Last updated: 2016-02-09Bibliographically approved
Winblad, U. & Isaksson, D. (2013). Geografisk närhet som en förklaring till privatisering.. In: Henrik Jordahl (Ed.), Välfärdstjänster i privat regi.: Framväxt och drivkrafter. (pp. 121-142). Stockholm: SNS förlag
Open this publication in new window or tab >>Geografisk närhet som en förklaring till privatisering.
2013 (Swedish)In: Välfärdstjänster i privat regi.: Framväxt och drivkrafter. / [ed] Henrik Jordahl, Stockholm: SNS förlag , 2013, p. 121-142Chapter in book (Refereed)
Place, publisher, year, edition, pages
Stockholm: SNS förlag, 2013
National Category
Public Administration Studies
Identifiers
urn:nbn:se:uu:diva-240447 (URN)978-91-86949-47-1 (ISBN)
Available from: 2015-01-07 Created: 2015-01-07 Last updated: 2015-01-07
Winblad, U., Dahlberg, M., Elinder, M., Isaksson, D., Jordahl, H., Lindbom, A., . . . Öhrvall, R. (2013). Inledning. In: Henrik Jordahl (Ed.), Välfärdstjänster i privat regi.: Framväxt och drivkrafter (pp. 21-32). Stockholm: SNS förlag
Open this publication in new window or tab >>Inledning
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2013 (Swedish)In: Välfärdstjänster i privat regi.: Framväxt och drivkrafter / [ed] Henrik Jordahl, Stockholm: SNS förlag , 2013, p. 21-32Chapter in book (Refereed)
Place, publisher, year, edition, pages
Stockholm: SNS förlag, 2013
National Category
Social Sciences Public Administration Studies
Identifiers
urn:nbn:se:uu:diva-240435 (URN)978-91-86949-47-1 (ISBN)
Available from: 2015-01-07 Created: 2015-01-07 Last updated: 2015-01-07
Dahlberg, M., Elinder, M., Isaksson, D., Jordahl, H., Lindbom, A., Lundqwist, H., . . . Öhrvall, R. (2013). Slutsaster.. In: Henrik Jordahl (Ed.), Välfärdstjänster i privat regi.: Framväxt och drivkrafter. (pp. 221-230). Stockholm: SNS förlag
Open this publication in new window or tab >>Slutsaster.
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2013 (Swedish)In: Välfärdstjänster i privat regi.: Framväxt och drivkrafter. / [ed] Henrik Jordahl, Stockholm: SNS förlag , 2013, p. 221-230Chapter in book (Refereed)
Place, publisher, year, edition, pages
Stockholm: SNS förlag, 2013
National Category
Public Administration Studies
Identifiers
urn:nbn:se:uu:diva-240467 (URN)978-91-86949-47-1 (ISBN)
Available from: 2015-01-07 Created: 2015-01-07 Last updated: 2015-01-07
Winblad, U., Isaksson, D. & Bergman, P. (2012). Effekter av valfrihet inom hälso- coh sjukvård: en kartläggning av kunskapsläget. Stockholm: Myndigheten för vårdanalys
Open this publication in new window or tab >>Effekter av valfrihet inom hälso- coh sjukvård: en kartläggning av kunskapsläget
2012 (Swedish)Report (Other academic)
Place, publisher, year, edition, pages
Stockholm: Myndigheten för vårdanalys, 2012. p. 176
Series
Myndigheten för vårdanalys ; 2012:2
Keywords
Valfrihet, hälso- och sjukvård, new public management, reformer, styrning
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-179961 (URN)9789187213014 (ISBN)
Available from: 2012-08-27 Created: 2012-08-27 Last updated: 2012-08-29Bibliographically approved
Blomqvist, P., Winblad, U. & Isaksson, D. (2010). Analysis of contracts in Swedish elder care: can quality aspects be monitored? Arbetsrapport 2010:2.
Open this publication in new window or tab >>Analysis of contracts in Swedish elder care: can quality aspects be monitored? Arbetsrapport 2010:2
2010 (English)Other (Other (popular science, discussion, etc.))
Identifiers
urn:nbn:se:uu:diva-148978 (URN)
Projects
Äldreomsorg på entreprenad: hur bevakas kvaliteten?
Available from: 2011-03-14 Created: 2011-03-14
Organisations

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