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The trade-off between choice and equity: Swedish policymakers’ arguments when introducing patient choice
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Government.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
2013 (English)In: Journal of European Social Policy, ISSN 0958-9287, E-ISSN 1461-7269, Vol. 23, no 2, 192-209 p.Article in journal (Refereed) Published
Abstract [en]

How do policymakers deal with the tension between choice and equity in healthcare? An analysis and critical examination of Swedish policymakers' arguments when introducing legislated choice of primary care provider in 2010 shows that even when deciding on a reform with a potentially great impact on distribution of health resources, implications for equity were not systematically addressed. Effects with regards to current patterns of healthcare consumption in the population as well as existing inequalities in health outcomes were not adequately addressed. Neither was the primary are choice reform, which is based on the values of consumerism and individual choice, problematized in relation to current healthcare legislation such as the Health and Medical Services Act. Given that the values of equity and social solidarity have had such a prominent place in Swedish health policy and discourse in past decades, this is a surprising finding. In conclusion, we argue that because inequalities in health constitute one of the main challenges for public health today, the impact of healthcare reforms on equity should receive more attention in policymaking.

Place, publisher, year, edition, pages
2013. Vol. 23, no 2, 192-209 p.
Keyword [en]
choice, equity, Sweden, health policy
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Public Administration Studies
Research subject
Health Care Research
Identifiers
URN: urn:nbn:se:uu:diva-162603DOI: 10.1177/0958928712463158ISI: 000318521200006OAI: oai:DiVA.org:uu-162603DiVA: diva2:461052
Available from: 2011-12-01 Created: 2011-12-01 Last updated: 2017-12-08Bibliographically approved
In thesis
1. Between Equity and Local Autonomy: A Governance Dilemma in Swedish Healthcare
Open this publication in new window or tab >>Between Equity and Local Autonomy: A Governance Dilemma in Swedish Healthcare
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Both national equity in healthcare and the county councils’ local autonomy are important values supported by Swedish law. Politically it is a balancing act; how much freedom should the county councils have and to what extent should healthcare be equal throughout the country? The general aim of this dissertation, concerning political governance in Swedish healthcare, is to investigate the tensional values of national equity and local autonomy in the light of current trends in healthcare governance in Sweden. How is this tension manifested? Four studies are included in the dissertation. These studies show that the Swedish state is becoming more active in governing and regulating healthcare, for example by the use of informative governance and legislation, which increasingly rely on monitoring and evaluation of results that are made public. The findings show that the tension between national equity and local autonomy is manifested in increasing emphasis on national equity – or rather national equivalence – which is interpreted in terms of Swedish healthcare being recentralized. Delivery and financing of healthcare are still the responsibilities of the county councils. Planning and arranging – the setting of the regulatory framework – is increasingly taken over by the central state. Although power seems to be transferred from local level to central level, the county councils’ autonomy is only partially restricted, which means Swedish healthcare is still decentralized. However, if the recentralization process proceeds further, the county councils´ autonomy may be seriously challenged. Another challenge is to maintain or strengthen the procedures for democratic legitimacy through citizen participation at the local level. When local autonomy looses ground, it becomes more difficult to tailor healthcare according to local needs and conditions in the county councils, and decisions are taken at greater distance from the citizens.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. 74 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 731
Keyword
healthcare, health policy, local autonomy, national equity, governance
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-162605 (URN)978-91-554-8239-8 (ISBN)
Public defence
2012-01-26, Museum Gustavianum, Auditorium Minus, Akademigatan 3, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2012-01-03 Created: 2011-12-01 Last updated: 2014-07-08Bibliographically approved

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Fredriksson, MioBlomqvist, PaulaWinblad, Ulrika

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