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Consequences of a decentralized healthcare governance model: Measuring regional authority support for patient choice in Sweden

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  • Fredriksson, Mio
  • Winblad, Ulrika

Abstract

What are the implications of a decentralized model of healthcare governance? This case study on patient choice in Sweden is an attempt to shed light on this issue. Due to decentralization and constitutional rights of self-determination, the regional authorities in Sweden, called County Councils (CCs), have far-reaching rights to manage the healthcare sector. The fact that patient choice is considered to be a soft law or a soft governance regulation, opens it up to regional variation. To examine the CCs level of support of patient choice, an index is presented. The Patient Choice Index (PCI) shows that there is extensive variation among the CCs. To explain the causes of these variations, a number of hypotheses are tested. The analyses imply that ideology and economy, and more specifically the CCs' governing majorities and running net profits, are major explanations for the level of support. A number of conclusions can be drawn from the results of this study. In short, the CCs appear to act according to a local point of view, which means that there is no functioning national patient choice standard, and thus patients do not have equal access to healthcare and patients' rights are unevenly distributed. Furthermore, the CCs' financial conditions and governing majorities seem to undermine equivalent reform realization in a national context. In summary, the results of this study emphasize the conflict between regional self-governance and national equality, which is particularly visible in the decentralized Swedish healthcare model.

Suggested Citation

  • Fredriksson, Mio & Winblad, Ulrika, 2008. "Consequences of a decentralized healthcare governance model: Measuring regional authority support for patient choice in Sweden," Social Science & Medicine, Elsevier, vol. 67(2), pages 271-279, July.
    • Handle: RePEc:eee:socmed:v:67:y:2008:i:2:p:271-279
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    References listed on IDEAS

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    1. Vrangbæk, Karsten & Østergren, Katarina, 2006. "Patient empowerment and the introduction of hospital choice in Denmark and Norway," Health Economics, Policy and Law, Cambridge University Press, vol. 1(4), pages 371-394, October.
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    1. Schmid, Hillel & Dolev, Talal & Szabo-Lael, Rachel, 2010. "Community-based programs for children at risk: The case of budget flexibility in Departments of Social Services in Israel," Children and Youth Services Review, Elsevier, vol. 32(2), pages 178-184, February.
    2. Nina Simonsen-Rehn & Ritva Laamanen & Mats Brommels & Sakari Suominen, 2012. "Determinants of effective health promotion actions in local contexts: a study of the perceptions of municipal politicians," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 57(5), pages 787-795, October.
    3. Adolph, Christopher & Greer, Scott L. & Massard da Fonseca, Elize, 2012. "Allocation of authority in European health policy," Social Science & Medicine, Elsevier, vol. 75(9), pages 1595-1603.
    4. Jansson, Elisabeth & Fosse, Elisabeth & Tillgren, Per, 2011. "National public health policy in a local context—Implementation in two Swedish municipalities," Health Policy, Elsevier, vol. 103(2), pages 219-227.
    5. Uddin, Shahzad & Mori, Yuji & Shahadat, Khandakar, 2020. "Private management and governance styles in a Japanese public hospital: A story of west meets east," Social Science & Medicine, Elsevier, vol. 245(C).
    6. Jolanki, Outi & Tynkkynen, Liina-Kaisa, 2018. "Primary health care nurses’ views on patients’ abilities and resources to make choices and take decisions on health care," Health Policy, Elsevier, vol. 122(9), pages 957-962.

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