Garpenby P
Centre for Medical Technology Assessment, Linköping University, Sweden.
Health Policy. 1997 Mar;39(3):195-206. doi: 10.1016/s0168-8510(96)00880-9.
This articles deals with quality assurance within the Swedish health care system at the regional and local levels. The overriding issue concerns the degree to which changes in Swedish health care in recent years with respect to increased freedom of choice for the individual, the purchaser-provider split and new forms of financial reimbursement have affected quality assurance. Special attention is directed toward the relationship between the political-administrative level in the county councils and the medical profession at the local level. Since political responsibility for health care is strongly decentralized and different organizational solutions can be found, Sweden offers a good opportunity for systematic comparisons within the health care sector. Following an overview of certain national initiatives with regard to the quality of health care, three Swedish county councils are compared. The aim is not to provide a general overview of the situation in Sweden with regard to quality assurance, but to compare the strategies and outcomes in county councils with different organizational configurations. The study is based on 35 interviews conducted in 1995 with health care politicians, health care administrators, hospital directors and clinical department heads. The article concludes that indirect incentives can be very strong factors in affecting care providers' active interest in quality assurance. This interest is aroused when providers feel they are in competition in that the number of patients decreases, or in that their activities are being called into question, such as in the form of discussions about possible structural changes in the county council.
本文探讨瑞典医疗保健系统在区域和地方层面的质量保证问题。首要问题是近年来瑞典医疗保健在个人选择自由度增加、购买者与提供者分离以及新的财务报销形式等方面的变化对质量保证产生了多大影响。特别关注郡议会的政治行政层面与地方医疗行业之间的关系。由于医疗保健的政治责任高度分散且存在不同的组织解决方案，瑞典为医疗保健部门内的系统比较提供了良好机会。在概述了瑞典在医疗保健质量方面的某些国家举措之后，对三个瑞典郡议会进行了比较。目的不是全面概述瑞典质量保证的情况，而是比较具有不同组织配置的郡议会的策略和成果。该研究基于1995年对医疗保健领域的政治家、医疗保健管理人员、医院院长和临床部门负责人进行的35次访谈。文章得出结论，间接激励可能是影响医疗服务提供者对质量保证积极兴趣的非常重要的因素。当提供者感到他们处于竞争之中，比如患者数量减少，或者他们的活动受到质疑，例如以郡议会可能进行结构调整的讨论形式时，这种兴趣就会被激发。
