Hanning M, Spångberg U W
Department of Health and Caring Sciences, University Hospital Uppsala, S-751 85, Uppsala, Sweden.
Health Policy. 2000 May;52(1):15-32. doi: 10.1016/s0168-8510(00)00060-9.
This article focuses on physicians as implementers of health policy reforms. In 1992, a maximum waiting-time guarantee was introduced in Sweden. Initially the policy was a successful way to come to terms with long waiting times. However, after 2 years the waiting lists started to increase. To understand this development it is important to look at the reactions to the policy among the implementers, i.e. the physicians. Three questions are addressed: Did the implementers understand the intentions and the goals of the reform? Were they able to fulfil the guarantee? And, did they approve of the initiative? The study subjects were chief physicians at the hospital departments involved with the guarantee. Their attitudes towards the policy were ascertained by two surveys. Other material, such as statistics on waiting times, was also used. The study shows that the physicians approved of the guarantee initially. The measures taken in the first years were effective and did not conflict with earlier practice. However, increased demand in combination with economic restraints necessitated new priorities among patient groups. These changes of clinical practice did not coincide with the physicians' professional values and hence they became more critical to the initiative and finally chose to abandon the intentions in the guarantee.
本文聚焦于医生作为卫生政策改革的实施者。1992年，瑞典引入了最长等待时间保障措施。最初，该政策是应对长时间等待的一种成功方式。然而，两年后等待名单开始增加。为理解这一发展情况，审视实施者（即医生）对该政策的反应很重要。本文探讨了三个问题：实施者是否理解改革的意图和目标？他们能否实现保障措施？以及，他们是否认可该举措？研究对象是参与保障措施的医院科室主任。通过两项调查确定了他们对该政策的态度。还使用了其他资料，如等待时间统计数据。研究表明，医生最初认可该保障措施。头几年采取的措施有效，且与先前做法不冲突。然而，需求增加与经济限制相结合，使得有必要在患者群体中重新确定优先次序。临床实践的这些变化与医生的职业价值观不一致，因此他们对该举措变得更加挑剔，最终选择放弃保障措施中的意图。
