Laamanen Ritva, Simonsen-Rehn Nina, Suominen Sakari, Øvretveit John, Brommels Mats
Department of Public Health, University of Helsinki, Helsinki, Finland.
Health Policy. 2008 Dec;88(2-3):294-307. doi: 10.1016/j.healthpol.2008.04.001. Epub 2008 May 22.
To explore outsourcing of primary health care (PHC) services in four municipalities in Finland with varying amounts and types of outsourcing: a Southern municipality (SM) which contracted all PHC services to a not-for-profit voluntary organization, and Eastern (EM), South-Western (SWM) and Western (WM) municipalities which had contracted out only a few services to profit or public organizations.
A mail survey to all municipality politicians (response rate 52%, N=101) in 2004. Data were analyzed using cross-tabulations, Spearman correlation and linear regression analyses.
Politicians were willing to outsource PHC services only partially, and many problems relating to outsourcing were reported. Politicians in all municipalities were least likely to outsource preventive services. A multiple linear regression model showed that reported preference to outsource in EM and in SWM was lower than in SM, and also lower among politicians from "leftist" political parties than "rightist" political parties. Perceived difficulties in local health policy issues were related to reduced preference to outsource. The model explained 27% of the variance of the inclination to outsource PHC services.
The findings highlight how important it is to take into account local health policy issues when assessing service-provision models.
探讨芬兰四个城市初级卫生保健（PHC）服务的外包情况，这四个城市的外包数量和类型各不相同：一个南部城市（SM）将所有初级卫生保健服务承包给了一个非营利性志愿组织，而东部（EM）、西南部（SWM）和西部（WM）城市仅将少数服务外包给了盈利性或公共组织。
2004年对所有城市的政治家进行邮件调查（回复率52%，N = 101）。使用交叉表、斯皮尔曼相关性分析和线性回归分析对数据进行分析。
政治家们仅愿意部分外包初级卫生保健服务，并且报告了许多与外包相关的问题。所有城市的政治家最不愿意外包预防服务。多元线性回归模型显示，EM和SWM中报告的外包偏好低于SM，并且“左翼”政党的政治家比“右翼”政党的政治家外包偏好更低。在当地卫生政策问题上感知到的困难与外包偏好降低有关。该模型解释了初级卫生保健服务外包倾向差异的27%。
研究结果凸显了在评估服务提供模式时考虑当地卫生政策问题的重要性。
