Garpenby Peter, Nedlund Ann-Charlotte
The National Centre for Priority Setting in Health Care, Department of Medical and Health Sciences, Linköping University, SE-581 83 Linköping, Sweden.
The National Centre for Priority Setting in Health Care, Department of Medical and Health Sciences, Linköping University, SE-581 83 Linköping, Sweden; National Institute for the Study of Ageing and Later Life, Department of Social and Welfare Studies, Linköping University, SE-581 83 Linköping, Sweden.
Soc Sci Med. 2016 Aug;163:63-70. doi: 10.1016/j.socscimed.2016.06.046. Epub 2016 Jun 28.
This paper contributes to the knowledge on the governing of healthcare in a democratic context in times of austerity. Resource allocation in healthcare is a highly political issue but the political nature of healthcare is not always made clear and the role of politicians is often obscure. The absence of politicians in rationing/disinvestment arrangements is usually explained with blame-shifting arguments; they prefer to delegate "the burden of responsibility" to administrative agencies or professionals. Drawing on a case where Swedish regional politicians involved themselves in setting priorities at a more detailed level than previously, the findings suggest that the subject of "blame avoidance" is more complicated than usually assumed. A qualitative case study was designed, involving semi-structured interviews with 14 regionally elected politicians in one Swedish health authority, conducted in June 2011. The interviews were analysed through a thematic analysis in accordance with the "framework approach" by Ritchie and Lewis. Findings show that an overarching strategy among the politicians was to appear united and to suppress conflict, which served to underpin the vital strategy of bringing the medical profession into the process. A key finding is the importance that politicians, when appearing "backstage", attach to the prevention of blame from the medical profession. This case illustrates that one has to take into account that priority settings requires various types of skills and knowledges - not only technical but also political and social. Another important lesson points toward the need to broaden the political leadership repertoire, as leadership in the case of priority setting is not about politicians being all in or all out. The results suggest that in a priority-setting process it is of importance to have politics on-board at an early stage to secure loyalty to the process, although not necessarily being involved in all details.
本文有助于增进人们对紧缩时期民主背景下医疗保健治理的认识。医疗保健领域的资源分配是一个高度政治化的问题，但医疗保健的政治性质并不总是清晰明了，政治家的角色也常常模糊不清。政治家在配给/撤资安排中缺席，通常被用推诿责任的论点来解释；他们更愿意将“责任负担”委托给行政机构或专业人员。基于瑞典地方政治家比以往更深入地参与确定优先事项的一个案例，研究结果表明，“避免指责”这一主题比通常认为的更为复杂。我们设计了一项定性案例研究，于2011年6月对瑞典一个卫生当局的14名地方当选政治家进行了半结构化访谈。访谈采用里奇和刘易斯的“框架方法”进行主题分析。研究结果表明，政治家们的一个总体策略是表现出团结并抑制冲突，这有助于巩固将医疗行业纳入这一过程的关键策略。一个关键发现是，政治家们在“幕后”时非常重视避免来自医疗行业的指责。这个案例说明，必须考虑到确定优先事项需要各种技能和知识——不仅是技术方面的，还有政治和社会方面的。另一个重要教训是需要拓宽政治领导能力，因为在确定优先事项的情况下，领导并非意味着政治家要么完全参与要么完全不参与。结果表明，在确定优先事项的过程中，尽早让政治参与进来以确保对该过程的忠诚很重要，尽管不一定参与所有细节。
