Korlén Sara, Amer-Wåhlin Isis, Lindgren Peter, von Thiele Schwarz Ulrica
Department of Learning Informatics Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
Health Serv Manage Res. 2017 Aug;30(3):148-155. doi: 10.1177/0951484817708941. Epub 2017 May 16.
Implementation of market-inspired competition and incentive models in health care is increasing worldwide, assumed to drive efficiency. However, the evidence for effects is mixed and unintended consequences have been reported. There is a need to better understand the practical consequences of such reforms. The aim of the present case study is to explore what consequences of a Swedish market-inspired patient choice reform professionals identify as relevant, and why. The study was designed as an explorative qualitative study in specialized orthopedics. Nineteen interviews were conducted with health care professionals at different providers. Data were analyzed using a hypo-deductive thematic approach. Consequences for the organization of care, patients, work environment, education and research were included in the professionals' analyses, covering both the perspective of their own organization and that of the health care system as a whole. In sum, the professionals provided multiple-level analyses that extended beyond the responsibilities of their own organization. Concluding, professionals are a valuable source of knowledge when evaluating policy reforms. Their analyses can contribute by covering a broad system perspective, serving as a guiding light to areas beyond the most obvious evaluation measures that should be included in more formal evaluations.
医疗保健领域中受市场启发的竞争和激励模式在全球范围内日益增多，人们认为这能提高效率。然而，关于其效果的证据并不一致，且已报道存在意外后果。有必要更好地理解此类改革的实际后果。本案例研究的目的是探讨瑞典受市场启发的患者选择改革的哪些后果被专业人员视为相关的，以及原因。该研究被设计为针对专科骨科的探索性定性研究。对不同医疗机构的医护人员进行了19次访谈。使用假设演绎主题分析法对数据进行了分析。医护人员的分析中包括了对护理组织、患者、工作环境、教育和研究的影响，涵盖了他们自身组织以及整个医疗保健系统的视角。总之，专业人员提供了超出其自身组织职责范围的多层次分析。结论是，在评估政策改革时，专业人员是宝贵的知识来源。他们的分析可以通过涵盖广泛的系统视角做出贡献，为超出更正式评估中应包括的最明显评估措施的领域提供指导。
