Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Box 564, 751 22 Uppsala, Sweden.
Department of Government, Uppsala University, Box 514, 751 20 Uppsala, Sweden.
BMC Health Serv Res. 2020 Jun 3;20(1):501. doi: 10.1186/s12913-020-05328-w.
Drawing on the literature on cutback management, this article deals with healthcare decommissioning in times of austerity. Politicians and decision-makers are typically reluctant to decommission healthcare, and if they do, the public generally reacts strongly towards reductions in service supply. Despite this, comprehensive decommissioning does take place, though empirical knowledge about its effects and economic sustainability is limited. To further the understanding of healthcare decommissioning, this paper aims to introduce the concepts of cutback management into the research on healthcare decommissioning, and apply its components to an empirical case of comprehensive decommissioning. In doing so, the study analyses whether decommissioning measures can be expected to generate long- or short-term economic payoff, and considers what other effects they might have on the healthcare system.
We developed a theoretical framework that enabled us to investigate the measures through which a local healthcare system in Sweden, region Dalarna, responded to an acute fiscal crisis in 2014, and what effects these measures are likely to generate. The method used was a deductive content analysis of Dalarna's decommissioning program, containing 122 austerity measures for saving 700 million Swedish Krona (SEK).
Dalarna's local decision-makers responded to the fiscal crisis through a combination of operational cuts (20% of undertaken measures), programme cuts (42% of undertaken measures), and structural reforms (38% of undertaken measures). The instruments most commonly used were increased patient fees and the merger of service facilities. By relying foremost on programme cuts and structural reforms, Dalarna adopted the measures most plausible to have moderate or long-term economic payoffs. Successful implementation, however, may be challenging and difficult to evaluate.
Healthcare politicians and decision makers have better potential to stabilize their long-term economic situation if they rely on responses such as operational cuts, programme cuts and structural reforms, as opposed to across-the-board cuts and cuts in investment and capital expenditures. However, with economics being only one important factor for sustainable healthcare systems, further studies should investigate how these measures affect important principles, such as equal healthcare distribution and access.
Not applicable.
本文借鉴削减管理文献，探讨了紧缩时期的医疗保健淘汰问题。政治家和决策者通常不愿意淘汰医疗保健，如果他们这样做，公众通常会强烈反对服务供应的减少。尽管如此，全面淘汰还是会发生，尽管关于其效果和经济可持续性的经验知识有限。为了进一步了解医疗保健淘汰，本文旨在将削减管理的概念引入医疗保健淘汰研究，并将其组成部分应用于全面淘汰的实证案例。在这样做的过程中，该研究分析了淘汰措施是否可以预期产生长期或短期的经济回报，并考虑了它们可能对医疗保健系统产生的其他影响。
我们开发了一个理论框架，使我们能够调查瑞典达拉纳地区的医疗系统如何应对 2014 年的急性财政危机，以及这些措施可能产生的影响。我们使用的方法是对达拉纳淘汰计划进行演绎内容分析，该计划包含了 122 项节约 7 亿瑞典克朗（SEK）的紧缩措施。
达拉纳的地方决策者通过运营削减（已采取措施的 20%）、项目削减（已采取措施的 42%）和结构改革（已采取措施的 38%）来应对财政危机。最常使用的工具是增加患者费用和服务设施合并。达拉纳主要依靠项目削减和结构改革，采取了最有可能产生中等或长期经济回报的措施。然而，成功实施可能具有挑战性，并且难以评估。
如果医疗保健政治家和决策者依靠运营削减、项目削减和结构改革等措施来稳定其长期经济状况，而不是一刀切的削减和削减投资和资本支出，他们就有更好的潜力。然而，由于经济学只是可持续医疗保健系统的一个重要因素，因此应该进一步研究这些措施如何影响平等医疗保健分配和获得等重要原则。
不适用。
