Bjorvatn Afsaneh, Nilssen Even
SNF - Centre for Applied Research at NHH, Helleveien 30, NO-5045, Bergen, Norway.
Western Norway University of Social Sciences, Møllendalsveien 6, PO Box 7030, Bergen, Norway.
Health Care Anal. 2024 Sep 17. doi: 10.1007/s10728-024-00489-9.
To study hospital physicians' awareness and perceptions of the legal and financial regulations, and their impact on professional discretion regarding equity in access to treatment and quality of care. A sample of 637 physicians in the Norwegian specialist healthcare services selected from a survey conducted by the Institute for Studies of the Medical Profession. The paper investigates how legal and financial policy instruments affect the application of professional discretion regarding the prioritisation of specialist health services. Descriptive statistics and regressions were conducted for the analyses. Compared with financial incentives, legal regulations (laws, priority rules and guidelines) were assessed to be less negative external interventions in the exercise of medical and professional judgement. The empirical analyses revealed a positive tendency in physicians' assessments of the impact of legal regulations on treatment equity and healthcare quality, but negative attitudes towards financial instruments. The variations revealed are attributable to various structural and epistemic features of the legal-bureaucratic and economic models of administration in this area of the welfare state. Legal and financial regulations are imposed to achieve certain social goals and values. The findings of this study can provide further insight for the health authorities in other countries concerning implementation of such regulations in the specialist healthcare services.
研究医院医生对法律和财务规定的认识与看法，以及这些规定对其在治疗可及性公平性和医疗质量方面专业裁量权的影响。从医学职业研究所在挪威专科医疗服务领域开展的一项调查中选取了637名医生作为样本。本文探讨法律和财务政策工具如何影响在专科医疗服务优先级方面专业裁量权的应用。分析采用了描述性统计和回归分析方法。与财务激励措施相比，法律规定（法律、优先规则和指南）在行使医疗和专业判断时被认为是负面影响较小的外部干预。实证分析显示，医生对法律规定对治疗公平性和医疗质量影响的评估呈积极趋势，但对财务工具持消极态度。所揭示的差异可归因于福利国家这一领域法律官僚和经济管理模式的各种结构和认知特征。实施法律和财务规定是为了实现某些社会目标和价值观。本研究结果可为其他国家的卫生当局在专科医疗服务中实施此类规定提供进一步的见解。
