Wide Jessika, Feltenius David
Department of Political Science, Umeå University, Umeå, Sweden.
J Health Organ Manag. 2025 Jun 24;39(9):344-359. doi: 10.1108/JHOM-12-2024-0527.
In Sweden, a decentralized unitary state, the 21 self-governing regions are responsible for healthcare. A governing tool in the relations between the central government and the regions is the use of "national agreements". The literature describes agreements as soft policy instruments, meaning they are voluntary, non-binding and lack detail. Our purpose is to analyse the content of national agreements in Swedish healthcare to explore their characteristics.
DESIGN/METHODOLOGY/APPROACH: We use document analysis to investigate whether the content of the national agreements in Swedish healthcare is primarily general or specific in terms of stated goals, measures, disbursement and review. The analysis includes eight agreements from 2022.
The content varies in specificity and detail across agreements in healthcare, some being specific while others are more general and broadly formulated. An important conclusion is that agreements within the same policy area can have different characteristics. Agreements are inherently "soft", but with potential variations in their application and consequences.
ORIGINALITY/VALUE: Due to their high level of detail and scope, agreements may pose a challenge to the principle of regional self-government. This could limit the regions' discretion to set their own priorities and make necessary adjustments, ultimately impacting both efficiency and accountability within healthcare.
在瑞典这个权力分散的单一制国家，21个自治地区负责医疗保健。中央政府与各地区之间关系的一种治理工具是使用“国家协议”。文献将协议描述为软性政策工具，这意味着它们是自愿性的、无约束力的且缺乏细节。我们的目的是分析瑞典医疗保健领域国家协议的内容，以探究其特点。
设计/方法/途径：我们采用文献分析来调查瑞典医疗保健领域国家协议在既定目标、措施、支出和审查方面的内容主要是笼统的还是具体的。分析涵盖了2022年的八项协议。
医疗保健领域各项协议的内容在具体程度和细节方面各不相同，有些协议较为具体，而有些则更为笼统且表述宽泛。一个重要结论是，同一政策领域内的协议可能具有不同特点。协议本质上是“软性的”，但其应用和后果可能存在差异。
原创性/价值：由于协议的详细程度和范围较高，可能对地区自治原则构成挑战。这可能会限制各地区确定自身优先事项并做出必要调整的自由裁量权，最终影响医疗保健领域的效率和问责制。
