Joint organisation: the key to improved efficiency in medical rehabilitation in primary and community care

BACKGROUND: Swedish health care is decentralised to regional and local providers. Through the Health Act from 1992 counties and communities have mutual responsibilities for medical rehabilitation. However, the limits of responsibilities are not well described in the law, and have to be worked out in regional and local agreements. Negotiations have often been protracted and in addition, parallel organisations with similar competences have been established in several regions increasing the total costs. THE PROJECT: In Lidköping a three years project was launched in 2005 with a common organisation for medical rehabilitation including the responsibilities for primary and community care. Technically the municipality has taken the full responsibility and all personnel is transferred to the community as employer with appropriate financial support from the county. A total of 50 persons with different professions are involved in the joint organisation covering all kinds of medical rehabilitation including technical aid. ASSESSMENT: The project has been assessed during the ongoing process with qualitative and quantitative methods. Common premises and documentation system, one single budget, in addition to less doubling of activities has decreased the costs and improved the service level. In interviews the common view has been that problems related to division of responsibilities between providers have been reduced. The project is still characterised by a pioneer spirit, and several details need to be worked out. The positive attitude seems to be in part supported by extensive involvement by the personnel in the planning procedure, and a whole-hearted support from the political and administrative management. THE FUTURE: A summary assessment is planned for spring 2008. The expectations are that this project will be turned into an exemplary permanent organisation of integrated care for medical rehabilitation.