Cargando…
Market-orienting reforms in rural health care in Sweden: how can equity in access be preserved?
BACKGROUND: Health care provision in rural and urban areas faces different challenges. In Sweden, health care provision has been predominantly public and equitable access to care has been pursued mainly through public planning and coordination. This is to ensure that health needs are met in the same...
Autores principales: | , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2018
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6098624/ https://www.ncbi.nlm.nih.gov/pubmed/30119665 http://dx.doi.org/10.1186/s12939-018-0819-8 |
_version_ | 1783348515800350720 |
---|---|
author | Kullberg, Linn Blomqvist, Paula Winblad, Ulrika |
author_facet | Kullberg, Linn Blomqvist, Paula Winblad, Ulrika |
author_sort | Kullberg, Linn |
collection | PubMed |
description | BACKGROUND: Health care provision in rural and urban areas faces different challenges. In Sweden, health care provision has been predominantly public and equitable access to care has been pursued mainly through public planning and coordination. This is to ensure that health needs are met in the same manner in all parts of the country, including rural or less affluent areas. However, a marketization of the health care system has taken place during recent decades and the publicly planned system has been partially replaced by a new market logic, where private providers guided by financial concerns can decide independently where to establish their practices. In this paper, we explore the effects of marketization policies on rural health care provision by asking how policy makers in rural counties have managed to combine two seemingly contradictory health policy goals: to create conditions for market competition among health care providers and to ensure equal access to health care for all patients, including those living in rural and remote areas. METHODS: A qualitative case study within three counties in the northern part of Sweden, characterized by vast rural areas, was carried out. Legal documents, the “accreditation documents” regulating the health care quasi-markets in the three counties were analyzed. In addition, interviews with policy makers in the three county councils, representing the political majority, the opposition, and the political administration were conducted in April and May 2013. RESULTS: The findings demonstrate the difficulties involved in introducing market dynamics in health care provision in rural areas, as these reforms not only undermined existing resource allocation systems based on health needs but also undercut attempts by local policy makers to arrange for care provision in remote locations through planning and coordination. CONCLUSION: Provision of health care in rural areas is not well suited for market reforms introducing competition, as this may undermine the goal of equity in access to health care, even in a publicly financed health care system. |
format | Online Article Text |
id | pubmed-6098624 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-60986242018-08-23 Market-orienting reforms in rural health care in Sweden: how can equity in access be preserved? Kullberg, Linn Blomqvist, Paula Winblad, Ulrika Int J Equity Health Research BACKGROUND: Health care provision in rural and urban areas faces different challenges. In Sweden, health care provision has been predominantly public and equitable access to care has been pursued mainly through public planning and coordination. This is to ensure that health needs are met in the same manner in all parts of the country, including rural or less affluent areas. However, a marketization of the health care system has taken place during recent decades and the publicly planned system has been partially replaced by a new market logic, where private providers guided by financial concerns can decide independently where to establish their practices. In this paper, we explore the effects of marketization policies on rural health care provision by asking how policy makers in rural counties have managed to combine two seemingly contradictory health policy goals: to create conditions for market competition among health care providers and to ensure equal access to health care for all patients, including those living in rural and remote areas. METHODS: A qualitative case study within three counties in the northern part of Sweden, characterized by vast rural areas, was carried out. Legal documents, the “accreditation documents” regulating the health care quasi-markets in the three counties were analyzed. In addition, interviews with policy makers in the three county councils, representing the political majority, the opposition, and the political administration were conducted in April and May 2013. RESULTS: The findings demonstrate the difficulties involved in introducing market dynamics in health care provision in rural areas, as these reforms not only undermined existing resource allocation systems based on health needs but also undercut attempts by local policy makers to arrange for care provision in remote locations through planning and coordination. CONCLUSION: Provision of health care in rural areas is not well suited for market reforms introducing competition, as this may undermine the goal of equity in access to health care, even in a publicly financed health care system. BioMed Central 2018-08-17 /pmc/articles/PMC6098624/ /pubmed/30119665 http://dx.doi.org/10.1186/s12939-018-0819-8 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Kullberg, Linn Blomqvist, Paula Winblad, Ulrika Market-orienting reforms in rural health care in Sweden: how can equity in access be preserved? |
title | Market-orienting reforms in rural health care in Sweden: how can equity in access be preserved? |
title_full | Market-orienting reforms in rural health care in Sweden: how can equity in access be preserved? |
title_fullStr | Market-orienting reforms in rural health care in Sweden: how can equity in access be preserved? |
title_full_unstemmed | Market-orienting reforms in rural health care in Sweden: how can equity in access be preserved? |
title_short | Market-orienting reforms in rural health care in Sweden: how can equity in access be preserved? |
title_sort | market-orienting reforms in rural health care in sweden: how can equity in access be preserved? |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6098624/ https://www.ncbi.nlm.nih.gov/pubmed/30119665 http://dx.doi.org/10.1186/s12939-018-0819-8 |
work_keys_str_mv | AT kullberglinn marketorientingreformsinruralhealthcareinswedenhowcanequityinaccessbepreserved AT blomqvistpaula marketorientingreformsinruralhealthcareinswedenhowcanequityinaccessbepreserved AT winbladulrika marketorientingreformsinruralhealthcareinswedenhowcanequityinaccessbepreserved |