Consequences of a decentralized healthcare governance model: Measuring regional authority support for patient choice in Sweden

National public health policy in a local context—Implementation in two Swedish municipalities

“…If a policy is comprehensive, requires substantial organizational changes, and is not legally binding, it is even more complicated for influence to be exerted at national level [15]. Without legislation, the government does not have the same responsibilities or opportunities with regard to determining whether any such policy has been right or wrong [33].…”

“…Implementation of the policy at local level paves the way for a wide range of locally interpreted, formulated and implemented policies [15]. What capacities does the national government have to achieve homogenously in all municipalities?…”

“…In other words, these are policies that are relatively easy to implement, by contrast with those in other objective domains. If, instead, a policy addresses an area dependent on wide cooperation and flexibility, it risks conflict between different levels of governance; in such case, a national governing body might choose soft laws as a governing tool [15]. In the Swedish multilevel system of governance, with its self-governing municipalities, enhanced scope for local action offers an opportunity for communities to shape their own politics and policies.…”

“…In a study of free patient choice of hospitals in Sweden, Fredriksson and Winblad [15] conclude that the decentralised model results in a lack of homogeneity in rules and regulations. The system of multi-governance and decentralisation makes it difficult for national government to have a strong influence on the implementation of policies.…”

Mellan kunskap och politik : Kvalitetssystem och offentlig kunskapsstyrning i hälso- och sjukvården

“…För att patienter ska kunna göra meningsfulla val behöver de tillgång till information om vårdkvaliteten hos de olika utförarna (Fredriksson & Winblad, 2008). Utvecklingen av kvalitetssystem och kvalitetsindikatorer bidrar där-med till denna institutionella omvandling mot en ökad transparens.…”