Formal priority setting in health care: the Swedish experience

Abstract

PurposeFrom the late 1980s and onwards health care in Sweden has come under increasing financial pressure, forcing policy makers to consider restrictions. The aim of this paper is to review experiences and to establish lessons of formal priority setting in four Swedish regional health authorities during the period 2003-2012. Design/methodology/approachThis paper draws on a variety of sources, and evidence is organised according to three broad aspects: design and implementation of models and processes, application of evidence and decision analysis tools, and decision making and implementation of decisions. FindingsThe processes accounted for here have resulted in useful experiences concerning technical arrangements as well as political and public strategies. All four sites used a particular model for priority setting that combined top-down and bottom-up driven elements. Although the process was authorised from the top it was clearly bottom-up driven and the template followed a professional rationale. New meeting grounds were introduced between politicians and clinical leaders. Overall a limited group of stakeholders were involved. By defusing political conflicts the likelihood that clinical leaders would regard this undertaking as important increased. Originality/valueOne tendency today is to unburden regional authorities of the hard decisions by introducing arrangements at national level. This study suggests that regional health authorities, in spite of being politically governed organisations, have the potential to execute a formal priority-setting process. Still, to make priority setting processes more robust to internal as well as external threat remains a challenge.

What Influences the Outcome of Active Disinvestment Processes in Healthcare? A Qualitative Interview Study on five Recent Cases of Active Disinvestment

“…Our nding that support, especially from healthcare providers and policymakers, is an important determinant of the outcome of the disinvestment process also has been described by previous studies in which support, especially from clinical leaders, but from the general public as well, was found to be essential for the success of the disinvestment process [6,33,34]. Furthermore, a lack of support from decision-makers has been described as a barrier to the implementation of disinvestment [17].…”

Success Factors of Demand-Driven Open Innovation as a Policy Instrument in the Case of the Healthcare Industry

“…In this case study, both qualitative and quantitative data were collected by the project partners. The data collection was done by using a mixed methods approach in which quantitative and qualitative methods are viewed as complementary data collecting methods [27,28]. During the validation, both qualitative and quantitative data were collected by the project partners using the detailed guidelines.…”

Asking the public: Citizens´ views on priority setting and resource allocation in democratically governed healthcare

“…At the time of the study, 2006, there had been a high level of media coverage of ongoing rationing activities in Östergötland (Bäckman, Nedlund, Carlsson & Garpenby, 2008). It was probably the first county council in Sweden to arrange a formal, explicit rationing process with the aim of limiting the supply of healthcare interventions due to economic restraints (Garpenby & Bäckman, 2016). In the Kalmar County Council there was no such similar explicit activity at this time.…”

“…At that time some of the Swedish county councils had engaged in more transparent ways of setting priorities (Garpenby & Bäckman, 2016). Still transparency, directed not just at patients but at the public in a broader sense, was considered to be of limited extent (Prioriteringscentrum, 2008).…”

“…Since the follow up by Prioriteringsdele-gationen, some participatory forms of public involvement that could relate to resource allocation (but not evidently to priority setting and rationing) have emerged in Sweden (Fredriksson et al 2018;Rosén, 2006). Different forms of so-called ʿcitizen dialogueʾ have been tested, in some counties occasionally, in others on a more regular basis (Garpenby & Bäckman, 2016;Fredriksson et al, 2018;Rosen, 2006). Still, in comparison with for example England, public involvement is described as mainly leaning on democratically elected representatives in the county council/healthcare regions, rather than on more betweenelection activities involving the public (Fredriksson et al, 2018).…”