Political strategies in difficult times – The “backstage” experience of Swedish politicians on formal priority setting in healthcare

Abstract

This paper contributes to the knowledge on the governing of healthcare in a democratic context in times of austerity. Resource allocation in healthcare is a highly political issue but the political nature of healthcare is not always made clear and the role of politicians is often obscure. The absence of politicians in rationing/disinvestment arrangements is usually explained with blame-shifting arguments; they prefer to delegate "the burden of responsibility" to administrative agencies or professionals. Drawing on a case where Swedish regional politicians involved themselves in setting priorities at a more detailed level than previously, the findings suggest that the subject of "blame avoidance" is more complicated than usually assumed. A qualitative case study was designed, involving semi-structured interviews with 14 regionally elected politicians in one Swedish health authority, conducted in June 2011. The interviews were analysed through a thematic analysis in accordance with the "framework approach" by Ritchie and Lewis. Findings show that an overarching strategy among the politicians was to appear united and to suppress conflict, which served to underpin the vital strategy of bringing the medical profession into the process. A key finding is the importance that politicians, when appearing "backstage", attach to the prevention of blame from the medical profession. This case illustrates that one has to take into account that priority settings requires various types of skills and knowledges - not only technical but also political and social. Another important lesson points toward the need to broaden the political leadership repertoire, as leadership in the case of priority setting is not about politicians being all in or all out. The results suggest that in a priority-setting process it is of importance to have politics on-board at an early stage to secure loyalty to the process, although not necessarily being involved in all details.

“A perfect society”— Swedish policymakers’ ethical and social views on preconception expanded carrier screening

“…According to their respondents, priority setting decisions are fast paced leading to convergence of decision-making to political leaders, who usually possess better comprehensive knowledge of the process. Consequently, it reinforced “elitist” structure of the proceedings and decisions (Garpenby and Nedlund 2016). This is reflected in the results in our study as well.…”

“…This is reflected in the results in our study as well. In addition, it gave little time for politicians to ponder ethical issues adequately (Garpenby and Nedlund 2016). Höglund and Falkenström (2018) analyzed seven national and local healthcare policy documents for ethical values and conducted in-depth interviews of 13 elected and non-elected government officials to examine how ethical procedures were integrated in their work and decision-making.…”

Decommissioning in a local healthcare system in Sweden: responses to fiscal stress

“…Decommissioning can occur at all levels in the healthcare system, and goes beyond prioritization between different services and patient groups which regularly take place in the healthcare system [5][6][7]. Active decommissioning is typically challenging for healthcare decisionmakers since the public and important stakeholders within the healthcare organization, such as managers and clinicians, usually react strongly to it [5,8,9]. For the users of services, the negative effects of decommissioning such as impaired access and service quality, are often perceived as immediate and concentrated while the potential benefits are more diffuse and long-term, making such policies unpopular [10].…”

Clinic managers’ perspectives on the sustainable implementation of a decommissioning programme in Sweden: a qualitative study

“…This task may become increasingly relevant because health systems today face many challenges that increase the pressure on existing resources (20,21). However, the public and professional groups often disapprove of decommissioning and, hence, it is difficult to implement (22)(23)(24). Although exploratory, Robert et al suggest best practice recommendations for the successful implementation of decommissioning decisions (16).…”