Professionals’ perspectives on a market-inspired policy reform: A guiding light to the blind spots of measurement

Abstract

Implementation of market-inspired competition and incentive models in health care is increasing worldwide, assumed to drive efficiency. However, the evidence for effects is mixed and unintended consequences have been reported. There is a need to better understand the practical consequences of such reforms. The aim of the present case study is to explore what consequences of a Swedish market-inspired patient choice reform professionals identify as relevant, and why. The study was designed as an explorative qualitative study in specialized orthopedics. Nineteen interviews were conducted with health care professionals at different providers. Data were analyzed using a hypo-deductive thematic approach. Consequences for the organization of care, patients, work environment, education and research were included in the professionals' analyses, covering both the perspective of their own organization and that of the health care system as a whole. In sum, the professionals provided multiple-level analyses that extended beyond the responsibilities of their own organization. Concluding, professionals are a valuable source of knowledge when evaluating policy reforms. Their analyses can contribute by covering a broad system perspective, serving as a guiding light to areas beyond the most obvious evaluation measures that should be included in more formal evaluations.

Workers’ experiences of healthy work environment indicators at well-functioning primary care units in Sweden: a qualitative study

“…Intrinsic motivation is connected to feelings of accomplishment and joy at doing well at work [35], and job-satisfaction is also related to a high degree of task delegation and good quality care [25]. Previous research has shown that intrinsic motivation decreased after the implementation of governance structure reforms in primary care [3], indicating that the well-functioning PCUs had other qualities that supported intrinsic motivation and joy at work. Frequent forums for communication, shared care models, team work and professional satisfaction have been found to influence joy at work among physicians in well-functioning primary care practices [20].…”

“…Swedish primary care is no exception, and has undergone several changes since 2010, including implementation of a more flexible system that allows patients to choose between private and publicly managed primary care providers [1,2]. The changes also included the introduction of a new form of performance target intended by decision makers to drive specific provider behaviours, even though research has shown the difficulty of making accurate predictions [3]. Primary care has traditionally been a public monopoly based upon a value ground of equity, with a shift of power since the 1980s resulting in a decentralised healthcare system [4–6].…”

As predicted by theory: choice and competition in a publicly funded and regulated regional health system yield improved access and cost control

“…Meaning units were identified, coded, and grouped into categories and themes. The 2014 interviews were originally collected for another study [ 15 ], but was subjected to a secondary analysis using a directed content analysis [ 14 ], guided by the findings from the 2010 and 2017 interviews.…”

Promises and pitfalls of value-based reimbursement in healthcare : A mixed method health economic approach

“…Policymakers have realized that productivity in the health care system can only be achieved through co-operation with the doctors, and through the involvement of professional bodies. (Garpenby, 1992) Healthcare professionals can contribute substantially to the evaluation and development of policy reforms, since professional insights can be used to predict possible effects of a policy reform on multiple stakeholders (Korlen et al, 2017).…”