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The dilemma of knowledge use in political decision-making: National Guidelines in a Swedish priority-setting context.

https://arctichealth.org/en/permalink/ahliterature310734
Source
Health Econ Policy Law. 2019 10; 14(4):425-442
Publication Type
Journal Article
Date
10-2019
Author
Johanna Sandberg
Bo Persson
Peter Garpenby
Author Affiliation
Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
Source
Health Econ Policy Law. 2019 10; 14(4):425-442
Date
10-2019
Language
English
Publication Type
Journal Article
Keywords
Decision Making
Delivery of Health Care - standards
Health Priorities
Humans
Knowledge
Politics
Sweden
Abstract
There is a growing recognition of the importance of evidence to support allocative policy decisions in health care. This study is based on interviews with politicians in four regional health authorities in Sweden. Drawing on theories of strategic use of knowledge, the article analyses how politicians perceive and make use of expert knowledge represented by the National Guidelines, embracing both a scientific and a political rationale. As health care is an organisation with a dual basis for legitimacy - at the same time a political and an action organisation - it affects knowledge use. We investigate how the context of health care priority setting influences the conditions for knowledge use among regional politicians. Our findings illustrate the dilemma of political decision-makers and how they prefer to use expert knowledge. The politicians use this policy instrument in a legitimising fashion, as it will fit into the current political debate on more equal care. As an instrument for resource allocation the politicians noted that 'facts' per se could not provide them with a sufficient basis for legitimising their governing of health care. The dualistic organisational context makes knowledge important as a political weapon in negotiations with the medical profession.
PubMed ID
29986792 View in PubMed
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It takes a giraffe to see the big picture - citizens' view on decision makers in health care rationing.

https://arctichealth.org/en/permalink/ahliterature269310
Source
Soc Sci Med. 2015 Mar;128:301-8
Publication Type
Article
Date
Mar-2015
Author
Mari Broqvist
Peter Garpenby
Source
Soc Sci Med. 2015 Mar;128:301-8
Date
Mar-2015
Language
English
Publication Type
Article
Keywords
Adult
Decision Making
Female
Health Care Rationing
Humans
Interviews as Topic
Male
Physician's Role
Politics
Public Opinion
Sweden
Abstract
Previous studies show that citizens usually prefer physicians as decision makers for rationing in health care, while politicians are downgraded. The findings are far from clear-cut due to methodological differences, and as the results are context sensitive they cannot easily be transferred between countries. Drawing on methodological experiences from previous research, this paper aims to identify and describe different ways Swedish citizens understand and experience decision makers for rationing in health care, exclusively on the programme level. We intend to address several challenges that arise when studying citizens' views on rationing by (a) using a method that allows for reflection, (b) using the respondents' nomination of decision makers, and (c) clearly identifying the rationing level. We used phenomenography, a qualitative method for studying variations and changes in perceiving phenomena. Open-ended interviews were conducted with 14 Swedish citizens selected by standard criteria (e.g. age) and by their attitude towards rationing. The main finding was that respondents viewed politicians as more legitimate decision makers in contrast to the results in most other studies. Interestingly, physicians, politicians, and citizens were all associated with some kind of risk related to self-interest in relation to rationing. A collaborative solution for decision making was preferred where the views of different actors were considered important. The fact that politicians were seen as appropriate decision makers could be explained by several factors: the respondents' new insights about necessary trade-offs at the programme level, awareness of the importance of an overview of different health care needs, awareness about self-interest among different categories of decision-makers, including physicians, and the national context of long-term political accountability for health care in Sweden. This study points to the importance of being aware of contextual and methodological issues in relation to research on how citizens experience arrangements for rationing in health care.
PubMed ID
25638017 View in PubMed
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Political strategies in difficult times - The "backstage" experience of Swedish politicians on formal priority setting in healthcare.

https://arctichealth.org/en/permalink/ahliterature287865
Source
Soc Sci Med. 2016 08;163:63-70
Publication Type
Article
Date
08-2016
Author
Peter Garpenby
Ann-Charlotte Nedlund
Source
Soc Sci Med. 2016 08;163:63-70
Date
08-2016
Language
English
Publication Type
Article
Keywords
Health Care Rationing - methods - standards
Health Priorities - standards - trends
Humans
Leadership
Politics
Qualitative Research
Sweden
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.
PubMed ID
27404909 View in PubMed
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[Quality registries are good tools for clinicians but are of doubtful value for customers].

https://arctichealth.org/en/permalink/ahliterature186022
Source
Lakartidningen. 2003 Feb 27;100(9):715-8
Publication Type
Article
Date
Feb-27-2003
Author
Peter Garpenby
Marie Lawrence
Author Affiliation
Centrum för utvärdering av medicinsk teknologi, institutionen för hlsa och samhälle, Linköpings universitet. peter.garpenby@ihs.liu.se
Source
Lakartidningen. 2003 Feb 27;100(9):715-8
Date
Feb-27-2003
Language
Swedish
Publication Type
Article
Keywords
Decision Making
Health Policy
Humans
Purchasing, Hospital
Quality Assurance, Health Care
Quality Indicators, Health Care
Questionnaires
Registries
Sweden
PubMed ID
12674560 View in PubMed
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To accept, or not to accept, that is the question: citizen reactions to rationing.

https://arctichealth.org/en/permalink/ahliterature257173
Source
Health Expect. 2014 Feb;17(1):82-92
Publication Type
Article
Date
Feb-2014
Author
Mari Broqvist
Peter Garpenby
Author Affiliation
Researcher andAssociate Professor, Department of Medical and Health Sciences, The National Centre for Priority Setting in Health Care, Linköping University, Linköping, Sweden.
Source
Health Expect. 2014 Feb;17(1):82-92
Date
Feb-2014
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Decision Making
Female
Health Care Rationing - economics
Health Knowledge, Attitudes, Practice
Health Priorities
Humans
Male
Middle Aged
Qualitative Research
State Medicine - economics
Sweden
Young Adult
Abstract
The publicly financed health service in Sweden has come under increasing pressure, forcing policy makers to consider restrictions.
To describe different perceptions of rationing, in particular, what citizens themselves believe influences their acceptance of having to stand aside for others in a public health service.
Qualitative interviews, analysed by phenomenography, describing perceptions by different categories.
Purposeful sample of 14 Swedish citizens, based on demographic criteria and attitudes towards allocation in health care.
Participants expressed high awareness of limitations in public resources and the necessity of rationing. Acceptance of rationing could increase or decrease, depending on one's (i) awareness that healthcare resources are limited, (ii) endorsement of universal health care, (iii) knowledge and acceptance of the principles guiding rationing and (iv) knowledge about alternatives to public health services.
This study suggests that decision makers should be more explicit in describing the dilemma of resource limitations in a publicly funded healthcare system. Openness enables citizens to gain the insight to make informed decisions, i.e. to use public services or to 'opt out' of the public sector solution if they consider rationing decisions unacceptable.
PubMed ID
22032636 View in PubMed
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