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Market-orienting reforms in rural health care in Sweden: how can equity in access be preserved?

https://arctichealth.org/en/permalink/ahliterature296545
Source
Int J Equity Health. 2018 08 17; 17(1):123
Publication Type
Evaluation Studies
Journal Article
Research Support, Non-U.S. Gov't
Date
08-17-2018
Author
Linn Kullberg
Paula Blomqvist
Ulrika Winblad
Author Affiliation
Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden. Linn.Kullberg@pubcare.uu.se.
Source
Int J Equity Health. 2018 08 17; 17(1):123
Date
08-17-2018
Language
English
Publication Type
Evaluation Studies
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Evaluation Studies as Topic
Health Care Reform - methods
Health Care Sector - standards
Health Equity - standards
Health Policy
Humans
Rural Health
Rural Health Services - standards
Sweden
Abstract
Health care provision in rural and urban areas faces different challenges. In Sweden, health care provision has been predominantly public and equitable access to care has been pursued mainly through public planning and coordination. This is to ensure that health needs are met in the same manner in all parts of the country, including rural or less affluent areas. However, a marketization of the health care system has taken place during recent decades and the publicly planned system has been partially replaced by a new market logic, where private providers guided by financial concerns can decide independently where to establish their practices. In this paper, we explore the effects of marketization policies on rural health care provision by asking how policy makers in rural counties have managed to combine two seemingly contradictory health policy goals: to create conditions for market competition among health care providers and to ensure equal access to health care for all patients, including those living in rural and remote areas.
A qualitative case study within three counties in the northern part of Sweden, characterized by vast rural areas, was carried out. Legal documents, the "accreditation documents" regulating the health care quasi-markets in the three counties were analyzed. In addition, interviews with policy makers in the three county councils, representing the political majority, the opposition, and the political administration were conducted in April and May 2013.
The findings demonstrate the difficulties involved in introducing market dynamics in health care provision in rural areas, as these reforms not only undermined existing resource allocation systems based on health needs but also undercut attempts by local policy makers to arrange for care provision in remote locations through planning and coordination.
Provision of health care in rural areas is not well suited for market reforms introducing competition, as this may undermine the goal of equity in access to health care, even in a publicly financed health care system.
PubMed ID
30119665 View in PubMed
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