Recentralizing healthcare through evidence-based guidelines – striving for national equity in Sweden
2014 (English)In: BMC Health Services Research, ISSN 1472-6963, Vol. 14, 509- p.Article in journal (Refereed) Published
Background: The Swedish government has increasingly begun to rely on so called informative governance when regulating healthcare. The question this article sets out to answer is: considered to be “the backbone” of the Swedish state’s strategy for informative governance in healthcare, what kind of regulatory arrangement is the evidence-based National Guidelines? Together with national medical registries and an extensive system of quality and efficiency indicators, the National Guidelines constitutes Sweden’s quality management system. Methods: A framework for evaluating and comparing regulatory arrangements was used. It asks for instance: what is the purpose of the regulation and are regulation methods oriented towards deterrence or compliance? Results: The Swedish National Guidelines is a regulatory arrangement intended to govern the prioritizations of alldecision makers – politicians and administrators in the self-governing county councils as well as healthcare professionals – through a compliance model backed up by top-down benchmarking and built-in mechanisms for monitoring. It is thus an instrument for the central state to steer local political authorities. The purpose is to achieve equitable and cost-effective healthcare. Conclusions: This article suggests that the use of evidence-based guidelines in Swedish healthcare should be seen in the light of Sweden’s constitutional setting, with several autonomous levels of political authority negotiating the scope for their decision-making power. As decision-making capacity is relocated to the central government – from the democratically elected county councils responsible for financing and provision of healthcare – the Swedish National Guidelines is part of an ongoing process of healthcare recentralization in Sweden, reducing the scope for local decision-making. This represents a new aspect of evidence-based medicine (EBM) and clinical practice guidelines (CPGs).
Place, publisher, year, edition, pages
2014. Vol. 14, 509- p.
EBM, CPG, guidelines, evidence, Sweden, local demcracy, primary care, health policy, citizen, patient
Health Care Service and Management, Health Policy and Services and Health Economy Public Administration Studies
Research subject Health Care Research
IdentifiersURN: urn:nbn:se:uu:diva-162604DOI: 10.1186/s12913-014-0509-1ISI: 000348416600001PubMedID: 25370710OAI: oai:DiVA.org:uu-162604DiVA: diva2:461055