Recentralizing healthcare through evidence-based guidelines – striving for national equity in Sweden

BMC Health Services Research

Ulrika Winblad¹  Paula Blomqvist²  Mio Fredriksson¹ 

[1] Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, 751 22, Sweden;Department of Government, Uppsala University, Uppsala, 751 20, Sweden

关键词: Prioritizations;    Cost-effectiveness;    Equity;    Sweden;    Recentralization;    Healthcare regulation;    Governance;    National guidelines;    Evidence-based guidelines;   

Others  :  1092327
DOI  :  10.1186/s12913-014-0509-1

 received in 2014-05-12, accepted in 2014-10-10,  发布年份 2014

【 摘 要 】

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 all decision 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).

【 授权许可】

   
2014 Fredriksson et al.; licensee BioMed Central Ltd.

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