Reforming decentralized integrated health care systems: Theory and the case of the Norwegian reform

In this essay a conceptual and theoretical scheme for decentralized integrated health care systems of the northern European kind is developed. With small changes it is also applicable to other countries, e.g. Italy, Spain, and Portugal. Three ideas tie together the scheme: modified fiscal federalism, principalagent thinking and the analysis of discrete structural alternatives from new institutional economics. As a special case it encompasses the ideas of planned markets and public competition developed by von Otter and Saltman. The scheme can be used to analyse driving forces behind reforms and prediction of effects. To illustrate the thinking the recent Norwegian reform is put into context, not only geographically but also theoretically. The geographical context is that of Scandinavia and there is a summary of reforms in the Scandinavian countries over the past 20-30 years. The essay thus serves the double purpose of presenting and evaluating the Norwegian reform in a Scandinavian context and to take part in the neglected discipline of developing a theory of health care reform. The Norwegian January 2002 reform is described in some detail. It is a reversal of the Scandinavian model of decentralization and a move towards more centralism. The hospital system was transferred to the state that established five regions with independent (non-political) boards and each region has a number of daughters (hospitals) that have great autonomy with their own boards and are outside the legal restrictions of the public sector. Basically the idea is to mimic the corporate structure of large private companies. The reform is evaluated based on principal-agent thinking and the analysis of discrete structural alternatives. Overall there is no a priori reason to expect large improvements in efficiency – but on the other hand neither should one expect things to get worse. Many effects depend, however, crucially, on (a) the financing system that will be put in place late 2002 or early 2003, and (b) whether or not the political and management culture change as a result of the reform. In the concluding sections possible implications for Denmark and Sweden are discussed.Health care reform; Norway; principal-agents; discrete structural analysis

What do Social Processes mean for Quality of Human Resource Practice?

Well implemented human resource practice (HRP) is linked to increased performance, innovation, and the well-being of both managers and employees. In the literature, a distinction between the hard and the soft HRM-models is drawn: the hard model focuses on employees as a cost, whereas the soft HRM-model treats them as a potential Nielsen (2008a). However, little is known about the informal aspects of HRP and which social processes actually lead to implementation success or failure. The purpose of this paper is to develop a concept of social processes between managers and employees that can increase the implementation and quality of HR-performance Two studies of HRP within two manufacturing companies are used to illustrate the pros and cons of this new theoretical concept from a performance perspective. Involvement, commitment, and competence development are identified as key aspects of the quality of HRP. Moreover, a good psychological working environment and systematic priority of HRP are essential contextual factors that can enable or hinder social processes. Otherwise, production pressure and power relations between managers and employees can hinder the implementation of the new concept. The concept of social processes can help HRP to contribute on social processes between managers and employees as important aspects of quality in work with human resources. However, the influence of team organization and the social processes between employees needs to be explored further

Demografien, den økonomiske krise og sundhedsvæsenet

Danish forecasts for 2040 of the economic consequences of population ageing and longer life expectancy are critically reviewed. Alone for 2010-2020 an annual increase in spending of 4-5 billion Dkr is needed accord- ing to the best estimates. To this is added the consequences of the economic crisis. e annual growth rate has come down from 3,3% p.a. to close to 1%. is situation is put into perspective by looking at the scal sustainability of the whole public sector and how much health care adds to the challenge of staying scal sustainable: At least 0,7% of BNP out of a sustainability index of 1,1% is due to health care. No coherent strategy for coping with demographics and the economic crisis has been developed. A number of initiatives are discussed and evaluated: Increased productivity, elimination of the costs of bad quality in health care, tougher prioritization by changing indication levels for treatment, and increased preventive activities, e.g. readmission to hospital. At present no radical reform proposal for the health care sector are discussed.

Kommunalreformen og sundhedsvæsnet: en forbedring?

På sundhedsområdet har reformen ført til ændringer af struktur: fra 14 amter til 5 regioner; opgavefordelingen er blevet ændret så kommunerne får større ansvar for forebyggelse, sundhedsfremme og genoptræning og endelig er finansieringen ændret. Regionerne må ikke som i amtstiden opkræve skatter, men får penge til sundhedsopgaven som bloktilskud fra staten, ligesom kommunerne er blevet medfinansierende af det regionale sundhedsvæsen, fordi man betaler et vist beløb til regionen, hver gang en borger i kommunen benytter det regionale sundhedsvæsen. Ideen med det sidste er at igangsætte en substitutionsproces. En hurtig analyse sætter imidlertid afgørende spørgsmålstegn ved denne antagelse. Hertil kommer, at fjernelsen af retten til skatteudskrivning gør det omkostningsfrit for regionerne at optræde sammen med andre interessent-grupper, som til enhver tid kræver flere ressourcer fra regering og Folketing. Dette kan let føre til øgede vækstprocenter for sundhedsudgifterne. Alt i alt peger ændringen af finansieringen i retning af en central svaghed ved reformen med potentiale til at skabe ustabilitet i grundkonstruktionen

Demografien, den økonomiske krise og sundhedsvæsenet

Danish forecasts for 2040 of the economic consequences of population ageing and longer life expectancy are critically reviewed. Alone for 2010-2020 an annual increase in spending of 4-5 billion Dkr is needed accord- ing to the best estimates. To this is added the consequences of the economic crisis. e annual growth rate has come down from 3,3% p.a. to close to 1%. is situation is put into perspective by looking at the scal sustainability of the whole public sector and how much health care adds to the challenge of staying scal sustainable: At least 0,7% of BNP out of a sustainability index of 1,1% is due to health care. No coherent strategy for coping with demographics and the economic crisis has been developed. A number of initiatives are discussed and evaluated: Increased productivity, elimination of the costs of bad quality in health care, tougher prioritization by changing indication levels for treatment, and increased preventive activities, e.g. readmission to hospital. At present no radical reform proposal for the health care sector are discussed.

Kritisk vurdering af udkastet til sundhedsreform

I denne artikel gives en kritisk vurdering af det udkast til en sundhedsreform, som VLAK-regeringen og Dansk Folkeparti indgik en aftale om i foråret 2019. Det kritiske blik rettes særligt mod de bestyrelser for sundhedsregionerne, der skal erstatte regionsrådene, etablering af sundhedsfællesskaber og styrkelsen af Det nære Sundhedsvæsen i kommunerne

Kommunalreformen og sundhedsvæsnet: en forbedring?

På sundhedsområdet har reformen ført til ændringer af struktur: fra 14 amter til 5 regioner; opgavefordelingen er blevet ændret så kommunerne får større ansvar for forebyggelse, sundhedsfremme og genoptræning og endelig er finansieringen ændret. Regionerne må ikke som i amtstiden opkræve skatter, men får penge til sundhedsopgaven som bloktilskud fra staten, ligesom kommunerne er blevet medfinansierende af det regionale sundhedsvæsen, fordi man betaler et vist beløb til regionen, hver gang en borger i kommunen benytter det regionale sundhedsvæsen. Ideen med det sidste er at igangsætte en substitutionsproces. En hurtig analyse sætter imidlertid afgørende spørgsmålstegn ved denne antagelse. Hertil kommer, at fjernelsen af retten til skatteudskrivning gør det omkostningsfrit for regionerne at optræde sammen med andre interessent-grupper, som til enhver tid kræver flere ressourcer fra regering og Folketing. Dette kan let føre til øgede vækstprocenter for sundhedsudgifterne. Alt i alt peger ændringen af finansieringen i retning af en central svaghed ved reformen med potentiale til at skabe ustabilitet i grundkonstruktionen