Search results

Payments to healthcare providers create incentives that can influence provider behaviour. Research on unit-level incentives in primary care is, however, scarce. This paper examines how managers and salaried physicians at Swedish primary healthcare centres perceive that payment incentives directed towards the healthcare centre affect their work.

An interview study was conducted with 24 respondents at 13 primary healthcare centres in two cities, located in regions with different payment systems. One had a mixed system comprised of fee-for-service and risk-adjusted capitation payments, and the other a mainly risk-adjusted capitation system.

Findings suggested that both managers and salaried physicians were aware of and adapted to unit-level payment incentives, albeit the latter sometimes to a lesser extent. Respondents perceived fee-for-service payments to stimulate production of shorter visits, up-coding of visits and skimming of healthier patients. Results also suggested that differentiated rates for patient visits affected horizontal prioritisations between physician and nurse visits. Respondents perceived that risk-adjustments for diagnoses led to a focus on registering diagnosis codes, and to some extent, also up-coding of secondary diagnoses.

Policymakers and responsible authorities need to design payment systems carefully, balancing different incentives and considering how and from where data used to calculate payments are retrieved, not relying too heavily on data supplied by providers.

This study contributes evidence on unit-level payment incentives in primary care, a scarcely researched topic, especially using qualitative methods.

This paper aims to analyse waiting‐time guarantees in the three Scandinavian countries (Denmark, Norway, and Sweden) and to assess whether their current policy designs have strengthened the role of patients in their healthcare systems.

The paper compares official documents and legislation in the three countries. The main findings are that waiting‐time guarantees have generally empowered patients in the Scandinavian health systems. This empowerment is stronger in Denmark and Norway, where formal waiting‐time guarantee rules are applied, than in Sweden, where the guarantee is based on the “softer” regulatory instrument of agreements. While patients are formally empowered in all three countries, and care providers are gradually adjusting to this situation, it is also clear that the practical conditions for empowering patients are not fully in place. The issue of information dissemination is particularly important.

Assessments are based on current regulatory configurations in the three countries, where the process of adapting and implementing the policies is ongoing. These assessments are based on a comparative analysis of the institutional designs. There is no detailed information on how patients use the waiting‐time guarantee.

It is important to consider carefully the information that patients have available in exercising their right to choose healthcare as well as the incentives for providing such information to them.

This is the first systematic comparison of waiting‐time guarantees in the three countries. It is a starting‐point for further research on the introduction of waiting‐time guarantees in public health systems.

The purpose of this paper is to outline the conditions for a new service system in healthcare, which will be able to match the available capacity in and between healthcare units, in order to match the need of care for the patients.

By drawing on statements from patients, experiences from similar services (a literature review), empirical research into the effects of the reforms on free choice and the care guarantee and a theoretically informed discussion drawing on value‐creation and service productivity, it is claimed that a matching system is needed to be developed.

As healthcare lacks incentives and structures of matching capacity between various care providers, and for coordinating episodes of care for the patient, the result is management of capacity that is difficult and uncertain for patients. Continuity and coordination during all the healthcare process are seen as important values by patients. It is valuable for patients to be matched in the coordination of contacts with providers and specialists.

Healthcare matching generates the supportive data for innovative service research. For management, it could be applicable in different organisational areas, for patients in their choices of provider and for the providers, when matching the needs for patients. In further research, it would be of value to discuss the barriers of matching.

Outlining the conditions for a service system, healthcare matching, has not been done before.