Suchergebnisse

Finnish ophthalmology services have been criticized for being suboptimal and in this regard, the authors analyze a development project set up to reform these services. The project descended into crisis 18 months after its launch, when its actors mapped out two different ways in which they perceived the problems related to ophthalmology and came up with different solutions to these problems. This paper pays special attention to the events following the crisis, when an external policy entrepreneur was recruited to lead the project. This policy entrepreneur did not adhere to either of the realities mapped out in the earlier stages of the project, but created interpretation of the problems at hand and their solutions. This paper focuses on the process in which the policy entrepreneur strove to convince other actors of the validity perceived interpretations. According to the analyse, the implementation of the new policy alternative consisted not only of a technically and politically feasible solution, but it also involved skillful policy making and right timing.

Purpose
The purpose of this paper is to analyze the dynamics of budgetary biasing in the context of public hospitals.


Design/methodology/approach
The study applies theories of accounting and budgeting behaviors in the specific institutional context of health care systems. Based on the theoretical framework, data from interviews with hospital budget officers were analyzed using qualitative content analysis.


Findings
A typology of biases is provided. It proved to be useful and highlighted the central empirical assumptions and preliminary results of biasing dynamics.


Practical implications
Understanding the logic of budgeting actors and the drivers of bias may help explain why bias so often appears in health care budgeting. It further contributes to understanding whether the bias is functional or dysfunctional.


Originality/value
The concepts of budgetary bias are rarely used in the context of health care budgeting, so the study fills a gap in research knowledge.

This paper presents a baseline picture of the co-operation between service purchasers and private elderly care and primary health care providers both at the national level and at the level of local welfare regimes in Finland. Data from two national surveys and from interviews conducted in six municipalities are analysed. The perceptions of the co-operation during the contractual period differed substantially between the private providers and the municipalities. The differences were evident especially between the for-profit providers and the municipalities. In general the private providers would be willing to work together with the municipalities, but to them it seems that the municipalities lack interest in this. The municipalities, in turn, considered that contracting is mostly a tool to reduce administrative responsibilities. However, in order to be able to gain benefits from contracting, to avoid excessive transaction costs and to co-ordinate the network of different service providers, the municipalities should invest in contract management and also be active during the contractual period.

Background In the literature there are only few empirical studies that analyse the decision makers' reasoning to contract out health care and social services to private sector. However, the decisions on the delivery patterns of health care and social services are considered to be of great importance as they have a potential to influence citizens' access to services and even affect their health. This study contributes to filling this cap by exploring the frames used by Finnish local authorities as they talk about contracting out of primary health care and elderly care services. Contracting with the private sector has gained increasing popularity, in Finland, during the past decade, as a practise of organising health care and social services. Methods Interview data drawn from six municipalities through thematic group interviews were used. The data were analysed applying frame analysis in order to reveal the underlying reasoning for the decisions. Results Five argumentation frames were found: Rational reasoning; Pragmatic realism; Promoting diversity among providers; Good for the municipality; Good for the local people. The interviewees saw contracting with the private sector mostly as a means to improve the performance of public providers, to improve service quality and efficiency and to boost the local economy. The decisions to contract out were mainly argued through the good for the municipal administration, political and ideological commitments, available resources and existing institutions. Conclusions This study suggests that the policy makers use a number of grounds to justify their decisions on contracting out. Most of the arguments were related to the benefits of the municipality rather than on what is best for the local people. The citizens were offered the role of active consumers who are willing to purchase services also out-of-pocket. This development has a potential to endanger the affordability of the services and lead to undermining some of the traditional principles of the Nordic welfare state. ; BioMed Central open access

Abstract Background In the literature there are only few empirical studies that analyse the decision makers' reasoning to contract out health care and social services to private sector. However, the decisions on the delivery patterns of health care and social services are considered to be of great importance as they have a potential to influence citizens' access to services and even affect their health. This study contributes to filling this cap by exploring the frames used by Finnish local authorities as they talk about contracting out of primary health care and elderly care services. Contracting with the private sector has gained increasing popularity, in Finland, during the past decade, as a practise of organising health care and social services. Methods Interview data drawn from six municipalities through thematic group interviews were used. The data were analysed applying frame analysis in order to reveal the underlying reasoning for the decisions. Results Five argumentation frames were found: Rational reasoning; Pragmatic realism; Promoting diversity among providers; Good for the municipality; Good for the local people . The interviewees saw contracting with the private sector mostly as a means to improve the performance of public providers, to improve service quality and efficiency and to boost the local economy. The decisions to contract out were mainly argued through the good for the municipal administration, political and ideological commitments, available resources and existing institutions. Conclusions This study suggests that the policy makers use a number of grounds to justify their decisions on contracting out. Most of the arguments were related to the benefits of the municipality rather than on what is best for the local people. The citizens were offered the role of active consumers who are willing to purchase services also out-of-pocket. This development has a potential to endanger the affordability of the services and lead to undermining some of the traditional principles of the Nordic welfare state.

The Nordic countries are healthcare systems with tax-based financing and ambitions for universal access to comprehensive services. This implies that distribution of healthcare resources should be based on individual needs, not on the ability to pay. Despite this ideological orientation, significant expansion in voluntary private health insurance (VPHI) contracts has occurred in recent decades. The development and role of VPHIs are different across the Nordic countries. Complementary VPHI plays a significant role in Denmark and in Finland. Supplementary VPHI is prominent in Norway and Sweden. The aim of this paper is to explore drivers behind the developments of the VPHI markets in the Nordic countries. We analyze the developments in terms of the following aspects: the performance of the statutory system (real or perceived), lack of coverage in certain areas of healthcare, governmental interventions or inability to reform the system, policy trends and the general socio-cultural environment, and policy responses to voting behavior or lobbying by certain interest groups. It seems that the early developments in VPHI markets have been an answer to the gaps in the national health systems created by institutional contexts, political decisions, and cultural interpretations on the functioning of the system. However, once the market is created it introduces new dynamics that have less to do with gaps and inflexibilities and more with cultural factors.

The issue to be addressed in this study is whether ownership and HRM practices are associated with employees' perceptions of organisational justice, job control and job demands. The study focuses on care personnel working in sheltered housing facilities for elderly people. Multi-level linear regression is applied to analyse the data. The results support the argument that an increased similarity between public, not-for-profit and for-profit organisations is emerging in HRM issues. HRM practices were found to associate with positive outcomes in organisational justice and job control. However, to be successful in the implementation of HRM, it is crucial that employees understand the justification for each procedure as well as find it a useful resource in terms of their own job.