Structural Reform in Denmark, 2007–09: Central Reform Processes in a Decentralised Environment
In: Local government studies, Band 36, Heft 2, S. 205-221
ISSN: 1743-9388
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In: Local government studies, Band 36, Heft 2, S. 205-221
ISSN: 1743-9388
In: International journal of public administration, Band 32, Heft 6, S. 508-535
ISSN: 1532-4265
In: International journal of public administration: IJPA, Band 32, Heft 6, S. 508
ISSN: 0190-0692
In: Christiansen , T & Vrangbæk , K 2018 , ' Hospital centralization and performance in Denmark : ten years on ' , Health Policy , vol. 122 , no. 4 , pp. 321- 328 . https://doi.org/10.1016/j.healthpol.2017.12.009
Denmark implemented a major reform of the administrative and political structure in 2007 when the previous 13 counties were merged into five new regions and the number of municipalities was reduced from 271 to 98. A main objective was to create administrative units that were large enough to support a hospital structure with few acute hospitals in each region and to centralize specialized care in fewer hospitals. This paper analyses the reorganization of the somatic hospital sector in Denmark since 2007, discusses the mechanisms behind the changes and analyses hospital performance after the reform. The reform focused on improving acute services and quality of care. The number of acute hospitals was reduced from about 40–21 hospitals with new joint acute facilities, which include emergency care wards. The restructuring and geographical placement of acute hospitals took place in a democratic process subject to central guidelines and requirements. Since the reform, hospital productivity has increased by more than 2 per cent per year and costs have been stable. Overall, indicators point to a successful reform. However, it has also been criticized that some people in remote areas feel "left behind" in the economic development and that hospital staff are under increased workload pressure. Concurrent with the centralization of hospitals municipalities strengthened their health service with an emphasis on prevention and health promotion.
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In: COHERE Discussion Papers, University of Southern Denmark, 2017:7
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Working paper
In: Christiansen , T & Vrangbæk , K 2017 ' Hospital centralization and performanced in Denmark - ten years on ' Odense , pp. 1-32 .
Denmark implemented a major reform of the administrative and political structure in 2007 when the previous 13 counties were merged into five new regions and the number of municipalities was reduced from 271 to 98. A main objective was to create administrative units that were large enough to support a hospital structure with few acute hospitals in each region and to centralize specialized care in fewer hospitals. This paper analyses the reorganization of the somatic hospital sector in Denmark since 2007, discusses the mechanisms behind the changes and analyses hospital performance after the reform. The reform emphasized an improved acute service and high quality. The number of acute hospitals was reduced from about 40 to 21 hospitals with joint acute facilities. The restructuring and geographical placement of acute hospitals took place in a democratic process subject to central guidelines and requirements. Since the reform, hospital productivity has increased by more than 2 per cent per year and costs have been stable. While the overall indicators point to a successful reform, it has also been criticized that some people in remote areas feel "left behind" in the economic development and that hospital staff are under increased workload pressure. Concurrent with the centralization of hospitals municipalities strengthened their health service with an emphasis on prevention and health promotion.
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In: West European politics, Band 37, Heft 4, S. 693-710
ISSN: 1743-9655
In: Nikolay Vasev & Karsten Vrangbæk (2014) Transposition and National-Level Resources: Introducing the Cross-Border Healthcare Directive in Eastern Europe, West European Politics, 37:4, 693-710
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In: West European politics, Band 37, Heft 4, S. 693-710
ISSN: 0140-2382
World Affairs Online
In: Public administration: an international quarterly, Band 86, Heft 1, S. 169-184
ISSN: 0033-3298
In: Scandinavian political studies: SPS ; a journal, Band 30, Heft 4, S. 491-520
ISSN: 0080-6757
Theoretisch
World Affairs Online
In: Scheele , C E & Vrangbæk , K 2016 , ' Co-location as a Driver for Cross-Sectoral Collaboration with General Practitioners as Coordinators : The Case of a Danish Municipal Health Centre ' , International Journal of Integrated Care , vol. 16 , no. 4 , 15 . https://doi.org/10.5334/ijic.2471
The issue of integrated care and inter-sectoral collaboration is on the health policy agenda in many countries. Yet, there is limited knowledge about the effects of the different policy instruments used to achieve this. This paper studies co-location as a driver for cross-sectoral collaboration with general practitioners (GPs) acting as coordinators in a municipal health centre. The purpose of the health centre, which is staffed by health professionals from municipal, regional and private sectors, is to provide primary health services to the citizens of the municipality. Co-locating these professionals is supposed to benefit e.g., elder citizens and patients with chronic diseases who frequently require services from health professionals across administrative sectors. Methodologically, the analysis is based on qualitative data in the form of semi-structured interviews with the health professionals employed at the health centre and with administrative managers from municipal and regional government levels. The study finds that co-location does not function as a driver for cross-sectoral collaboration in a health centre when GPs act as coordinators. Cross-sectoral collaboration is hampered by the general practitioners' work routines and professional identity, by organisational factors and by a lack of clarity concerning the content of collaboration with regard to economic and professional incentives.
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In: Tidsskrift for Forskning i Sygdom og Samfund: tidsskrift for idéhistorie, Band 8, Heft 15
ISSN: 1904-7975
Denne artikel diskuterer problemer med MTV-teori og -praksis særligt i forhold til komplekse, sociale teknologier. Det hævdes, at traditionelle statistisk baserede metodetilgange har begrænsninger i forhold til at analysere betydningen af den dynamiske organisatoriske kontekst for opnåelse af kliniske effekter. Dette betyder, at organisationsanalyserne i denne type MTVer bliver meget vigtige, og at de må baseres på andre typer teoretiske og metodiske tilgange. Artiklen diskuterer nyere udviklinger indenfor evalueringsteori, og særligt den kontekstfokuserede 'realistiske' evalueringstilgang som supplement til de hidtidigt anvendte organisationsteoretiske tilgange til MTV. Den teoretiske diskussion illustreres med eksempler fra en nyligt publiceret MTV om 'diabetiske fodsår' (Sundhedsstyrelsen, 2011).
In: International journal of public administration, Band 34, Heft 8, S. 486-496
ISSN: 1532-4265
In: Public Administration, Band 86:1, Heft 169-184
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