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

Abstract：

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).

journal_name

BMC Health Serv Res

journal_title

BMC health services research

authors

Fredriksson M,Blomqvist P,Winblad U

doi

10.1186/s12913-014-0509-1

subject

Has Abstract

pub_date

2014-11-05 00:00:00

pages

509

issn

1472-6963

pii

s12913-014-0509-1

journal_volume

pub_type

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