Från beslut till verklighet : Läkarnas roll vid implementeringen av valfrihetsreformer i hälso- och sjukvården
Sammanfattning: Several policies were introduced in Sweden at the beginning of the 1990’s with the intention to give patients the right to choose health care provider. The effects of these policies have been moderate, e.g. few patients are aware of their rights to choose. The aim of the thesis has been to investigate the physicians’ role in bringing the policies into effect. In order to examine attitudes, knowledge and behaviour among the physicians a questionnaire was sent out to 960 physicians in Stockholm County Council. The results show that only a minority of the physicians, on a regular basis, help patients choose health care provider by giving them information and letting them choose where they want to be referred. The next question was to explain why physicians did not encourage patients to choose care provider? A case study in Stockholm County Council showed that from a formal perspective there was no conflict between national and locally governed rules. However, knowledge about local rules concerning these policies was poor among the physicians in general. Physicians who were more knowledgeable about the policies were more prone to assist patients to choose health care provider at hospital level. Finally, it was shown that a majority of the physicians experienced no conflict between the policies and their day-to-day clinical decision-making. However, physicians who felt professionally threatened by the policies were less willing to inform patients about patient choice. To summarize, a decade later, still only a minority of physicians act in accordance with the political intentions. This could explain why so many patients are still unaware of their right to choose hospital.
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