Changes in political governance structures in the Swedish county health care

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Changes in political governance structures in the
Swedish county health care

• Jesper Stenberg
• Master of Public Policy and Management
• PhD candidate
• Medical Management Centre/Karolinska Institutet
• EHMA 2008-06-26

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Agenda

• The Swedish healthcare system
• Changes in political governance structures
• Theoretical framework
• Empirical findings
• Discussion
• Future research themes and policy implications

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The Swedish healthcare system - a decentralized
taxbased system

• Three levels of authority state, county council,
  municipality
• Instrument of Government
• Art. 1. Swedish democracy shall be realised
  through a representative and parliamentary polity
  and through local self-government.
• Art. 7. Sweden has municipalities and county
  councils. The decision-making power in these
  local authorities is exercised by elected
  assemblies.
• The local authorities may levy taxes in order to
  perform their tasks.
• Health and Medical Services Act (1982)
• Assure the entire population good healthcare and
  car on equal terms
• Every county council shall offer good health and
  medical services to persons living within its
  boundaries and promote their health

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The Swedish healthcare system
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The Swedish healthcare system

• State
• foreign policy, public order, higher education
  and research, labour market, social insurance and
  transfer payments
• County council
• health care, support to cultural activities,
  public transport
• Municipalities
• social services, schools, spatial planning and
  building, health and environmental protection,
  refuse collection and waste disposal, rescue
  services, water and sewerage, recreation
  activities, culture, housing, energy, industrial
  facilities

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The Swedish Healthcare sysem

• 21 geographical areas
• Population varies between 130,000 and 2.0 million
• Medium size 250 000 300 000 inhabitants
• Three regions accounts for half of the total
  population- Skåne, Stockholm and Västra Götaland
• Politicians elected every fourth year
• Right to levy regional income tax
• Free to choose whatever operational structure
  they consider suitable
• Within each cc there are usually several
  districts, managed by its own board, each with
  the overall responsibility for the health of
  the population in its area
• The ccs are grouped into six medical care
  regions, to facilitate cooperation in highly
  specialised (tertiary) care

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Changes in political governance structures-
Quick vote on organizational change!

• How many of you have experienced an
  organizational change the last couple of years?
• The main argument for organizational change?
• New leadership organizational changes?

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Changes in political governance structures

• The purpose is to describe the changes in
  political governance structures in the Swedish
  health care system during the period 1998- 2007.
  The time period covers three general elections.
• Aim
• To review lit. and suggest a theoretical
  framework on structures
• 2. To test the theoretical framework on
  political governance structures
• How often do political governance structures
  change?
• To what structure?
• Changing political leadership structural change?

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Changes in political governance structures - a
baseline model of County Council
Citizens
County Council Assembly
Org.unit
Org.unit
Political Governance Structure
County Council Executive Committee,
Org.unit
Org.unit
CEO
Adm. Organization
Adm, support
Medical Services Organization
Hospital
Centra
Division
Function
Geo.area
Patients
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Theoretical framework- structural complexity
Changes in political governance structures

• D. S. Pugh, D. J. Hickson, C. R. Hinings and C.
  Turner (1968). Dimensions of Organization
  Structure Administrative Science Quarterly, Vol.
  13, No. 1, pp. 65-105
• The concept horizontal structural complexity is
  operationalized as follows
• How many unique organizational units are there
  and to what organizational body are the units
  connected to?

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Theoretical finding classification
Changes in political governance structures
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Emperical finding
Changes in political governance structures
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Empirical Finding
Changes in political governance structures

• A majority of the county councils has changed the
  political governance structure
• Changed it towards an EA model
• Political color do not matter/choice of model
• Changes in political governance structures do not
  correspond with changes in political leadership

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Discussion
Changes in political governance structures

• Model implications
• Capture model change, not incremental change
• Degree of centralization
• Size of county council
• Analyzing the other domains
• The EA model
• Change frequency

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Themes for future research and policy development

• Combining models and model change whith
  performance indicators?
• Analyzing centralization capturing incremental
  change
• Changing the organization towards integration or
  differentation? - analyze the structural
  complexity component
• Changes roles of the professional management
• The impact of changes in the political
  goverenance structures in the medical services
  organization?

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Thank you for listening! Jesper.stenberg_at_ki.se
46702969901