FINSAM: Förändring av en välfärdsorganisation genom försöksverksamhet
Research output: Thesis › Doctoral Thesis (monograph)
The subject for this dissertation is an experimental reform (FINSAM) which during the years 1992-1996 has been in progress in five areas within five different administrative provinces (län) in Sweden. The purpose of the experiment was to co-ordinate the resources in the social insurance system and the health and medical services. The reform originated in the context of an increase in social insurance costs during the late 1980s and early 1990s, together with deteriorating financial circumstances for and larger strain on the health and medical services. There was an assumption that transferring resources from the social security to the county council (landsting) budget would lead to shorter waiting lists for treatments, which in term would lead to shorter sick leaves which would entail a decrease in social insurance costs. Existing bases for the decision clearly indicates that the reform should be seen as an economic measure and not as an attempt to improve the medical care for the patients. The theoretical assumption is that difficulties in achieving the goals that are set out prevail because of the structure of the organizations in terms of e. g. co-operation, communication and the agents’ attitudes. The experimental reform should be seen as a form of steering, facilitating the realization of decisions regarding reforms, and possibly changing the organization culture. This is a case-study. The empirical material consists of document analyses and interviews with the project leaders in the experiment areas, district medical officers and family doctors in two of the areas, and patient organizations. Available statistical material has been used to some degree. The results of the study show that the realization of the reform was hampered, mostly in the health and medical services since its organization consists of separate divisions between which there were co-operation problems. The difficulties can also be explained by the communication situation between the managerial function and the care function, and the various agents’ attitude towards the reform. Regarding the state’s steering of the reform, the conclusion is that the implementing authorities were given a decisive influence over the realization. The circumstances and the agents within the different organizations have also had an effect on the conditions for the outcome.
|Research areas and keywords||
Subject classification (UKÄ) – MANDATORY
|Award date||1997 Mar 6|
|Publication status||Published - 1997|
Defence details Date: 1997-03-06 Time: 10:15 Place: Carolinasalen, Lunds universitet External reviewer(s) Name: Isacsson, Åke Title: [unknown] Affiliation: [unknown] ---