By Emmanuele Pavolini, Ana M. Guillén (eds.)
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Extra info for Health Care Systems in Europe under Austerity: Institutional Reforms and Performance
Possibly, the primary care choice reform presents a certain challenge, in that it restricts the ability of the county councils to control the establishment of the health care centers. Still, the county councils are able to control the spending levels through the design of local payment systems. Organizational performance Organizational performance is another area where there are no obvious effects of the regulatory reforms carried out in the system in the 2000s. The structure and organization of the provision of care was reformed already in the 1990s in many county councils, which then undertook substantive rationalization measures in response to the economic crisis during this time (Anell, Glenngård & Merkur, 2012).
However, there are as yet no studies in Sweden linking patient satisfaction to either the primary care choice reform or the waitingtime guarantee, why it is still too early to draw any firm conclusions regarding the relation between these reforms and the level of satisfaction with the system. Social inequalities in access to care Social inequality in access to care has generally not been perceived a big problem in the Swedish system, as it is based on the principle of equal access to care for all on the basis of citizenship.
The mechanisms of change The regulatory reforms introduced in Sweden during the 2000s can be said to represent gradual institutional change. This is reflected, we argue, in the limited scope of the reforms themselves, the largely incremental manner in which they have been implemented and the high degree of continuity in relation to policies in the previous decades. Considering the origins of the changes, there is no doubt that most of them are the products of top-down steering, as they have been initiated by central governments.