In tension between primary care and hospital care

What are the conditions for successful implementation of the new primary care reform?

Project description

The Swedish government has recently initiated a primary care reform which implies two central objectives: that health care should be as accessible as possible, and that it should be maximally personalized and adapted to individual circumstances. Instead of focusing solely on hospital-based care, the underlying motivation is to implement healthcare interventions within the context of a patient’s home or at a local care facility– such as a primary care center where municipal and regional actors converge and collaborate. By developing an ethos of “close care” and implementing support for increased collaboration, the reform aims to improve citizen accessibility, patient participation, and continuity of care. Broadly, the long-term objective is to develop a more person-centered health care.

The primary care reform entails a major restructuring of the current health-care model which is primarily centered on hospital-based care. This change requires not only new organizational solutions and working methodologies, but also reallocation of resources from hospitals to primary care networks. Implementing such large-scale changes will undoubtedly pose many difficulties. Particularly in the case of Sweden– with its pronounced multi-level governance system and well-established medical professions– the primary care reform will entail great challenges, especially concerning the working relationships between national and regional systems, as well as between different organizations and professional groups within the healthcare system.

Through a close analysis of the unfolding implementation of the Swedish primary care reform, the research project aims to investigate how regional actors balance the national government’s primary care objectives with their own regional priorities, demands, and specific organizational circumstances. Additionally, the project aims to assess regional implementation of the primary care reform with regards to the stated objectives of healthcare accessibility, patient participation, and continuity. Therefore, this project will contribute relevant and timely knowledge concerning aspects about reform and systemic implementation in multi-level governance including: power relations between national and regional levels of government; regional capacities and abilities to facilitate organizational change; and the role played by professional norms and interests in the process of implementing reform.