The Municipality as Negotiator in Multilevel Governance of Health Care

2015 ◽  
Vol 11 (2) ◽  
Author(s):  
Gro Sandkjær Hanssen ◽  
Marit Kristine Helgesen ◽  
Ann Karin Tennås Holmen
Keyword(s):  
Health Care ◽  
Health Services ◽  
Chief Executive ◽  
Multilevel Governance ◽  
Regional Health ◽  
Health Care Coordination ◽  
Health Authorities ◽  
Regional Health Authorities ◽  
Political Steering

AbstractThis article focuses on the new role of municipalities–as negotiators in multilevel governance of health services. The 2012 health care coordination reform in Norway involves a partnership between health services at the national and municipal levels. Negotiations in these regional partnerships result in regionally different solutions concerning the provision of health services. What does this new role of municipalities require with regards to political steering and administrative management? From interviews in nine municipalities and two regional health authorities, the authors find that the formal cooperation agreements have affected the interaction between municipalities and regional health authorities, with a shift from professional deliberation to strategic negotiations. The new negotiating role of the municipalities requires political will to clarify the room of maneuver for the negotiating actors and support the negotiating solutions when these are within the defined frames. The negotiations stimulate integration between management and professionals, in order to inform the chief executive officer, who is often the negotiator. The negotiators assume an essential role as bridge-builders between the political and professional world in the municipalities, and the professional world of the hospitals and regional health authorities.

Revisiting Health Regionalization in Canada

2016 ◽  
Vol 47 (2) ◽  
pp. 333-351 ◽  
Author(s):  
Paul Barker ◽  
John Church
Keyword(s):  
Health Care ◽  
Health Services ◽  
Health Care Systems ◽  
Health Care Expenditures ◽  
Regional Health ◽  
Health Authorities ◽  
Care Systems ◽  
Physician Care ◽  
Regional Health Authorities ◽  
Regional Authorities

Twenty years ago, many of Canada’s provinces began to introduce regional health authorities to address problems with their health care systems. With this action, the provinces sought to achieve advances in community decision-making, the integration of health services, and the provision of care in the home and community. The authorities were also to help restrict health care costs. An assessment of the authorities indicates, however, that over the past two decades they have been unable to meet their objectives. Community representatives continue to play little role in determining the appropriate health services for their regions. Gains have been made towards integrating health services, but the plan for a near seamless set of health services has not been realized. Funding for health services remains focused on hospital and physician care, and health care expenditures have until very recently been little affected by regional authorities. This disappointing performance has caused some provinces to abandon their regional authorities, but this article argues that the provision of greater autonomy and a better public appreciation of their role and potential may lead to more successful regional authorities. Accordingly, the objective of this article is to reveal the shortcomings of regional health authorities in Canada while at the same time arguing that changes can be made to increase the chances of more workable authorities.

scholarly journals Formal priority setting in health care: the Swedish experience

2016 ◽  
Vol 30 (6) ◽  
pp. 891-907 ◽  
Author(s):  
Peter Garpenby ◽  
Karin Bäckman
Keyword(s):  
Health Care ◽  
Priority Setting ◽  
National Level ◽  
Regional Health ◽  
Bottom Up ◽  
Content Type ◽  
Political Conflicts ◽  
Health Authorities ◽  
Financial Pressure ◽  
Regional Health Authorities

Purpose From the late 1980s and onwards health care in Sweden has come under increasing financial pressure, forcing policy makers to consider restrictions. The purpose of this paper is to review experiences and to establish lessons of formal priority setting in four Swedish regional health authorities during the period 2003-2012. Design/methodology/approach This paper draws on a variety of sources, and evidence is organised according to three broad aspects: design and implementation of models and processes, application of evidence and decision analysis tools and decision making and implementation of decisions. Findings The processes accounted for here have resulted in useful experiences concerning technical arrangements as well as political and public strategies. All four sites used a particular model for priority setting that combined top-down- and bottom-up-driven elements. Although the process was authorised from the top it was clearly bottom-up driven and the template followed a professional rationale. New meeting grounds were introduced between politicians and clinical leaders. Overall a limited group of stakeholders were involved. By defusing political conflicts the likelihood that clinical leaders would regard this undertaking as important increased. Originality/value One tendency today is to unburden regional authorities of the hard decisions by introducing arrangements at national level. This study suggests that regional health authorities, in spite of being politically governed organisations, have the potential to execute a formal priority-setting process. Still, to make priority-setting processes more robust to internal as well as external threat remains a challenge.

The role of regional health systems on the waiting time inequalities in health care services: Evidences from Italy

2020 ◽  
pp. 095148482092830
Author(s):  
Stefano Landi ◽  
Enrico Ivaldi ◽  
Angela Testi
Keyword(s):  
Health Care ◽  
Health Systems ◽  
Waiting Time ◽  
Health Care Access ◽  
Health Care Services ◽  
Waiting Times ◽  
Healthcare Services ◽  
Regional Health ◽  
Health Authorities ◽  
Regional Health Authorities

Inequalities in effective access to healthcare are present among countries and within the same country. Despite in Italy exist the principle of equity in access to health system, there are evidence of different access rates in the form of unequal waiting time within the country. Waiting times are an instruments to ration healthcare services dealing with resource scarsity. Theoretically, it is a fair tool because waiting times should depend only on health needs and not on the ability to pay. However, a growing literature has pointed out that belonging to a particular socioeconomic status leads to waiting times inequalities for healthcare services. Many countries have socioeconomic disparities among regions, and healthcare organizations need to take into account these differences. The increasing power of Regional Health Authorities in decentralized health systems, as in the case of Italy, has generated different organizational ways to provide health care, possibly leading to different access rates in the form of unequal waiting time within the country. This paper aims to understand if the administrative area (Regional Health Authorities) in charge of health services affects waiting times lowering or strengthening health care access inequalities. Using a series of logistic regression models, this work suggests the presence of two vectors: socioeconomic inequalities and regional inequalities. Health organizations need to implement different kinds of answers for each vectors of inequalities.

Assessing the Removal of Regional Health Authorities in Ontario

2021 ◽  
pp. e2020105
Author(s):  
Paul Barker
Keyword(s):  
Health Care ◽  
Health Authority ◽  
Effective Control ◽  
Local Health ◽  
Regional Health ◽  
Health Authorities ◽  
Connected Set ◽  
Regional Health Authorities ◽  
The Many ◽  
Regional Authorities

A little more than a decade ago, a series of regional bodies were introduced throughout Ontario to help resolve difficulties with the province’s health care system. The Local Health Integration Networks, the name given to the new health entities, sought to create a connected set of health services and to achieve more effective control and distribution of health care finances. A third intent was to engage the community when setting priorities for health care. Recently, the new government of Ontario replaced the LHINs with a single health authority. It asserted that the single authority was better equipped to handle the many problems that still prevailed. An assessment of this decision offers some grounds for disbanding the LHINs. However, the findings offer stronger support for the alternative of keeping the regional authorities and providing them with greater autonomy.

scholarly journals Recruitment into psychiatry

1996 ◽  
Vol 20 (3) ◽  
pp. 177-177 ◽  
Author(s):  
David Storer
Keyword(s):  
Advisory Committee ◽  
Manpower Planning ◽  
Regional Health ◽  
Senior Registrar ◽  
Adequate Supply ◽  
Health Authorities ◽  
Joint Planning ◽  
Regional Health Authorities

The major problem of manpower planning in psychiatry has until fairly recently been one of securing enough posts in the training grades to place doctors wishing to train in psychiatry and to ensure an adequate supply of applicants for consultant posts. Numerous consultant vacancies and a ‘bottleneck’ between registrar and senior registrar grades was the frustrating combination largely consequent upon the failure of some regional health authorities to fund the posts which Joint Planning Advisory Committee (JPAC) had approved.

scholarly journals The role of health care workers in collaborating with traditional healers in primary health care. Part 1

1997 ◽  
Vol 2 (1) ◽  
pp. 29-35 ◽  
Author(s):  
Rosemare Troskie
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Services ◽  
Health Plan ◽  
Health Care Workers ◽  
Full Text ◽  
Traditional Healers ◽  
Primary Health ◽  
Care Workers

The Reconstruction and Development Plan as well as the National Health Plan of the ANC supports the reorganisation of health services. OpsommingDie Heropbou en Ontwikkelingsprogram sowel as die Nasionale Gesondheidsplan van die ANC staan die herorganisasie van gesondheidsdienste voor. *Please note: This is a reduced version of the abstract. Please refer to PDF for full text.

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