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Cooperation has long been important within both regional andmunicipal activities and there is much to suggest thatcollaboration needs will increase even more. Within health care there is onecontinuous development towards new and more specialized knowledge that also gains organizational consequences. Teamwork in healthcare has become increasingly important, as well level structuring and concentration of highly specialized care. This development is also affected by challenges in the form of finances and supply of skills. The greatest challenge for future care is generally considered to be the recruitment of sufficient competence and capacity, rather than a lack of money. It becomes essential to use the competence and capacity that actually exists so effectively as possible.This report presents an evaluation of the Southern Healthcare Region's workwith the name Collaboration for better care (SFBV), mainly when it comes to itworking method used in sub-projects and what the overall results areachieved. The aim is to highlight success factors, obstacles and challenges as well identify and make suggestions for measures that can improve the possibilities for the future collaborative project to achieve the goals. The following sub-questions are answered:• What perceptions exist regarding the work and decision-making process for "Cooperation for better care"?• What is the quality of the final and follow-up reports?• What results have been achieved for the completed sub-projects? How to communicate assignments and results?• Which success factors and respective challenges and obstacles can be identified?• What actions can improve the opportunities for future collaborative projects to reach the goals?The evaluation is based on empirical material in the form of 26 interviews withconcerned actors and documentation and reports from a selection consisting ofof 22 completed sub-projects. The empirical material is analyzed usingliterature on collaboration and governance through agreem

Reducing socioeconomic health inequalities is a key goal of most health systems. When care providers are paid prospectively, e.g., by a fixed sum per patient, existing inequalities may be sustained by the incentives to undertreat relatively unhealthy patients. To counter these incentives, prospective payments are often risk-adjusted based on observable patient characteristics. Despite that risk adjustment (RA) is widely used, empirical evidence is lacking on how it affects the behavior of care providers. This paper provides such evidence using detailed administrative data from a Swedish region. We examine how a novel RA model applied to the prospective payment for primary care providers – capitation – affected socioeconomic differences in care utilization among individuals with a chronic condition. On average, the new RA model implied substantial increases of the capitation for patients with low socioeconomic status (SES). Yet, we do not find any robust evidence of greater access to primary care for individuals with low SES relative to individuals with high SES after the model was introduced. We find a small increase in hospital emergency department visits (a substitute to primary care), but no effects on hospitalizations. These results do not suggest that the new RA model reduced socioeconomic health inequalities. Our findings highlight that a risk-adjusted prospective payment may not by itself guide treatment decisions. We discuss other governance and management policies that may address undesired health inequalities.

Market frictions, such as imperfect information or hassle costs, may reduce benefits from market incentives in healthcare settings. We use data from two randomised policy interventions in a Swedish region, which improved the access to provider information and reduced the switching costs of one percent of the adult population and of a sample of new residents. We examine the effects of the interventions on a large number of clinical process quality measures, access to care, and adverse health events, measured at the individual level. We find no significant effect of the interventions on any of the quality measures.

Consumers of services that are financed by a third party, such as publicly financed health care or firm-sponsored health plans, are often allowed to freely choose provider. The rationale is that consumer choice may improve the matching of consumers and providers and spur quality competition. Such improvements are contingent on consumers having access to comparative information about providers and acting on this information when making their choice. However, in the presence of information frictions and switching costs, consumers may have limited ability to find suitable providers. We use two large-scale randomized field experiments in primary health care to examine if the choice of provider is affected when consumers receive comparative information by postal mail and small costs associated with switching are reduced. The first experiment targeted a subset of the general population in the Swedish region Skåane, and the second targeted new residents in the region, who should have less prior information and lower switching costs. In both cases, the propensity to switch provider increased significantly after the intervention. The effects were larger for new residents than for the general population, and were driven by individuals living reasonably close to alternative providers.

Objective: A pay for performance programme was introduced in 2009 by a Swedish county with 1.6 million inhabitants. A process measure with payment linked to coding for medication reviews among the elderly was adopted. We assessed the association with inappropriate medication for five years after baseline.Design and setting: Observational study that compared medication for elderly patients enrolled at primary care units that coded for a high or low volume of medication reviews.Patients: 144,222 individuals at 196 primary care centres, age 75 or older.Main outcome measures: Percentage of patients receiving inappropriate drugs or polypharmacy during five years at primary care units with various levels of reported medication reviews.Results: The proportion of patients with a registered medication review had increased from 3.2% to 44.1% after five years. The high-coding units performed better for most indicators but had already done so at baseline. Primary care units with the lowest payment for coding for medication reviews improved just as well in terms of inappropriate drugs as units with the highest payment – from 13.0 to 8.5%, compared to 11.6 to 7.4% and from 13.6 to 7.2% vs 11.8 to 6.5% for polypharmacy.Conclusions: Payment linked to coding for medication reviews was associated with an increase in the percentage of patients for whom a medication review had been registered. However, the impact of payment on quality improvement is uncertain, given that units with the lowest payment for medication reviews improved equally well as units with the highest payment.

The Nordic countries represent an institutional setting with tax-based health care financing and universal access to health care services. Very few health care services are excluded from what are offered within the publically financed health care system. User fees are often non-existing or low and capped. Nevertheless, the markets for voluntary private health insurance (VPHI) have been rapidly expanding. In this paper we describe the development of the market for VPHI in the Nordic countries. We outline similarities and differences and provide discussion of the rationale for the existence of different types of VPHI. Data is collected on the population covered by VPHI, type and scope of coverage, suppliers of VPHI and their relations with health providers. It seems that the main roles of VPHI are to cover out-of-pocket payments for services that are only partly financed by the public health care system (complementary), and to provide preferential access to treatments that are also available free of charge within the public health care system, but often with some waiting time (duplicate)., The Nordic countries represent an institutional setting with tax-based health care financing and universal access to health care services. Very few health care services are excluded from what are offered within the publically financed health care system. User fees are often non-existing or low and capped. Nevertheless, the markets for voluntary private health insurance (VPHI) have been rapidly expanding. In this paper we describe the development of the market for VPHI in the Nordic countries. We outline similarities and differences and provide discussion of the rationale for the existence of different types of VPHI. Data is collected on the population covered by VPHI, type and scope of coverage, suppliers of VPHI and their relations with health providers. It seems that the main roles of VPHI are to cover out-of-pocket payments for services that are only partly financed by the public health care system (complementary), and to provide preferential access to treatments that are also available free of charge within the public health care system, but often with some waiting time (duplicate).