Policy analysis of the Swedish primary healthcare reform.

Introduction: Primary healthcare (PHC) in Sweden is under transformation following an extensive governmental reform, called "Good quality, local health care". The reform aims to re-establish PHC as 'front-line care' and to strengthen the quality of PHC, largely by integrating person-centred solutions. Digital solutions are foreseen to play a significant part in the transformation as well as stronger coordination between municipalities and regions. The suggested focus of the reform indicates areas where policy makers think changes are needed. It is important to scrutinize the "solutions" proposed, as problem representations justify or legitimise certain policies or policy solutions. Aim and method: This policy analysis aims to explore problem representations in the Swedish healthcare reform. Four main policies underpinning the reform were identified and documentations of those retrieved. To unpack the 'problems' represented in the reform, the "What is the problem represented to be" (WPR) approach developed by Bacchi was applied (1). Guided by Bacchi, the proposed solutions in the policy documents were analysed and evolved into three preliminary themes, which form the basis for the problem formulations. This paper is work under progress. Key findings: Three overarching problem formulations unfolded. First, by proposing that the development of a modern, accessible, and effective healthcare system that focus on PHC will depend upon a new definition and a common roadmap, the reform represents the 'problem' as a 'nebulous care mission and narrow health system scope'. The second 'problem' was developed based on solutions concerned with strengthening the collaboration between regional and municipal care actors. The reform locates the 'problem' primarily within the organisational realm of the health system while representing it as the 'silos of differentiated care systems and processes'. The third 'problem' builds on solutions intended to bring services closer to people and ensuring that the services are relevant to the needs, wishes and preferences of the patient(s). In this regard, the 'problem' is represented as care that is 'distant and detached from (individual) patients'. Conclusion: The problem representations developed by the policy analysis can be traced to earlier PHC reforms aiming to give the municipalities the responsibility of elderly care (2) and individual patients more power to influence their care (3). The reform is silent on equity between social groups which warrants further scrutiny. Implications to the ICIC 2022 Conference: The paper suits the first theme since personcenteredness is at the core of the reform. Being a policy proposal, it adheres especially well to the sixth pillar which directly addresses policymaking. Knowledge-sharing from Swedish healthcare may thus be useful for other countries in transition. 1. Bacchi C, Eveline J. What's the problem represented to be Mainstreaming Politics: Gendering Practices and Feminist Theory. 2010;111. 2. Edebalk PG. Den dramatiska Ädelreformen. Äldre i centrum: tidskrift för aktuell äldreforskning, 2021, 35, 111-113 3. Burström, B., Burström, K., Nilsson, G., Tomson, G., Whitehead, M., & Winblad, U. (2017). Equity aspects of the Primary Health Care Choice Reform in Sweden-a scoping review. International journal for equity in health, 2017, 16(1), 1-10. [ABSTRACT FROM AUTHOR]