suggest that the transition will run along the following lines in two
distinct regions:
1. Urban Areas
Policies and solutions will become less homogeneous. In the bigger urban
areas, income, education and political trends will favor provider pluralism
and - incrementally - additional financing (private insurance).
Hospitals now owned by the regional authorities will turn into publicly
traded companies; this measure will increase productivity and budget
control.
Private providers will expand as successive sectors (e.g., nursing homes,
public dentistry) are forced to compete.
Public and private producers will build alliances. International companies
will enter the market and operate hospitals that were once publicly owned.
2. Rural Areas
In more traditionalist parts of the country, generally those with sparser,
older and less well educated populations, you will not see much change.
The regional and local governments will hesitate to contract out services.
These areas will also attract fewer entrepreneurs (who, of course, prefer
environments where competition is welcomed).
Patients will still be willing to stand in line for treatment.
The aggressive consumer will have hardly any impact on the northern parts of
Sweden.
PATIENT VOUCHERS IN A DECENTRALIZED MARKETPLACE
Efficiency will rapidly become the single most important driving factor. Not
from a narrow budget perspective, but from a value-for-money and
quality-of-life viewpoint, How can I best use my (tax) money to improve my
health and quality of life? will become an increasingly common question
among young people as private pension funds and other savings grow at high
rates.
The political system will lose much of its power (not without controversy,
of course). Fewer citizens, as sophisticated consumers, will trust elected
bodies to solve the problems of the individual through collective measures.
With better education and higher levels of social competence, people will
feel comfortable creating their own solutions within the publicly financed
system.
The ever more apparent potential for dramatic improvements will keep up the
pressure for change. The combination of pharmaceutical and technological
advancements is already opening new possibilities every day. It's doubtful
that the system will withstand the pressure for better, albeit more costly,
service by saying no to individual needs. When patients ask for the latest
treatment, the financial aspect will become crucial.
In ten years' time, basic health care will still be financed by taxes, but
many services will be for sale in the out-of-pocket or private insurance
markets. Regional authorities will be responsible for most of the hospitals,
but private contractors will operate from within these facilities.
In large parts of the country, primary health care will be privately owned
and operated but publicly paid for through patient vouchers. In general,
networking will be the predominant approach; i.e., combinations of public
and private suppliers will be seen in many fields.
Throughout Sweden, the focus will center on customer satisfaction in a
system that measures and guarantees quality outputs, including
evidence-based routines and best-practice treatments. Working conditions
within the care services will improve noticeably, thanks to stronger owners,
better management, expanding career opportunities and the efforts of manpowe
r companies.
Care will no longer be looked upon as a basically political question, but as
a matter between well-informed consumers and their partners in the
healthcare field.
*Johan Hjertqvist has successively been entrepreneur, consultant, deputy
mayor of the city of Tyreso, author and research director on the reform of
social services in Sweden. He took part in the creation of a Nordic body
tasked with implementing modern health care in the Baltic States. He acts as
adviser to the Greater Stockholm Council on the health system and is
director of Health in transition, a four-year pilot project whose
objective is to describe and analyze the operation of a competitive market
within the public system. In addition, he is currently writing a book about
how the combination of new consumer values and scientific progress will
change the meaning of health care.
- Original Message -
From: Michael Perelman [EMAIL PROTECTED]
To: [EMAIL PROTECTED]
Sent: Thursday, June 13, 2002 5:23 PM
Subject: [PEN-L:26871] Re: Costly privatizing of firefighting
Does anybody know of any examples where privatization has created any
efficiencies other than attacking wages and working conditions? Does
anyone know of any case where it has not increased overhead and
administrative bloat?
--
Michael Perelman
Economics Department
California State University
Chico, CA 95929
Tel. 530-898-5321
E-Mail [EMAIL PROTECTED]
