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FINSAM: Förändring av en välfärdsorganisation genom försöksverksamhet

Hammarsköld, Claes-Göran LU (1997)
Abstract (Swedish)
Popular Abstract in Swedish

1993 inleddes FINSAM, en försöksverksamhet för finansiell samordning av socialförsäkringens och hälso- och sjukvårdens resurser i fem svenska landsting. Genom att erbjuda tidigare vård och olika typer av rehabilitering hoppades man kunna reducera antalet sjukskrivningsdagar. Syftet var att minska kostnaderna i sjukförsäkringen samtidigt som man utan budgetbelastning skulle kunna bygga ut hälso- och sjukvården.



Att genomföra en samordning av det här slaget skulle normalt kräva en lagändring. Genom att istället utforma den som en försöksverksamhet kan man bygga upp och pröva en organisation utan den tidskrävande procedur som lagstiftning innebär. Samtidigt undviker man den... (More)
Popular Abstract in Swedish

1993 inleddes FINSAM, en försöksverksamhet för finansiell samordning av socialförsäkringens och hälso- och sjukvårdens resurser i fem svenska landsting. Genom att erbjuda tidigare vård och olika typer av rehabilitering hoppades man kunna reducera antalet sjukskrivningsdagar. Syftet var att minska kostnaderna i sjukförsäkringen samtidigt som man utan budgetbelastning skulle kunna bygga ut hälso- och sjukvården.



Att genomföra en samordning av det här slaget skulle normalt kräva en lagändring. Genom att istället utforma den som en försöksverksamhet kan man bygga upp och pröva en organisation utan den tidskrävande procedur som lagstiftning innebär. Samtidigt undviker man den granskaning som lagförslag genomgår, medan den organisation som byggs upp under försöksperioden kan bli svår att bryta ner. I denna rättssociologiska studie av FINSAM ställs bland annat frågorna: Har försöksverksamheten blivit ett nytt styrmedel? Kan vår välfärdsorganisation permanent förändras utan rättslig kontroll? (Less)
Abstract
The subject for this dissertation is an experimental reform (FINSAM) which during the years 1992-1996 has been in progress in five areas within five different administrative provinces (län) in Sweden. The purpose of the experiment was to co-ordinate the resources in the social insurance system and the health and medical services. The reform originated in the context of an increase in social insurance costs during the late 1980s and early 1990s, together with deteriorating financial circumstances for and larger strain on the health and medical services. There was an assumption that transferring resources from the social security to the county council (landsting) budget would lead to shorter waiting lists for treatments, which in term would... (More)
The subject for this dissertation is an experimental reform (FINSAM) which during the years 1992-1996 has been in progress in five areas within five different administrative provinces (län) in Sweden. The purpose of the experiment was to co-ordinate the resources in the social insurance system and the health and medical services. The reform originated in the context of an increase in social insurance costs during the late 1980s and early 1990s, together with deteriorating financial circumstances for and larger strain on the health and medical services. There was an assumption that transferring resources from the social security to the county council (landsting) budget would lead to shorter waiting lists for treatments, which in term would lead to shorter sick leaves which would entail a decrease in social insurance costs. Existing bases for the decision clearly indicates that the reform should be seen as an economic measure and not as an attempt to improve the medical care for the patients. The theoretical assumption is that difficulties in achieving the goals that are set out prevail because of the structure of the organizations in terms of e. g. co-operation, communication and the agents’ attitudes. The experimental reform should be seen as a form of steering, facilitating the realization of decisions regarding reforms, and possibly changing the organization culture. This is a case-study. The empirical material consists of document analyses and interviews with the project leaders in the experiment areas, district medical officers and family doctors in two of the areas, and patient organizations. Available statistical material has been used to some degree. The results of the study show that the realization of the reform was hampered, mostly in the health and medical services since its organization consists of separate divisions between which there were co-operation problems. The difficulties can also be explained by the communication situation between the managerial function and the care function, and the various agents’ attitude towards the reform. Regarding the state’s steering of the reform, the conclusion is that the implementing authorities were given a decisive influence over the realization. The circumstances and the agents within the different organizations have also had an effect on the conditions for the outcome. (Less)
Please use this url to cite or link to this publication:
author
opponent
  • Isacsson, Åke
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Social problems and welfare, sociology of law, organization, social reform, social steering, medical health system, welfare state, social insurance, welfare policy, national insurance, Sociala problem, social välfärd, socialförsäkring
pages
286 pages
publisher
Bokbox förlag
defense location
Carolinasalen, Lunds universitet
defense date
1997-03-06 10:15
external identifiers
  • Other:ISRN: LUSADG/SARS--97/1018--SE
ISBN
91-86980-19-X
language
Swedish
LU publication?
yes
id
d1a2681e-a011-426b-9be6-fc62d9bcfe03 (old id 18159)
date added to LUP
2007-05-24 11:20:06
date last changed
2016-09-19 08:45:13
@misc{d1a2681e-a011-426b-9be6-fc62d9bcfe03,
  abstract     = {The subject for this dissertation is an experimental reform (FINSAM) which during the years 1992-1996 has been in progress in five areas within five different administrative provinces (län) in Sweden. The purpose of the experiment was to co-ordinate the resources in the social insurance system and the health and medical services. The reform originated in the context of an increase in social insurance costs during the late 1980s and early 1990s, together with deteriorating financial circumstances for and larger strain on the health and medical services. There was an assumption that transferring resources from the social security to the county council (landsting) budget would lead to shorter waiting lists for treatments, which in term would lead to shorter sick leaves which would entail a decrease in social insurance costs. Existing bases for the decision clearly indicates that the reform should be seen as an economic measure and not as an attempt to improve the medical care for the patients. The theoretical assumption is that difficulties in achieving the goals that are set out prevail because of the structure of the organizations in terms of e. g. co-operation, communication and the agents’ attitudes. The experimental reform should be seen as a form of steering, facilitating the realization of decisions regarding reforms, and possibly changing the organization culture. This is a case-study. The empirical material consists of document analyses and interviews with the project leaders in the experiment areas, district medical officers and family doctors in two of the areas, and patient organizations. Available statistical material has been used to some degree. The results of the study show that the realization of the reform was hampered, mostly in the health and medical services since its organization consists of separate divisions between which there were co-operation problems. The difficulties can also be explained by the communication situation between the managerial function and the care function, and the various agents’ attitude towards the reform. Regarding the state’s steering of the reform, the conclusion is that the implementing authorities were given a decisive influence over the realization. The circumstances and the agents within the different organizations have also had an effect on the conditions for the outcome.},
  author       = {Hammarsköld, Claes-Göran},
  isbn         = {91-86980-19-X},
  keyword      = {Social problems and welfare,sociology of law,organization,social reform,social steering,medical health system,welfare state,social insurance,welfare policy,national insurance,Sociala problem,social välfärd,socialförsäkring},
  language     = {swe},
  pages        = {286},
  publisher    = {ARRAY(0x6ab3d20)},
  title        = {FINSAM: Förändring av en välfärdsorganisation genom försöksverksamhet},
  year         = {1997},
}