Exploring Paths of Justice in the Digital Healthcare : A Socio-Legal Study of Swedish Online Doctors
(2021) In Lund Studies in Sociology of Law 51.- Abstract
- Online doctor services, healthcare provided via smartphone apps, have gone from being peripheral to seriously challenging the conventional Swedish way of providing healthcare services. The accessibility of online doctors is unsurpassed but all patient groups have not gotten better access to healthcare thanks to online doctors.
The aim of this study was to investigate how perceptions of the online doctor service Kry influence the willingness to use said service. This has been achieved through two online surveys conducted in 2016 and 2017, generating two study samples of 1,264 and 882 cases, respectively. Survey items operationalised perceptions of justice as well as benefits and risk beliefs associated with Kry. Statistical... (More) - Online doctor services, healthcare provided via smartphone apps, have gone from being peripheral to seriously challenging the conventional Swedish way of providing healthcare services. The accessibility of online doctors is unsurpassed but all patient groups have not gotten better access to healthcare thanks to online doctors.
The aim of this study was to investigate how perceptions of the online doctor service Kry influence the willingness to use said service. This has been achieved through two online surveys conducted in 2016 and 2017, generating two study samples of 1,264 and 882 cases, respectively. Survey items operationalised perceptions of justice as well as benefits and risk beliefs associated with Kry. Statistical modelling was performed, applying PLS path analysis.
Inspired by the meta-theoretical perspective of critical realism, the aim was also to explain the underlying mechanisms that cause online doctors as a Swedish healthcare phenomenon. This has been achieved through a descriptive analysis based on, for instance, legal documents, governmental reports, regional recommendations, statistics, and newspaper articles. The descriptive study has been guided by Alan Norrie’s sociology of law and the theoretical figure of law’s
architectonic, where the legal is always also the ethico-legal, the juridico political, and the socio-legal.
Results from the surveys and the subsequent statistical modelling showed that the willingness to use Kry was predicted by perceptions of distributive justice, i.e., whether the service was perceived as accessible and inclusive (equality), and whether it was perceived as providing value for time and money spent (equity). Furthermore, perceptions of equality and equity were mediated by perceptions of perceived trust and interest in Kry. Perceptions of procedural justice did not impact the willingness to use Kry to the same extent.
The descriptive study showed that Swedish online doctors as a phenomenon has emerged in a health system shaped by ethico-legal, juridico-political, and what I call econo-legal conflicts. Swedish healthcare law is based on the principle stating that those in most need of care should receive care first and on the overarching goal stating that the healthcare should strive towards an equal healthcare for the entire population. With the free choice of care reform, implemented in 2010, the Swedish health system was transformed into a quasi market and the principle of demand, stating that the patient should receive healthcare when she demands it rather than when she needs it, has entered the health system under the label free choice. This ethical and normative ambivalence is found in and expressed through healthcare law.
Unlike the health system at large, online doctors are well equipped for a healthcare that is becoming increasingly consumer-driven. This may explain why distributive justice predict the will to use Kry. Much like the online marketplace
experience, patients are judging the online doctor experience based on value for time and money spent. (Less) - Abstract (Swedish)
- Nätläkare, vårdgivare som tillhandahåller sjukvårdstjänster via smartphoneappar, har gått från att vara perifera inslag i den svenska sjukvården till att på allvar utmana det konventionella sättet att bedriva sjukvård. Den tillgänglighet som nätläkare erbjuder är oöverträffad men alla patientgrupper har inte sett sin tillgång till vård förbättras i samma utsträckning tack vare nätläkare.
Syftet med studien var att undersöka hur uppfattningar om nätläkartjänsten Kry påverkar viljan att använda tjänsten. Två webbenkäter genomfördes 2016 och 2017, vilket resulterade i två urval om 1264 respektive 882 respondenter. Enkätfrågorna baserades på teorier om upplevd rättvisa samt fördelar och risker förknippade med Kry. PLS-baserad... (More) - Nätläkare, vårdgivare som tillhandahåller sjukvårdstjänster via smartphoneappar, har gått från att vara perifera inslag i den svenska sjukvården till att på allvar utmana det konventionella sättet att bedriva sjukvård. Den tillgänglighet som nätläkare erbjuder är oöverträffad men alla patientgrupper har inte sett sin tillgång till vård förbättras i samma utsträckning tack vare nätläkare.
Syftet med studien var att undersöka hur uppfattningar om nätläkartjänsten Kry påverkar viljan att använda tjänsten. Två webbenkäter genomfördes 2016 och 2017, vilket resulterade i två urval om 1264 respektive 882 respondenter. Enkätfrågorna baserades på teorier om upplevd rättvisa samt fördelar och risker förknippade med Kry. PLS-baserad strukturell ekvationsmodellering tillämpades.
Med det metateoretiska perspektivet kritisk realism som grund var målet också att förklara bakomliggande mekanismer till nätläkare som sjukvårdsfenomen. Detta åstadkoms genom en deskriptiv analys av rättskällor, regionala rekommendationer, statistik och nyhetsartiklar. Här var Alan Norries rättssociologi central; i synnerhet begreppet law’s architectonic, där det rättsliga alltid samtidigt är det etisk-rättsliga, det rättspolitiska och det rättssociologiska.
Resultaten från undersökningarna och den efterföljande statistiska modelleringen visade att respondenternas upplevelse av Kry som distributivt rättvis, dvs om tjänsten upplevdes som tillgänglig och inkluderande (jämlikhet) samt om ett besök ansågs vara värt sitt pris (rimlighet), påverkade respondenternas vilja att använda Kry. Det här sambandet medierades dessutom av respondenternas upplevelse av tillit och intresse i relation till Kry. Upplevelser av processuell rättvisa påverkade inte respondenternas vilja att använda Kry i samma utsträckning.
Den deskriptiva studien visade att nätläkare som fenomen har uppstått i ett hälsosystem format av etisk-rättsliga, rättspolitiska och vad jag har valt att kalla ekonomisk-rättsliga konflikter. Sedan länge bygger svensk hälso- och sjukvårdsrätt på principen att den med störst vårdbehov ska ges vård först. Sjukvården ska dessutom eftersträva en jämlik sjukvård för hela befolkningen. Med 2010 års valfrihetsreform har dock det svenska sjukvårdssystemet omvandlats till en kvasi-marknad, baserad på principen om att patienten ska ges vård när hon efterfrågar det snarare än när hon behöver det. Detta har skapat en etisk och normativ ambivalens i sjukvårdens uppdrag, vilket även den svenska hälso- och sjukvårdsrätten ger uttryck för.
Till skillnad från den svenska sjukvården i stort står nätläkare väl rustade för en vård som har blivit alltmer konsumtionsdriven. Detta kan delvis förklara varför respondenternas upplevelse av distributiv rättvisa i sådan utsträckning påverkar deras vilja att använda Kry. Respondenternas värdering av ett besök hos Kry tycks till stor del baseras på upplevelser om fördelar med tjänsten i förhållande till vad besöket kostar, ett beteende som till mångt och mycket påminner om hur konsumenter agerar i näthandeln. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/34315a1c-ba42-4a3f-8a60-84dfab53dc78
- author
- Bergwall, Peter LU
- supervisor
-
- Måns Svensson LU
- Karl Dahlstrand LU
- opponent
-
- Professor Lemann Kristiansen, Bettina, School of Business and Social Sciences, Aarhus Universitet
- organization
- publishing date
- 2021-04-07
- type
- Thesis
- publication status
- published
- subject
- keywords
- rättssociologi, ehealth, critical realism, distributive justice, ethical principles in healthcare, free choice, healthcare demands, healthcare law and ethics, healthcare need, Kry, latent variables, mHealth, Alan Norrie, online doctors, online survey, PLS path modelling, PLS-SEM, privacy calculus, procedural justice, retail health, SmartPLS, sociology of law, Swedish healthcare, telehealth, quasi-market
- in
- Lund Studies in Sociology of Law
- volume
- 51
- pages
- 242 pages
- publisher
- Department of Sociology of Law, Lund University
- defense location
- Online, Zoom link: https://lu-se.zoom.us/j/62396798039?pwd=UExWM1RBNFpxRGN3OGZmTlgvRTZEUT09 Passcode: 2020
- defense date
- 2021-05-07 13:00:00
- ISSN
- 1403-7246
- ISBN
- 978-91-7895-843-6
- 978-91-7895-844-3
- language
- English
- LU publication?
- yes
- id
- 34315a1c-ba42-4a3f-8a60-84dfab53dc78
- date added to LUP
- 2021-04-14 15:45:39
- date last changed
- 2021-06-02 13:01:11
@phdthesis{34315a1c-ba42-4a3f-8a60-84dfab53dc78,
abstract = {{Online doctor services, healthcare provided via smartphone apps, have gone from being peripheral to seriously challenging the conventional Swedish way of providing healthcare services. The accessibility of online doctors is unsurpassed but all patient groups have not gotten better access to healthcare thanks to online doctors.<br/><br/>The aim of this study was to investigate how perceptions of the online doctor service Kry influence the willingness to use said service. This has been achieved through two online surveys conducted in 2016 and 2017, generating two study samples of 1,264 and 882 cases, respectively. Survey items operationalised perceptions of justice as well as benefits and risk beliefs associated with Kry. Statistical modelling was performed, applying PLS path analysis.<br/><br/>Inspired by the meta-theoretical perspective of critical realism, the aim was also to explain the underlying mechanisms that cause online doctors as a Swedish healthcare phenomenon. This has been achieved through a descriptive analysis based on, for instance, legal documents, governmental reports, regional recommendations, statistics, and newspaper articles. The descriptive study has been guided by Alan Norrie’s sociology of law and the theoretical figure of law’s<br/>architectonic, where the legal is always also the ethico-legal, the juridico political, and the socio-legal.<br/><br/>Results from the surveys and the subsequent statistical modelling showed that the willingness to use Kry was predicted by perceptions of distributive justice, i.e., whether the service was perceived as accessible and inclusive (equality), and whether it was perceived as providing value for time and money spent (equity). Furthermore, perceptions of equality and equity were mediated by perceptions of perceived trust and interest in Kry. Perceptions of procedural justice did not impact the willingness to use Kry to the same extent.<br/><br/>The descriptive study showed that Swedish online doctors as a phenomenon has emerged in a health system shaped by ethico-legal, juridico-political, and what I call econo-legal conflicts. Swedish healthcare law is based on the principle stating that those in most need of care should receive care first and on the overarching goal stating that the healthcare should strive towards an equal healthcare for the entire population. With the free choice of care reform, implemented in 2010, the Swedish health system was transformed into a quasi market and the principle of demand, stating that the patient should receive healthcare when she demands it rather than when she needs it, has entered the health system under the label free choice. This ethical and normative ambivalence is found in and expressed through healthcare law.<br/><br/>Unlike the health system at large, online doctors are well equipped for a healthcare that is becoming increasingly consumer-driven. This may explain why distributive justice predict the will to use Kry. Much like the online marketplace<br/>experience, patients are judging the online doctor experience based on value for time and money spent.}},
author = {{Bergwall, Peter}},
isbn = {{978-91-7895-843-6}},
issn = {{1403-7246}},
keywords = {{rättssociologi; ehealth; critical realism; distributive justice; ethical principles in healthcare; free choice; healthcare demands; healthcare law and ethics; healthcare need; Kry; latent variables; mHealth; Alan Norrie; online doctors; online survey; PLS path modelling; PLS-SEM; privacy calculus; procedural justice; retail health; SmartPLS; sociology of law; Swedish healthcare; telehealth; quasi-market}},
language = {{eng}},
month = {{04}},
publisher = {{Department of Sociology of Law, Lund University}},
school = {{Lund University}},
series = {{Lund Studies in Sociology of Law}},
title = {{Exploring Paths of Justice in the Digital Healthcare : A Socio-Legal Study of Swedish Online Doctors}},
url = {{https://lup.lub.lu.se/search/files/96679301/2021_Bergwall_Exploring_Paths_of_Justice.pdf}},
volume = {{51}},
year = {{2021}},
}