Journal of health politics, policy and law
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J Health Polit Policy Law · Jan 1995
Comparative StudyHealth care reform in Sweden in the 1990s: local pluralism versus national coordination.
Because of the poor state of the Swedish economy, publicly provided health care services, like other welfare services, are increasingly vulnerable to possible cutbacks. A growing discontent among the public in the late 1980s paved the way for experiments with new economic incentives among health care providers. ⋯ The prospects for implementing major organizational changes in health care through a top-down procedure, however, are limited. The appointment of the Committee on Funding and Organization of Health Care in 1992 by the previous government can be regarded as merely a way to show activity rather than as an instrument to achieve meaningful change.
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Race continues to impede access to health services, for acute as well as long-term care. Whites, for example, use disproportionately more days of nursing home care than nonwhites, not simply because they are more likely to be private payers and, therefore, are preferred over nonwhites: the difference in utilization persists even among those whose nursing home stays are covered by Medicare. Using data from a study of patients awaiting alternative placement in North Carolina acute care general hospitals in 1991, this article examines racial differences in discharge delay, that is, in the time between when a patient is medically ready for discharge to another form of care and when he or she actually is discharged. ⋯ The inescapable conclusion is that nursing homes discriminate on the basis of race in admitting patients. This practice is patently objectionable; it also is costly to hospitals, thus to society, since hospitals bear the direct costs of delayed discharges and hospitals do not keep costs to themselves. While research is needed to determine whether the North Carolina findings are replicable in other states, past research suggests that the problem is not confined to this state.
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J Health Polit Policy Law · Jan 1993
ReviewLay participation in health care decision making: a conceptual framework.
Lay participation in health care decision making has attracted increasing interest in Canada, with numerous provincial government reports advocating this initiative. Interest stems from a number of factors. Among them is a growing recognition that patient preferences ought to be incorporated into decision making that involves individual treatment choices. ⋯ There is, however, still considerable confusion over what lay participation really means. In addition, little consideration has been given to whether and how lay participation can lead to better decision making and the criteria by which it should be judged. This article presents a framework based on decision-making domains, role perspectives, and levels of participation and is intended as an initial step toward providing greater conceptual clarity regarding the key dimensions and goals of lay participation in health care decision making.