Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-26T05:08:01.806Z Has data issue: false hasContentIssue false
  • English
  • Français

The reactions to macro-economic crises in Nordic health system policies: Denmark, Finland and Sweden, 1980–2013

Published online by Cambridge University Press:  21 July 2014

Juhani Lehto ,
Karsten Vrangbæk  and
Ulrika Winblad
Juhani Lehto*
Affiliation:
Professor of Social and Health Policy, School of Health Sciences, University of Tampere, Tampereen yliopisto, Finland
Karsten Vrangbæk
Affiliation:
Professor of Health Policy and Economics, Departments of Political Science and Public Health, University of Copenhagen, Denmark
Ulrika Winblad
Affiliation:
Associate Professor of Health Services Research, Uppsala University, Sweden
*
*Correspondence to: Juhani Lehto, School of Health Sciences, University of Tampere, 33014 Tampereen yliopisto, Finland. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Denmark, Finland and Sweden have experienced two major recessions during the last 25 years. The adjustments to the earlier crisis in the late 1980s (Denmark) and early 1990s (Finland and Sweden) resembled the policies in many other European countries during the present crisis. The analysis of relationship of deep economic crises and growth period between them to the health system policies and institutions in the three countries from the 1980s to 2013 is based on a categorisation of reactions to external shocks as path conforming or path breaking. The results of the empirical long-term trends show that the reactions to deep recessions have been mainly temporary adjustments and acceleration of changes already prepared before economic crisis. The economic crisis in the three countries has not been ‘good enough’ to enable paradigmatic changes in the Nordic public, decentralised and equity-oriented health systems. Changes such as the slow privatisation in care funding and production and the adoption of new management practices indicate an ongoing paradigmatic change related to longer-term societal, ideological and political developments rather than directly to economic crises or growth.

Type
Paper
Information
Health Economics, Policy and Law , Volume 10 , Special Issue 1: SPECIAL ISSUE: Global Financial Crisis, Health and Health Care , January 2015 , pp. 61 - 81
Copyright
© Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alink, F., Boin, A. and ’t Hart, P. (2001), ‘Institutional crises and reforms in policy sectors: the case of asylum policy in Europe’, Journal of European Public Policy, 8(2): 286–306.Google Scholar
Anell, A., Glenngård, A. H. and Merkus, S. (2012), ‘Sweden: health system review’, Health Systems in Transition, 14(5): 1–159.Google Scholar
Anttonen, A. and Häikiö, L. (2011), ‘Care ‘going market’: Finnish elderly-care policies in transition’, Nordic Journal of Social Research, 2(1): 1–21.Google Scholar
Armingeon, K. (2012), ‘The politics of fiscal responses to the crisis 2008–2009’, Governance, 25(4): 543–565.CrossRefGoogle Scholar
Bertelsen, T. and Rostgaard, T. (2013), ‘Marketization in Eldercare in Denmark: Free Choice and the Quest for Quality and Efficiency’, in G. Meagher and M. Szebehely (eds), Marketization in Nordic Eldercare, Stockholm: Department of Social Work, Stockholm University, 127–162.Google Scholar
Blank, R. and Burau, V. (2004), Comparative Health Policy, Houndmills: Palgrave Macmillan.Google Scholar
Blomqvist, P. and Winblad, U. (2014), ‘Sweden: Continued Marketization within a Universalist System’, in E. Pavolini and A. M. Guillen (eds), Health Care Systems in Europe. Institutional Reforms and Performances. Palgrave Macmillan Publishers, 11–28.Google Scholar
Boin, A., ’t Hart, P., Stern, E. K. and Sundelius, B. (2005), The Politics of Crisis Management: Public Leadership Under Pressure, Cambridge: Cambridge University Press.CrossRefGoogle Scholar
Buse, K., Mays, N. and Walt, G. (2005), Making Health Policy, Maidenhead: Open University Press.Google Scholar
Cylus, J., Mladovsky, P. and McKee, M. (2012), ‘Is there a statistical relationship between economic crises and changes in government health expenditure growth? An analysis of twenty-four European countries’, Health Services Research, 47(6): 2204–2224.CrossRefGoogle Scholar
Danish Healthcare Quality Programme (2013), http://www.ikas.dk/IKAS/English.aspx [17 May 2014].Google Scholar
Danish Ministry of Health (2012), Report of changes in acute ambulatory care. http://www.sum.dk/Tal-og-analyser/~/media/Filer%20%20Publikationer_i_pdf/2012/Tal%20og%20analyser/Tal%20på%20sundhed%20april%202012.ashx [12 September 2012].Google Scholar
Dubois, C. A., McKee, M. and Nolte, E. (eds) (2006), Human Resources for Health in Europe, Maidenhead: Open University Press.Google Scholar
Erlandsson, S., Storm, P., Stranz, A., Szebehely, M. and Trydegård, G.-B. (2013), ‘Marketising Trends in Swedish Eldercare: Competition, Choice and Calls for Stricter Regulation’, in G. Meagher and M. Szebehely (eds), Marketisation in Nordic Eldercare: A Research Report on Legislation, Oversight, Extent and Consequences. Report from Normacare, Department of Social Work, Stockholm University.Google Scholar
Esping Andersen, G. (1990), The Three Worlds of Welfare Capitalism, Cambridge: Polity Press.Google Scholar
Eurostat (2014), Statistical Database. www.eurostat.com [17 May 2014].Google Scholar
Fredriksson, M. (2012), ‘Between Equity and Local Autonomy: A Governance Dilemma in Swedish Healthcare’, Dissertation, Acta Universitatis Upsaliensis, Uppsala University, Uppsala.Google Scholar
Freeman, C. (2008), Systems of Innovation: Selected Essays in Evolutionary Economics, Celtenham: Edgar Elgar.CrossRefGoogle Scholar
Häkkinen, U. and Lehto, J. (2005), ‘Reform, change, and continuity in Finnish health care’, Journal of Health Politics, Policy and Law, 30(1–2): 79–96.CrossRefGoogle ScholarPubMed
Kiander, J. (2001), Laman opetukset (Lessons of the Recession), Helsinki: VATT.Google Scholar
Lehto, J. and Viialainen, R. (eds) (1998), Strukturomvandlingen i social- och hälsovården (Structural Change in Social and Health Care), Saarijärvi: Stakes.Google Scholar
Lehto, J. and Blomster, P. (2000), ‘Talouskriisin jäljet sosiaali-ja terveyspalvelujärjestelmässä (The Impact of the Economic Crisis on Social Welfare and Health Care Systems)’, Kunnallistieteellinen aikakauskirja, 28(1): 44–60.Google Scholar
Lehto, J., Moss, N. and Rostgaard, T. (1999), ‘Universal Public Social Care and Health Services?’, in M. Kautto, M. Heikkilä, B. Hvinden, S. Marklund and N. Ploug (eds), Nordic Social Policy. Changing Welfare States, London: Routledge, 104–132.Google Scholar
Linna, M. and Häkkinen, U. (2008), ‘Benchmarking Finnish hospitals’, Advances in Health Economics and Health Services Research, 18(2): 179–190.Google Scholar
Magnussen, J., Vrangbaek, K. and Saltman, R. (eds) (2009), Nordic Health Care Systems. Recent Reforms and Current Policy Challenges, Maidenhead: Open University Press.Google Scholar
Marmot, T. and Wendt, C. (eds) 2011), Reforming Health Care Systems. Volumes I and II, Celtenham: Edgar Elgar.Google Scholar
Miettinen, J., Jussi, T., Lauri, V., Hanna, K., Ulla, T., Timo, M. and Hannamari, M. (2013), ‘Sairaanhoitovakuutuksen korvaamien yksityisten terveyspalvelujen käytön kehitys ja hintavertailu’, Kela Työpapereita 45, Helsinki.Google Scholar
Mladovsky, P., Srivastava, D., Cylus, J., Karanikolos, M., Evetovits, T., Thomson, S. and McKee, M. (2012), Health Policy Responses to the Financial Crisis in Europe. Policy Summary 5, Copenhagen: WHO.Google Scholar
OECD (2014), OECD Statistical Database Paris: OECD.Google Scholar
OECD Health Data (2014), Paris: OECD.Google Scholar
OECD Economic Outlook 94 (2014), Paris: OECD.Google Scholar
Oliver, A. and Mossialos, E. (2005), ‘European health system reforms: looking backward to see forward’, Journal of Health Economics, Policy and Law, 30(1–2): 7–28.CrossRefGoogle ScholarPubMed
Pierson, P. (2000), ‘Increasing returns, path dependence, and the study of politics’, The American Political Science Review, 94(2): 251–267.Google Scholar
Pierson, P. (2001), ‘Post-Industrial Pressures on the Mature Welfare States’, in P. Pierson (ed.), The New Politics of the Welfare State, Oxford: Oxford University Press, 80–106.CrossRefGoogle Scholar
Rostgaard, T. and Fridberg, T. (1998), Caring for Children and Older People: A Comparison of European Policies and Practices, Copenhagen: Danish National Institute of Social Research.Google Scholar
Rostgaard, T. and Lehto, J. (2001), ‘Health and Social Care Systems: How Different is the Nordic Model?’, in M. Kautto, J. Fritzell, B. Hvinden, J. Kvist and H. Uusitalo (eds), Nordic Welfare States in the European Context, London: Routledge.Google Scholar
Rostgaard, T. and Szebehely, M. (2012), ‘Changing policies, changing patterns of care: Danish and Swedish home care at the crossroads’, European Journal of Ageing, 9(2): 101–109.Google Scholar
Saltman, R., Vrangbaek, K., Lehto, J. and Winblad, U. (2012), ‘Consolidating national authority in Nordic health systems’, Eurohealth, 18(3): 21–24.Google Scholar
Selznick, P. (1957), Leadership in Administration: A Sociological Interpretation, Evanston: Peterson.Google Scholar
SKL och SoS (2012), Öppna jämförelser av hälso- och sjukvårdens kvalitet och effektivitet. Jämförelser mellan landsting 2012 (Open Comparisons on the Quality of Health Care 2012), Stockholm: Sveriges Kommuner och Landsting och Socialstyrelsen.Google Scholar
Socialstyrelsen (1996), Social service, vård och omsorg i Sverige (Social Services and Social Care in Sweden), Stockholm: Socialstyrelsen.Google Scholar
Socialstyrelsen (2012), Statistikdatabasen – hälso och sjukvårdspersonal (Statistical Database – Healthcare Employees), Stockholm: Socialstyrelsen.Google Scholar
Stakes (2009), Yksityinen sosiaali- ja terveydenhuolto, tilastoraportti (Private Social and Health Care, Statistical Report), Helsinki: Stakes.Google Scholar
Statistics Denmark (2012), http://www.dst.dk/en/Statistik/emner/valg/folketingsvalg.aspx [1 October 2012].Google Scholar
Statistics Finland (2012), http://www.stat.fi/tk/he/vaalit/index_en.html [1 October 2012].Google Scholar
Statistics Sweden (2012), http://www.scb.se/en_/Finding-statistics/Statistics-by-subject-area/Democracy/General-elections/General-elections-results/ [1 October 2012].Google Scholar
Stolt, R., Blomqvist, P. and Winblad, U. (2011), ‘Privatization of social services: quality differences in Swedish elderly care’, Social Science & Medicine, 72(4): 560–567.Google Scholar
Stone, D. (1999), Policy Paradox: The Art of Political Decision Making, New York: Norton.Google Scholar
Suchman, M. (1995), ‘Managing legitimacy: strategic and institutional approaches’, Academy of Management Review, 20(3): 571–610.Google Scholar
TEM (2012), Terveysalan toimialaraportti (Sectoral Report on Health Service Industry), Helsinki: Ministry of Labour and Industry.Google Scholar
Thomas, S., Keegan, C., Barry, S. and Layle, R. (2012), ‘The Irish Health System and the Economic Crisis’, Lancet, 380(9847): 1056–1057.Google Scholar
Tynkkynen, L. K., Lehto, J. and Miettinen, S. (2011), ‘Framing the decision to contract out elderly care and primary care services’, BMC Health Services Research, 12: 201.Google Scholar
Vuorenkoski, L., Mladovsky, P. and Mossialos, E. (2008), ‘Finland: health system review’, Health Systems in Transition, 10(4): 1–168.Google Scholar
Wilsford, D. (1994), ‘Path dependency, or why history makes it difficult but not impossible to reform health care systems in a big way’, Journal of Public Policy, 14(3): 251–283.Google Scholar
Winblad, U. and Ringard, Å. (2009), ‘Meeting Rising Public Expectations: The Changing Roles of Patients and Citizens’, in J. Magnusson, K. Vrangbaeck and R. Saltman (eds), Nordic Health Care Systems: Recent Reforms and Current Policy Challenges, Maidenhead: Open University Press, 126–150.Google Scholar