Background Rationing is an apparent activity at all levels in a publicly funded healthcare system. In Sweden, where the main providers of health services are the county councils (CCs), the responsibility for rationing is shared by locally elected politicians, administrators and professionals. Thus, the work of rationing is described differently depending on whom you ask. This paper focus at the policy work for provision on assistive technologies (AT) in two CCs. Issues of ATs affect the users’ quality of life which emphasises the controversial character of rationing. Hence, the work is related to issues of legitimacy.
Objectives To study how provision of AT is organised in the context of rationing.
Methods 57 semi-structured open-ended interviews with prescribers of AT and administrators involved in the provision on AT. Studies of archive data.
Findings These two cases serve as an example of how health workers at different levels encountered various types of pressures that they had to handle, pressures that seldom were in harmony. In order to manage situations the actors interacted, interpreted and negotiated in different locations, and together institutionalised the policy. The approaches differed considerably between the two CCs. In both CCs “mediating institutions” played an important role in this work.
Implications Governance of rationing is not a simple act of craftsmanship by an elusive category of "policy makers", rather it is an interactive work of juggling that involves several actors. Mediating institutions play a crucial role in the governance and could be a way of handling issues of legitimacy.
The 9th Conference of the International Society on Priorities in Health Care. Vancouver, Kanada