AbstractsEconomics

The process of reforming health care systems was initiated in several industrialized countries for more than two decades ago, but so far, we have limited knowledge of the outcome of the reforms. The present study was designed to research institutional changes as a result of changes in financial reallocation. The research question was: how does a change from horizontal to vertical financial reallocation contribute to apolysis, integration and technicalization of health care services? To study institutional changes a novel concept, apolysis, was created and defined for its content covering structural, operational, contentual and contextual changes. The target for the investigation was the public specialist-based hospital care in Finland, were the financial reallocation of hospitals had been changed from a horizontal and independent to a vertical and resource dependent form. This change in financial reallocation occurred in 1992. Forty-eight of 51 eligible public hospitals were included and the study period covered 15 years, from 1988 to 2002. The period from 1988 to 1992 served as control period and the interval from 1993 to 2002 as the period of intervention. Reallocation promoted institutional pressures and initiated a deinstitutionalization process. Structural, operational, contentual and contextual changes occurred on all levels of hospital care studied. Horizontal more than vertical integration was supported among providers of hospital care services. A previous social environment was transferred in a more technical oriented direction. The amount of ward as well as outpatient clinic services increased significantly for all disciplines of specialized care, in internal medicine and in surgery, less in gynecology. The onset of increase was closely related to the very early years after reallocation in 1992. Reallocation promoted further hospital productivity and cost-efficiency in surgery and internal medicine, but the effect was modest. Useissa teollistuneissa maissa käynnistettiin terveydenhuoltojärjestelmien muutosprosessi noin 20 vuotta sitten. Uudistusten vaikutuksista meillä on kuitenkin edelleen varsin vähän tietoa. Tässä tutkimuksessa haluttiin selvittää, minkälaisia institutionaalisia muutoksia syntyy, kun rahoituspohjaa muutetaan. Päätavoitteena oli saada selville, miten horisontaallisesta vertikaaliseksi muuttunut rahoituspohjan muutos vaikuttaa institutionaaliseen apolyysiin, integratioon ja teknistymiseen palveluiden tuottamisessa. Institutionaalisten muutosten mittaamiseksi luotiin uusi käsite, apolyysi, joka tarkoittaa rakenteellisia, operatiivisia, kontentuaalisia ja kontekstuaalisia muutoksia. Suomen 51 erikoissairaanhoitoa tuottavasta julkisesta sairaalasta 48 sairaalaa osallistui tutkimukseen. Sairaaloissa muuttui rahoituspohja v 1992 horisonttaalisesta ja riippumattomasta vertikaaliseksi ja riippuvaiseksi. Tutkimus käsitti 15 vuotta, vuodesta 1988 vuoteen 2002, ja se jakaantui kahteen osaan: kontrollijakso 1988-1992 ja tutkimusjakso 1993-2002. Rahoituspohjan muutos aiheutti institutionaalisia…