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Portrait of Anna Glenngård. Photo.

Anna Glenngård

Assistant head Accounting and Corporate Finance, Department of Business Administration

Portrait of Anna Glenngård. Photo.

Limited Consequences of a Transition From Activity-Based Financing to Budgeting : Four Reasons Why According to Swedish Hospital Managers

Author

  • Lina Maria Ellegård
  • Anna Häger Glenngård

Summary, in English

Activity-based financing (ABF) and global budgeting are two common reimbursement models in hospital care that embody different incentives for cost containment and quality. The purpose of this study was to explore and describe perceptions from the provider perspective about how and why replacing variable ABF by global budgets affects daily operations and provided services. The study setting is a large Swedish county council that went from traditional budgeting to an ABF system and then back again in the period 2005-2012. Based on semistructured interviews with midlevel managers and analysis of administrative data, we conclude that the transition back from ABF to budgeting has had limited consequences and suggest 4 reasons why: (1) Midlevel managers dampen effects of changes in the external control; (2) the actual design of the different reimbursement models differed from the textbook design; (3) the purchasing body's use of other management controls did not change; (4) incentives bypassing the purchasing body's controls dampened the consequences. The study highlights the challenges associated with improvement strategies that rely exclusively on budget system changes within traditional tax-funded and politically managed health care systems.

Department/s

  • Department of Economics
  • Department of Business Administration

Publishing year

2019-04-15

Language

English

Publication/Series

Inquiry: The Journal of Health Care Organization, Provision and Financing

Volume

56

Document type

Journal article

Publisher

SAGE Publications

Topic

  • Economics and Business
  • Health Care Service and Management, Health Policy and Services and Health Economy

Keywords

  • activity-based financing
  • budgets
  • health care managers
  • health care delivery
  • qualitative research
  • Sweden

Status

Published

Project

  • Public Management Research

ISBN/ISSN/Other

  • ISSN: 0046-9580