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Table 2 Regional collaboration as a basis for Population Health Management: expectations, intended PHM strategies and prior experiences as reported by stakeholders

From: How executives’ expectations and experiences shape population health management strategies

Stakeholder groups’*expectation (short (5-), middle (10-), long (20 years) term) Stakeholder groups’ intended strategies (short (5-), middle (10-), long (20 years) term)
Short HCI, M, PCG, PM: Increased collaboration across sectors with an increasing number of stakeholders with an increasing number of target groups. H, HCI: Increased collaboration within the care sector on specific population groups. Value for money is established.
B, H, HCI, M, PCG, PM, PRO: Collaboration is increasingly based on a regional vision - M, PRO, B: and increasingly based on (above) regional coordination mechanisms from a social-economic perspective.
HCI: Main focus on care sector. Sharpen hospital profiles by allocation, substitution and concentration of specific care. Slowly increase collaboration with municipalities. H: Keep complex care in hospital. Delay the shift of low complex care.
HCI: Investments in regional relationships. Intensify collaboration with municipalities.
B, M, HCI, PCG, PM, PRO: Investments in shared responsibility based on a long-term vision – data and funding that support an integral policy (H, HCI, PCG, PM) - from a social-economic perspective (B, M, PRO).
Middle HCI, M, PCG, PM: Collaboration across sectors with an increasing number of stakeholders with an increasing number of target groups continuous.
M, HCI, PCG, PM: Increased collaboration between municipalities and healthcare insurers. Shift from curative to preventive care and self-management.
B, HCI, M, PCG, PRO: Stabilization of decentralization** via sustainable collaboration between regional stakeholders.
HCI: idem short term.
PCG: Expand collaboration with hospitals on current projects and in Public Private Partnerships and with other stakeholders in social sector.
H, HCI, M, PCG, PM, PRO: Organize larger projects and projects that have more impact on TA, more prevention, more stakeholders using concepts such as Positive Health.
Long B, H, HCI, M, PCG, PM, PRO: Regional health policy is based on a regional vision.
Prior strategies and outcomes contextual factors-mechanisms
HCI: Investments in PHM initiatives. PHM is too costly and time consuming.
HCI: Investments in regional relationships in order to establish regional responsibility for addressing the social determinants of health. Positive experiences.
M: Collaboration with healthcare insurers for risk groups. Difficulties with establishing business cases. Slow progress.
H: Mergers of hospitals. Mergers continued.
PCG: -Substitution of care and professionalizing of PCG organizations. Slow progress.
-PCG pacts to influence politics in order to cut hospital budgets, were unsuccessful.
HCI: Hindering factors for investments in PHM are highly competitive markets, to many involved stakeholders, too little regional market power of the insurer, no collaborative agenda especially with municipalities, no insight into data to support business cases. B, HCI, M, PCG, PM: Hindering factors for PHM are top down management culture within healthcare insurer, differences in legitimacy between healthcare insurer and municipalities***, differences in financial interests, differences in culture (e.g. decision-making structure), differences in operational scale (too small numbers of insured people within one municipality), and high turnovers within healthcare insurers which prohibits understanding the regional situation. B, M, PCG, PM: Municipalities have more freedom to invest in projects when purchasing from the Social Support Act, the Participation Act and Youth Aid, compared to healthcare insurers when purchasing from the Healthcare law, which allowed healthcare insurers to only compensate prevention for patients with health problems to prevent worse. H, HCI: Business cases are drivers for collaboration. M: The healthcare insurers have commercial interests, which municipalities have not.
H: hospitals experience difficulties regarding the induced 0% growth by the government, high market competition, the demand for more transparency, quality and efficiency, continuous pressures to match supply and demand, financial bottlenecks (i.e. real estate problems), internal resistance to concentration, redistribution and substitution of care. The preconditions of hospital directors’ and MSBs**** to get agreement on a new hospital profile, which healthcare insurers demand, are: more focus, time and upfront financial guarantees.
HCI. PHM development which is assigned to specific managers within several healthcare insurance organisations facilitated going beyond care. Investments in providers and municipalities are important to address the social determinants of health. B, HCI, M, PCG, PRO: Relationships and regional coordination of PHM are the drivers for collaboration.
PCG, PM: Increased tasks and paperwork do not weigh up to financial uncertainties. Hospitals are too internally focused. Rigorous cuts in hospital budgets are necessary for real transition and real responsibility of healthcare insurers to control hospital budgets. Political pressure on gatekeeper function during the national elections has made PCGs more aware that building on and PHM experiences and showing results was pivotal for their profession.
  1. *B = Businesses; H = Hospital; HCI = Health care insurer; M = Municipality; PM = Program manager; PCG = Physician care group; PRO = Patient representative organization
  2. **Decentralization of tasks from the central to the local government (since 2015) entails safeguarding 1. the wellness of children up to 18 years, 2. the support people need to be able to work, 3. the care and social support people need to live in their own homes as long as possible
  3. ***Insurers’ legitimacy: ensure public interests: quality, affordability and accessibility of care to safeguard the macro care-budget and safety and quality norms; municipality’s legitimacy: ensure interest of regional societal issues
  4. ****MSBs = Associations of medical specialists within a hospital