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More than meets the eye: a critical discourse analysis of a Swedish health system reform
Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Arctic Research Centre at Umeå University.ORCID iD: 0000-0002-5902-3798
Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Arctic Research Centre at Umeå University.ORCID iD: 0000-0003-4714-9331
Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.ORCID iD: 0000-0001-7087-1467
2023 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, no 1, article id 1226Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In line with international trends acknowledging the importance of Primary Health Care (PHC) for improving population health and reducing health inequalities, the Swedish health system is undergoing a restructuring towards the coordinated development of a modern, equitable, accessible, and effective system, with PHC principles and functions at its core. Since discursive analyses of documents underpinning PHC reforms are scarce in Sweden and beyond, the aim of this study was to explore how the reorientation towards good quality and local health care has been represented in official government reports.

METHODS: Based on a policy-as-discourse analysis, four Swedish Government Official Reports underpinning the good quality and local health care reform were interrogated following four questions of Bacchi's "What's the Problem Represented to be?" (WPR) approach. By applying the first WPR question, concrete proposals guiding the reorientation were identified, analyzed and thematized into candidate problem representations. These problem representations were then analyzed in relation to previous empirical and conceptual research considering WPR questions two and three, which resulted in the development of three problem representations. Potential silences that the problem representations might produce were then identified by applying WPR question four.

RESULTS: The three problem representations connected the Swedish health system "problem" to a narrow mission, a siloed structure, and a front-line service disconnected, especially from the needs and preferences of individual patients. By representing the problem along these lines, the analysis also illustrated how the policy reorientation towards good quality and local health care risk silencing important PHC aspects such as health promotion, equitable access, and human resources.

CONCLUSION: The results from this study indicate that as discursively framed within concrete proposals, government official reports in Sweden represent the health system problem in particular ways and with these problem representations overlooking several aspects that are central to a health system characterized by PHC principles and functions. In the continued reorientation towards good quality and local health care, these silences might need to be acknowledged.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023. Vol. 23, no 1, article id 1226
Keywords [en]
Discourse, Policy analysis, Primary health care, Reform, Sweden, WPR
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-216605DOI: 10.1186/s12913-023-10212-4PubMedID: 37946232Scopus ID: 2-s2.0-85176104373OAI: oai:DiVA.org:umu-216605DiVA, id: diva2:1811526
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2017-00183Available from: 2023-11-13 Created: 2023-11-13 Last updated: 2023-11-16Bibliographically approved

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Jonsson, FridaBlåhed, HannaHurtig, Anna-Karin

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