Hög tillgänglighet och god kvalitet? En intervjustudie om produktionsbaserad styrning inom offentlig vård

Sammanfattning: During the last decades, market-oriented policies have entailed significant changes within the Swedish public sector. In Västra Götalandsregionen, primary care clinics for physiotherapy since 2014 get funding based on collected contact points. The points are generated by patients visiting the clinics. Furthermore, the physiotherapists working at the clinics are assigned a daily target number. The points system was introduced partly as an incentive to receive a high number of patients and implies production-based steering. Through qualitative interviews with physiotherapists, this thesis examines how this steering is manifested, and how the steering affects the prospect of carrying out healthcare. The theoretical framework draws upon a concretisation of ‘steering as practise’ along with theories of discretionary authority, economic governance, and different logics for organising work. Findings of the study demonstrate that the steering is manifested in extensive monitoring of target numbers, and disciplinary measures taken to ensure that the individual meets the target. The prospect of carrying out professional healthcare is occasionally compromised, due to the constrained time available to receive each patient – a problem that is more evident for physiotherapists working with fragile patients. Furthermore, a limit in the compensation system entails that clinics occasionally are hindered from receiving vulnerable patients.