The Swedish Health Consumer Index: Impact on media, policy discussion
A high degree of activity after our launch 2005 shows that the councils now are starting to view The Swedish Health Consumer Index as quite important. The reasoning behind the ranking system is starting to register on the mental radar of the county councils. The consumer point of view on healthcare can not longer be ignored by politicians, civil servants or media.
In April 2004, when the Swedish Health Consumer Index (SHCI) was first published, the Index had a huge coverage in media - but was in many ways treated primarily a curiosity. Few county councils (there are 21 of these tax-funded regional governments around Sweden, responsible for funding and generally also providing care services) commented on the Index ranking outcomes. The Swedish Association for County Councils (SALAR) dismissed the whole reasoning behind SHCI. Typically the individual council reports on SHCI was limited to statements like "Our county council is the third best in Sweden".
Though a wide-spread impact (assessed as 82 daily paper clippings and radio/TV news items) with some exceptions the SHCI disappeared from the news coverage within a week. This was what we expected; when an independent think tank introduces an unconventional, challenging new perspective and assessment tool it would be far too much to count on a general acceptance and sustained debate already in the first year.
After the 2004 launch Swedish patient organisations have been using the Index outcomes and documentation for discussions with their elected politicians and county council managers. Some politicians have argued that their councils should implement the SHCI approach and indicators to better evaluate and benchmark the public health care system. We recently noticed that a county council mentioned scoring a good mark in the SHCI 2004 in the annual report evidently putting high value to this information. This kind of daily impact though has not yet attracted attention from media or national politics.
When presented in May the SHCI 2005 got a somewhat different treatment. The "ordinary" news coverage was excellent (est. 120 media hits in the first 48 hrs, incl. the three big national TV news rooms). The regional media paid a lot of attention to the outcomes regarding their council. But adding to this impact several news articles elaborated on the Index themes, i.e. the lack of information for health consumers, the discrepancy between cost and quality in Swedish healthcare and that healthcare in every county, no matter the ranking in the index, suffers from a serious lack of access.
The opinion that county councils and healthcare provision can be measured and compared is this year far more accepted among journalists and politicians than in the first year. In several media hits the SHCI is compared to international surveys of healthcare and the attitudes among health consumers. We judge that the Index idea of comparing outcomes now is well established. Furthermore media in a striking way accept the Index focus and parameters, highlighting consumer access and service. "Consumer-designed health care" is becoming a common phrase (seldom used before 2004).
The SALAR comment on the 2005 Index: "Open comparisons between county councils, hospitals and primary health care centres stimulate the patient influence as well as the development of the healthcare"
Ms. Ellen Hyttsten, the head of the SALAR healthcare department.
We can see that SHCI is used as an argument in discussions about healthcare policy and quality. Either does the political opposition in the county council criticise the services provided based on results from SHCI or does the majority in power points to a potentially favourable ranking as evidence of the high quality. When heavy-weight councillors of the Social Democrat or Left Party refers to the Index debating centre-right opponents it is a clear sign that SHCI no longer is looked upon as a free market whim but a part of reality. In the winning county - Kalmar - the centre-left parliamentarians furiously attack the centre-right majority for relying on the Index outcomes - while in a neighbourhood council (Östergötland, in bronze position) the Social Democrat government publicly announce that the good ranking proves the excellent performance by the regional health care system....
In 2005 you find many examples of how the county councils comment on the Index on their websites and they are generally positive. One out of three councils quickly presented such comments. We notice that this time they were well prepared to meet media alerts (we have a dialogue with each council regarding the background figures). Most web site comments stress that this kind of comparisons are important and that today's healthcare does not pay enough attention to the consumer perspective. Most interesting: some county councils now declare they work hard to meet the EHCI requirements, improving conditions regarding information, service or access to treatments. "We must not stay in a bottom position" or "In the next years Index we will be positioned over average" are the kind of statements you easily find. Getting a low score is bad PR, gaining a good one is a reward. Logically many of the bad performers now announce action: programs for better access, new information policies, own consumer surveys to learn more and so on.
Far more county councils got in touch with the Powerhouse after the 2005 launch than in 2004 claiming better points in the Index. They could not prove their claims but the higher degree of activity shows that the councils view the SHCI ranking as quite important. The reasoning behind the ranking system is starting to register on the mental radar of the county councils
A few quotes from the county councils confirm this:
"Comparisons show that the over all efficiency of the Swedish healthcare and hospital system is good. The Health Consumer Powerhouse Health Consumer Index gives our county council good marks in this year's examination and puts us at an honourable sixth place. They measure among other ting consumer focus, level of service and healthcare information"
Alf Norberg (Social Democrat), county councillor of the Gävleborg County Council.
"I want to see more measurements - it is positive. We have just started a huge development project for the primary care in Uppsala".
Kerstin Söderlund, director for the primary care in Uppsala county council (the council with the worst outcomes in SHCI!).
"A respectful reception, good access, good information and active dialogue are important components in a healthcare system that puts the patient in focus. In this aspect the Kalmar council have made good start, which shows in the Health Consumer Index that compares all county councils. But there is a lot left to do. It is our ambition constantly working on improvements and stressing quality to be a county council at the front."
Anders Andersson (Christian Democrat), chairman of the county council of Kalmar (the council with the top scores in SHCI).