Vårdlogistik - Improved co-ordination of community funded transports in the Swedish health care sector
Overview
Background & policy context:
Forecasts for the county of Dalarna in Sweden indicate that the number of inhabitants over 65 years of age will increase by between 15-33 per cent, and the ones above 85 years by 12-57 per cent, in the next 30 years from the year 2000. The lower per cent figure in the intervals are expected at unaltered mortality and the higher figures are expected at the mortality expected if current falling trends in mortality are extrapolated (DFR-report 2004:4).
Simultaneously, there is a current trend toward a higher degree of care of elderly people in their homes instead of at institutions. There are also discussions made in the County Council concerning fusions of health care centres and a change in the number of district medical offices and a centralisation is being carried out regarding specialized care functions. Within the special housing centres for elderly, the number of rooms has been reduced by 25 per cent between the years 2002 and 2005. All these changes affect and increase the need for more transports. The above described trends create an increased demand for publicly funded transports in the health care sector concerning elderly people. In Sweden, the health care sector has a divided responsibility picture were municipalities and county council account for separate sub-sectors. The relevant publicly funded transports include transport services for disabled, transports to and from health care, staff journeys as well as transports of equipment and provisions.
The total costs for the transport of disabled persons within the county of Dalarna in 2003 amounted to 52 million SEK and the costs of transports to and from health care for the county council totalled 75.6 million SEK, i e a total of 127.6 million SEK (approx. €13.7 million), costs that are increasing for each year.
The other transport costs are not well known, but they seem to be substantial and increasing. One example illustrating this is the fact that there currently are 1100 cars belonging to municipalities and the county council that are mostly used for staff journeys. The journeys are currently not co-ordinated to any greater extent. This could be compared to the total number of taxis in the whole county: 300.
The trend described above has created a demand for functional models, methods and routines for the decision making, planning and organising, and evaluation of the total amount of publicly funded transports within the health care sector. The costs for the transports must be minimised but they
Objectives:
The project is directed towards studying the potential for a more far-reaching efficiency and co-ordination of all publicly funded transports focusing on the health care sector. The aim is also to study the existing co-operation between the health care and transport sector to enable a better co-ordination and integration in the planning process of all publicly funded transport in the health care sector. The knowledge gathered and the solutions studied within the project may give great cost reductions for the health care sector.
There could be a great potential in studying how needs and demands, decisions, regulations and routines within the sector affect the transport system and the demand for publicly funded transport. Furthermore, the health care sector probably could be improved and develop in a more favourable manner if the transport perspective is considered on a strategic level when decisions are made. This also means that the quality of the care could be greatly improved if transport issues are considered, since the opportunity for the persons receiving care to be able to travel are a such an important part of the health care sector in general.
Methodology:
The following description is only applicable to the second sub project. The re-structuring of the health care sector and the influence on public economy and important goals in the national transport policy. The extent of the transportation carried out by the home-help service staff was surveyed by conducting a diary study where the staff noted their daily journeys during a week. Interviews were held with staff responsible for equipment and provisions and the taxi company responsible of transporting the disabled. A scenario was created where the number of senior citizens currently living in their homes was reduced to the level present in 2002. The reduction in the transport demand for home-help service was calculated tor the scenario. Cost-benefit assessments were made and compared for the current situation as well as for the scenario.
The project is carried out in Borlänge and Falu municipalities, the county council of Dalarna as well as the Public Transport Authority of Dalarna. The lessons learned could be implemented within the any of the municipalities. The solutions discussed in the county of Dalarna will be compared with solutions and activities being conducted in other regions and counties in Sweden.
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