Bricks & bridges in healthcare A series of international comparative studies on how rationalization strategies are applied across different levels of health care systems

The thesis seeks to contribute to the international knowledge on how rational decision-making strategies are implemented in health care. It offers an overview and examines how different rationalisation strategies have developed at 5 different levels in health care systems: 1) the professional/patient interaction, 2) professional practice, 3) health care organisations, 4) national and 5) international health system level.
The five chapters in this manuscript use both explorative and descriptive research techniques, building on larger international studies (QUALICOPC and DUQuE), the work of the OECD and international expert groups. They focus on the decision-making 1) that takes place between doctors and patients in primary care where shared decision-making (SDM) is assumed to contribute to optimal decisions and high value outcomes, 2) on the practice level in primary health care on rational prescribing of medication, 3) at the level of health care organizations, such as hospitals, on how the rationale of clinical knowledge is embedded in the organization’s management decision, 4) at the national level, on the decisions on rational use of pharmaceuticals, and 5) on whether and how the performance of systems is benchmarked through OECD data.
This research does not offer clear-cut solutions but shows how different countries use scientific evidence for policy-making. It illustrates how the bricks of rationalisation strategies need bridging across the various levels of health care systems.