title: Recentralizing healthcare through evidence-based guidelines - striving for national equity in Sweden.
abstract: BACKGROUND
  The Swedish government has increasingly begun to rely on so called informative governance when regulating healthcare. The question this article sets out to answer is: considered to be "the backbone" of the Swedish state's strategy for informative governance in healthcare, what kind of regulatory arrangement is the evidence-based National Guidelines? Together with national medical registries and an extensive system of quality and efficiency indicators, the National Guidelines constitutes Sweden's quality management system.
  
  
  METHODS
  A framework for evaluating and comparing regulatory arrangements was used. It asks for instance: what is the purpose of the regulation and are regulation methods oriented towards deterrence or compliance?
  
  
  RESULTS
  The Swedish National Guidelines is a regulatory arrangement intended to govern the prioritizations of all decision makers - politicians and administrators in the self-governing county councils as well as healthcare professionals - through a compliance model backed up by top-down benchmarking and built-in mechanisms for monitoring. It is thus an instrument for the central state to steer local political authorities. The purpose is to achieve equitable and cost-effective healthcare.
  
  
  CONCLUSIONS
  This article suggests that the use of evidence-based guidelines in Swedish healthcare should be seen in the light of Sweden's constitutional setting, with several autonomous levels of political authority negotiating the scope for their decision-making power. As decision-making capacity is relocated to the central government - from the democratically elected county councils responsible for financing and provision of healthcare - the Swedish National Guidelines is part of an ongoing process of healthcare recentralization in Sweden, reducing the scope for local decision-making. This represents a new aspect of evidence-based medicine (EBM) and clinical practice guidelines (CPGs).
authors.forename: Mio
authors.initials: M
authors.lastname: Fredriksson
authors.forename: Paula
authors.initials: P
authors.lastname: Blomqvist
authors.forename: Ulrika
authors.initials: U
authors.lastname: Winblad
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration*; D019317:Evidence-Based Medicine; D033161:Government Regulation; D054625:Healthcare Disparities; D006801:Humans; D013548:Sweden