Table 1 Overview of rationales and... | Emerald Publishing

Table 1

Overview of rationales and themes in politician’s narratives of primary healthcare governance

Themes	Goals and commissions	Problematic situations	Preferred solutions
Rationales	Goals and commissions	Problematic situations	Preferred solutions
Scientific	Being the healthcare frontline – PHC* prevents the use of more expensive specialist care and has a legal obligation to coordinate/integrate healthcare between healthcare authorities	Limited finances create challenges to compete for staff against other regions Medical experts' words carry a lot of weight but might have a narrow focus. Compensating wrong things could lead to crowding out of patients	Streamlining processes, implementing technical advances and law changes. Ideas hold by knowledgeable people. Law changes by national-level politicians. Financial incentives can motivate desired actions
Clinical	Being the healthcare frontline – PHC* prevents burdening higher healthcare levels. Politicians provide goals, guides, and aims for care units to fulfil	Lack of overview of PHC units creates difficulties in governing. Limited staff resources and organisational structures promote care at the wrong healthcare level. National-level politics affect the PHC* units processes	Improving structures, processes and management could increase the impact of governance. Feedback from professionals is needed to shape realistic compensation models and avoid displacing patients. Unspecified state grants and long-term solutions
Cultural	Being the healthcare frontline – PHC* prevents citizens from getting sick. Political mission includes responsibility for all citizens. Dialogues with professionals and citizens	Officials gain power if dialogues between politicians and professionals/citizens are limited. Equality aspects could be lost with certain solutions. Conflict between allocating resources vs preventive care. Social consequences. Lack of people who want to settle in rural areas	Enact political initiatives to impose change and secure resources. Collaboration with other authorities. Politicians’ opinion on how PHC* practices are organised. Strengthen citizens’ rights. Support others’ prioritisation decisions

Themes	Goals and commissions	Problematic situations	Preferred solutions
Rationales	Goals and commissions	Problematic situations	Preferred solutions
Scientific	Being the healthcare frontline – PHC* prevents the use of more expensive specialist care and has a legal obligation to coordinate/integrate healthcare between healthcare authorities	Limited finances create challenges to compete for staff against other regionsMedical experts' words carry a lot of weight but might have a narrow focus. Compensating wrong things could lead to crowding out of patients	Streamlining processes, implementing technical advances and law changes. Ideas hold by knowledgeable people. Law changes by national-level politicians. Financial incentives can motivate desired actions
Clinical	Being the healthcare frontline – PHC* prevents burdening higher healthcare levels. Politicians provide goals, guides, and aims for care units to fulfil	Lack of overview of PHC units creates difficulties in governing. Limited staff resources and organisational structures promote care at the wrong healthcare level. National-level politics affect the PHC* units processes	Improving structures, processes and management could increase the impact of governance. Feedback from professionals is needed to shape realistic compensation models and avoid displacing patients. Unspecified state grants and long-term solutions
Cultural	Being the healthcare frontline – PHC* prevents citizens from getting sick. Political mission includes responsibility for all citizens. Dialogues with professionals and citizens	Officials gain power if dialogues between politicians and professionals/citizens are limited. Equality aspects could be lost with certain solutions. Conflict between allocating resources vs preventive care. Social consequences. Lack of people who want to settle in rural areas	Enact political initiatives to impose change and secure resources. Collaboration with other authorities. Politicians’ opinion on how PHC* practices are organised. Strengthen citizens’ rights. Support others’ prioritisation decisions

Note(s): *PHC-Primary healthcare