Aluetason kuntoutusjärjestelmä -Rakenne, organisaatio ja toiminta palvelujen saatavuuden näkökulmasta

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dc.contributor.author Pulkki, Jutta -
dc.date.accessioned 2012-12-03T12:08:41Z
dc.date.available 2012-12-03T12:08:41Z
dc.date.issued 2012 -
dc.identifier.isbn 978-951-44-8720-0 -
dc.identifier.uri http://tampub.uta.fi/handle/10024/66859
dc.description.abstract Jutta Pulkin väitöskirjatutkimuksessa selvitettiin aluetason kuntoutusjärjestelmän rakennetta ja organisointia sekä kuntoutuspalvelujen käyttöä yhden sairaanhoitopiirin alueella. Aluetason kuntoutusjärjestelmän muodostamisen tarvetta ja edellytyksiä tarkasteltiin erityisesti kuntoutuspalvelujen saatavuuden näkökulmasta. Kuntoutuksen järjestäminen on Suomessa usean eri hyvinvoinnin osajärjestelmän tehtävä. Tämän hajautuneen kuntoutusjärjestelmän ongelmista on puhuttu jo usean vuosikymmenen ajan, mutta empiiristä tutkimusta järjestelmän kokonaisuuden toimivuudesta ja kuntoutuspalveluiden kohdentumisesta ei ole juuri tehty. Tutkimuksessa käytettiin sekä laadullisia että määrällisiä tutkimusmenetelmiä. Tutkimusaineisto koostui haastatteluista, osajärjestelmien asiakirjoista sekä kuntoutuspalvelujen käyttöä vuosina 2004 ja 2005 kuvaavista rekisteritiedoista. Tutkimus koostui neljästä osatutkimuksesta. Tutkimustulosten mukaan yhteistä aluetason kuntoutusjärjestelmää ei ole toiminnallisena kokonaisuutena hahmotettavissa, Kuntoutuksen alueellisen kokonaisuuden kehittäminen tai koordinointi ei ollut minkään tahon vastuulla. Eri tahojen asiakirjoista ei löytynyt samansuuntaisia tavoitteita. Yhteiset tavoitteet ajatellaan olevan edellytyksenä yhteisen järjestelmän muodostamiselle. Tutkimus osoitti väestöryhmien välisiä eroja palvelujen käytössä sekä palvelujen käytön kasautumista pienelle käyttäjäryhmälle. Kuntoutuspalvelut jakautuivat epätasaisesti alueen kuntien välillä suhteessa kuntien asukkaiden väestötason tarpeisiin. Suurimmat palvelujen käyttäjäryhmät olivat naiset ja työikäiset, erityisesti 50 57 -vuotiaat. Palvelujen käyttö laski jyrkästi nuorilla eläkeikäisillä, nousten taas noin 75 -vuotiailla. 9 % kuntoutujista käytti kahden tai useamman osajärjestelmän palveluja kahden vuoden aikana. Nämä moni-asiakkaat käyttivät noin neljänneksen kaikista kuntoutuspalveluista. Kuntoutuksen osajärjestelmistä kuntien tuottamia kuntoutuspalveluja käytettiin eniten. Tutkija pohtii lopuksi aluetason kuntoutusjärjestelmän muodostamisen mahdollisuuksia. Aluetason järjestelmän tarve nousee tutkijan mukaan palvelujen saatavuuden turvaamisen tarpeesta yhdenvertaisesti alueen väestölle. Mikäli kuntoutusjärjestelmää halutaan kehittää yhtenäisemmäksi, tulee ottaa huomioon kuntoutuksen osajärjestelmien erilaiset kehityshistoriat, lainsäädännöt, toimintalogiikat, organisaatiorakenteet ja hallintakeinot. Lisäksi olisi otettava huomioon eri toimintojen ja kuntoutuspalvelujen vaatimat erilaiset organisointirakenteet ja koordinointitavat. Lopulta palvelujen saatavuuden turvaamiseksi muodostettava aluetason kuntoutusjärjestelmän kokonaisuus tulisi todennäköisesti näyttämään hybridiltä rakenteelta sisältäen sekä eriasteisesti keskitettyjä ja hajautettuja, että eri tavoin koordinoituja toimintoja. fi
dc.description.abstract In Finland, several welfare systems organize rehabilitation. The rehabilitation system can be seen as a fragmented and complex construction formed by these subsystems. For decades there has been commentary on the failings in rehabilitation performance which are generated by this complex system. While the system is criticized, there are hardly any empirical studies of its structure, organization and performance as a whole. The rehabilitation system is integrated into the general welfare system. The features of the welfare system, and also rehabilitation system, can be outlined through their objectives, organization structures and means of governance. Subsystems have a similar objective, to organize rehabilitation services, but the means to achieve this end vary. The organization structures of the subsystems vary in their degree of centralization: some are highly decentralized while others are fully centralized. There are also differences in the ways of coordination, e.g. the modes of governance in the subsystems. Altogether, these variations in the features of subsystems make it difficult to see the rehabilitation system as a whole, as well as the possibility to develop a more consistent entity. One of the central objectives in welfare states and their systems is equity, which in practice is modified to access to the services. This means similar services to those with similar needs regardless of gender, age or place of residence. Despite the objective of access and many acts to achieve it, there are differences in use of services between people which are not explained by the need. Access to the services, including the rehabilitation services, is produced in a process affected by the structure and organization of the system as well as practices. In this study the focus was in a regional rehabilitation system, its structure and organization, and in the use of rehabilitation services in one hospital district area. To study the regional system as a whole, all modes of rehabilitation medical, occupational, social and educational and different subsystems where included when possible. The need and preconditions to form a consistent regional rehabilitation system were discussed from the accessibility point of view. This study addresses the need to study the functioning of the rehabilitation system and the distribution of rehabilitation services. Both qualitative and quantitative methods were used following the mixed-methods paradigm. Data consisted of interviews with rehabilitation experts in the area, and of documents collected from the subsystems. Interviews and documents were analyzed by using content analysis. The structure of the regional rehabilitation system was scrutinized by using the interviews and the need and possibilities to construct a consistent regional system were analysed through the objectives found from the documents. Additionally, register data were gathered and analysed using statistical methods to establish the quantity, content and distribution of rehabilitation services in the area in years 2004 and 2005. The rehabilitation system was not considered a consistent system at the regional level. Particularly the lack of a clear area of responsibilities, both inside and outside of the system, blurred the picture of the regional system. The development and coordination of rehabilitation at the regional level was nobody s responsibility. While interviewees perceived that the objective was clear and common between the subsystems, similarities were not found from the documents. If common objectives are a condition for establishing a consistent system, there are no grounds to form a regional system. Instead, it might be more possible to construct informal network structures based on cooperation around separate rehabilitation modes. Rehabilitation services were allocated unequally between the municipalities in proportion to the need at population level. Services were used least in middle-size municipalities. Medical and occupational rehabilitation services were used most in large municipalities whereas other types of rehabilitation were commonly used in small municipalities. Out of all subsystems, rehabilitation services produced by municipalities were used most. Women and people in working age, particularly those from 50 to 57 years of age, used rehabilitation services most commonly. Utilization of services declined rapidly in young pensioners while rising again with people aged 75. Nine percent of rehabilitants used services produced by two or more subsystems in the two-year study period. These multi-clients used approximately a quarter of all rehabilitation services. Previous studies support the results obtained here on the rehabilitation system and the use and distribution of rehabilitation services. On the other hand, the results from interviews and documents indicate no need or preconditions to form a consistent regional rehabilitation system. However, the results based on register data showed differences in access to services in the area, which is seen in other contexts as a reason to centralize actions, particularly the funding under one organization. The need to form a regional rehabilitation system arises from the objective to ensure access to services to all in the area. When developing the regional rehabilitation system it should be taken into consideration that different actions and rehabilitation services need different kinds of organizational structures and means of coordination. For example, centralization of funding at regional level appears to be reasonable from the access point of view, but careful situation-based assessment is needed if the production of services is to be centralized. Current network organizations based on cooperation and created between subsystems may work in separate cases, but they cannot resolve coordination problems at the system level. To plan, coordinate and develop services in the region, a more formal and solid structure of organization is needed. Also, when developing a more consistent rehabilitation system it is necessary to consider the different history, legislation, logic of action, structures of organizations and means of governance within the subsystems. In the end the consistent regional system established to ensure access to services would probably appear as a hybrid structure consisting of both central and de-central parts, as well as different means of governance. en
dc.language.iso fi -
dc.publisher Tampere University Press -
dc.relation.isformatof 978-951-44-8719-4 -
dc.subject Kuntoutus -
dc.subject järjestelmä -
dc.subject aluetaso -
dc.subject palvelujen käyttö -
dc.subject palvelujen saatavuus -
dc.subject Rehabilitation -
dc.subject system -
dc.subject regional -
dc.subject use of services -
dc.subject access to services -
dc.title Aluetason kuntoutusjärjestelmä -Rakenne, organisaatio ja toiminta palvelujen saatavuuden näkökulmasta -
dc.type.ontasot fi=Väitöskirja | en=Doctoral dissertation| -
dc.identifier.urn urn:isbn:978-951-44-8720-0 -
dc.relation.numberinseries 1703 -
dc.seriesname Acta Universitatis Tamperensis -
dc.administrativeunit fi=Terveystieteiden yksikkö | en=School of Health Sciences| -
dc.oldstats 426 -
dc.seriesname.electronic Acta Electronica Universitatis Tamperensis -
dc.relation.numberinserieselectronic 1170 -
dc.publisher.electronic Tampere University Press -
dc.subject.study Sosiaali- ja terveyspolitiikka - Social and Health Policy -
dc.date.dissertation 2012-02-17 -
dc.onsale 1 -

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