The purpose of this thesis is to explicate and explain deficiencies in the health care system in Sweden, leading to inefficiency amongst the medical doctors. The health care system is mostly financed by the public (i.e., taxes). In order to reach conclusions we conducted a three-step empirical approach in the publicly financed health care system. The study uses a theoretical analytical lens strongly supported by previous research, which is supposed to help explain the results of the empirical studies. Study 1 consisted of semi-structured interviews. Study 2 was based on register data and examined if we could confirm that there is a correlation between administration and number of patients. Study 3 is a post-hoc analysis based on survey data from a total of 124 respondents. By using three different research methods, the study offer a more complete and holistic view of the medical doctors’ situation and the aspects of control within Swedish health care. The results confirm earlier findings in previous studies is somewhat consistent across the three separate studies (Study 1-3) that Swedish medical doctors meet very few patients. The study further identify variation among medical doctors meeting patients is very high. While some meet only one patient per day other meet up to 25 patients in a day. We could not find significant differences between doctors meeting few from those meeting many patients. Furthermore, no difference come in terms of administration between routine patient meetings or returning patients. The post-hoc analysis in part explains that management control system is poorly developed. Our result implies administrative work is not correlated to patient visits. Medical doctors themselves means that the reason to why many doctors not have a large number of patient visits is due to more administrative work. Data from patient record systems does not verify their statements. The correlation is thus opposite. The more patient visits the more administrative work. Additionally, the study implies that predetermined times modules for patient visits complicates measurements of doctors’ performances. We hope the thesis will attract attention amongst the citizens in Sweden but also amongst Swedish agencies that leads to further examinations and improvements of the publicly financed health care system. / Sverige har femte flest läkare inom EU. Ändå växer vårdköerna och det talas om läkarbrist. Är det verkligen problemet eller bottnar det i en ineffektivitet? Syftet med examensarbetet är att förklara situationen inom den offentliga svenska hälso- och sjukvården med avseende på läkarnas effektivitet och vilken roll styrningen har för prestationen. För att uppfylla syftet och besvara forskningsfrågan kommer studien att utgå från Sveriges landsting och regioner med fokus på situationen för läkarna och med tonvikt på styrningen inom landstingen. Examensarbetet använder en teoretisk analys som bygger på tidigare forskning som stöd till förståelse och förklaringar av resultaten. Examensarbetet har tre olika delstudier. I studie ett (1) genomfördes semistrukturerade djupintervjuer inom samma landsting med ett antal personer med olika befattningar för att spegla olika värdeperspektiv. I studie två (2) tog vi del av intern registerdata på en klinik för att påvisa ett eventuellt samband mellan antal fysiska patientmöten och administrativt patientarbete. Studie tre (3) var en post-hoc analys där vi diskuterar kring samband och förklaringar i utfall från studie 1 och 2. I post-hoc analysen undersöktes Sveriges samtliga landsting och regioner genom enkätundersökningen där totalt 124 läkare runtom i Sverige deltog. Resultatet visar att det är många olika faktorer som spelar in avseende läkarnas effektivitet och den situation som råder inom svensk offentlig hälso- och sjukvård idag. Bilden att svenska läkare generellt tar emot färre patienter jämfört andra europeiska länder bekräftas samtidigt som vi kan påvisa stora variationer. Ett argument som ofta framförs är att svenska doktorer arbetar med patienten administrativt och att detta arbete inte återspeglas när man mäter antal fysiska möten. Genom journalstudier kan vi inte bekräfta detta samband. Våra resultat visar att rent administrativt patientarbete korrelerar till antal fysiska möten mellan läkare och patient. Vi ser också att styrning genom exempelvis förutbestämda tidsmoduler gör att prestationer verkar bli svårare att följa upp. Vår förhoppning med examensarbetet är att väcka ett större intresse hos allmänheten och myndigheter för dessa frågor vilka kan leda till granskning och förbättring av den offentliga svenska sjukvården.

The purpose of the study is to understand whether, and if so why, the Swedish medical profession's position on the availability and shortage of doctors during the 1950s and 1960s could be interpreted as an expression of an overall common mentality within the medical profession. The start and end points of the study (1950 and 1970) cover the emergence of the Swedish welfare state. The emergence of the welfare state is the contextual background to this study and how that influenced the medical profession's social status and perception of the future role of their own profession. The source material for the study is mainly from the Swedish medical journal (Svenska Läkartidningen) and meeting minutes from various Swedish medical organisations, primarily the Swedish Medical Association (Sveriges Läkarförbund). Government public inquiries, government bills and the daily press have also been analysed. The analysis is based on three central proposals for action from the government to secure the future supply of doctors and stem the shortage of doctors. The proposals were the transfer of foreign doctors to Sweden, the expansion of education of doctors and the reorganisation of the Swedish health care system. The study shows that the argumentation from the Swedish medical profession against all proposals from the government consisted of several different rhetorical manoeuvres to exercise social closure. Another conclusion is that until the mid-1960s, both the Swedish Association of Young Doctors and the Swedish Medical Association acted mainly as professional associations, rather than as traditional trade unions regarding the expansion of the medical profession. From the mid-1960s, there are tendencies indicating that the association more began to resemble a traditional trade union. However, professional issues such as improvement in the profession, demands for exclusivity, social status and issues of legitimisation appear to have been more important throughout the period than more traditional trade union issues such as pay, employment conditions and the working environment. The professions' opposition to increasing the number of doctors, regardless of the method proposed by the government and responsible authorities, was characterised by a clear guild spirit. The study shows that the medical organisation arguments against the various proposals were driven by union strategies, attitudes, and norms and in some cases ideology. The mentality of medical professional representatives and individual doctors was influenced by the professional status of the medical profession with inherent norms and attitudes based on the doctors' self-perceived expertise and scientifically anchored professional identity. A central conclusion from the study is that the main rhetorical line of the professional representatives was that more doctors were neither desirable nor needed in the medical profession and therefore most of the arguments against an expanded medical profession were based on some form of protectionism. This was justified by the profession by using historical analogies and by conducting their own 'objective and scientific' investigations. A right-wing based criticism of society at the time and a fundamentally conservative view of the economy, the tax system and the expansion of the welfare state also served as rhetorical tools from the medical profession in the debate on the shortage of doctors.