Det finns ett uttalat behov av nya innovativa vårdmodeller inom hälso- och sjukvården. Svensk vård står inför signifikanta utmaningar och karaktäriseras av brist på sjukvårdsplatser, eskalerande kostnader och minskat patientförtroende. Hospital at Home (HaH) erbjuder möjligheter till förbättrad tillgänglighet, kostnadseffektivitet och patienttillit inom vården, men dess implementering begränsas av bristande förståelse för rådande finansiella förutsättningar, otillräckliga regelverk och inadekvata ersättningsmodeller. Denna studie syftar till att fördjupa förståelsen för de finansiella förutsättningar som påverkar implementeringen av innovativa vårdmodeller, såsom HaH, i komplexa decentraliserade sjukvårdssystem. Genom att utveckla ett teoretiskt ramverk som utforskar hur befintliga ersättningsstrukturer påverkar införandet av innovativa vårdformer, syftar denna studie till att bidra till förbättrat strategiskt beslutsfattande för en framgångsrik implementering och effektiv integrering av HaH i den svenska vården. Studien har tillämpat en utforskande abduktiv ansats, vilken realiserats genom en mixad metod som kombinerar enkäter och fallstudier. Datainsamlingen genomfördes via enkäter distribuerade till Sveriges 21 regioner samt genom semi-strukturerade intervjuer med representanter från tre svenska HaH-initiativ. Studien konstaterar att förberedelse och implementering av vårdinnovationer i decentraliserade system påverkas av flertalet både yttre och inre faktorer. Regelverk och direktiv, avtal samt extern budgetering och resursfördelning utgör grunden för hur vårdtjänster struktureras och finansieras. Dessa externa ramar är fundamentala i skapandet av en miljö som främjar vårdinnovation. Lokala variationer, vårdaktörer, verksamhetsformer och ersättningsmodeller spelar sedan en direkt roll i hur olika vårdmodeller utformas, finansieras och levereras i praktiken. Slutligen understryker studien behovet av en nationell definition av HaH och dess verksamhetsform, revidering av begränsande regelverk samt inkorporering av rörliga ersättningskomponenter till HaH-vårdutförare för att underlätta en storskalig implementering av HaH i Sverige. / There is a pressing need for innovative care delivery models within healthcare. Swedish healthcare faces formidable challenges including a shortage of hospital beds, escalating costs, and diminishing patient trust. Hospital at Home (HaH) presents an opportunity to enhance accessibility, cost-effectiveness, and patient trust within the healthcare system. However, its widespread adoption is impeded by a lack of understanding of current financial preconditions, insufficient regulations, and inadequate reimbursement models. This study seeks to enhance the understanding of financial preconditions influencing the implementation of innovative care models, such as HaH, within decentralized healthcare systems. Through the development of a theoretical framework that examines how current compensation structures impact the adoption of innovative care models, this study aims to inform strategic decision-making for the successful implementation and effective integration of HaH into Swedish healthcare. This thesis employs an exploratory abductive approach, utilizing a mixed-methods strategy that combines surveys and case studies. Data was collected through surveys distributed across all 21 Swedish regions, complemented by semi-structured interviews with representatives from three Swedish HaH initiatives. The study finds that the preparation and implementation of healthcare innovations in decentralized systems are significantly shaped by a range of external and internal factors. Regulatory frameworks, contractual agreements, and mechanisms for budgeting and resource distribution form the basis for how healthcare services are structured and financed. These external factors are fundamental in creating an environment that promotes healthcare innovation. Moreover, local variations, healthcare providers, operational forms, and reimbursement models directly influence how different care models are designed, financed, and delivered in practice. Finally, the study highlights the critical need for a national definition of HaH, the revision of restrictive regulations, and the integration of variable reimbursement components to facilitate widespread adoption of HaH across Sweden.

Personnel shortages and ineffective healthcare is a global problem. While other industries have used automation and robotics to solve similar problems, the number of automation solutions linked to basic care in Swedish public hospitals remains low. Therefore, this thesis aims to investigate factors that affects the collaboration between the automation industry and Swedish university hospitals. Test bed as an innovation tool is also studied and value-creating factors linked to it are mapped. The research questions were answered by conducting 30 interviews with representatives of the automation industry, university hospitals and other test beds, as well as a procurement lawyer. By using grounded theory, a theory was built based on the collected empirics. This study showed that there is an interest from both parties (automation industry and hospitals) to work together. The industry has the technical know-how needed to develop solutions to hospital environments, but economic factors as well as the procurement processes are too costly and time consuming to engage in these collaborations. Test bed is a suitable platform for product development and value-creating factors are: a clear aim and clear requirement specifications during the projects conducted on the test bed. The results give insight in factors that affect collaborations between automation industry and hospitals, and parallels can be drawn to other industries and Swedish government-controlled businesses. The findings also shine a light on valuable aspects to consider when implementing a test bed.