The ALF negotiations are heading towards a conclusion. The new agreement means that university hospitals will compete for resources, based on the quality of their clinical research. The benchmark will probably be published research results, but Dean Olle Larkö explains in his article that this is not a change we need to feel anxious about.
I expect the new agreement to be ready before the summer holidays, such that it can come into force at the turn of the year, as planned
”We can now glimpse the end of a long journey. Negotiations have been under way for 18 months, and the issue has been discussed often in the Council of Deans, which is the management forum for all faculties of medicine in Sweden. Recently, Pam Fredman and I met Bengt Norrving, who represents the government in the negotiations. I expect the new agreement to be ready before the summer holidays, such that it can come into force at the turn of the year, as planned.
ALF funds are the government’s way of remunerating the university hospitals for training doctors and for clinical research. Fairly large sums are involved: each year SEK 1.7 billion is granted for clinical research at the university hospitals, and a further SEK 0.5 billion for the clinical training of medical students.
The previous ALF agreement was a matter for the county councils only, and they negotiated between themselves how the money was to be distributed. This method of distribution was beneficial for Sahlgrenska University Hospital, which has never had any reason to be dissatisfied. There were, however, university hospitals that received less resources than they thought they had a right to. The government requested a method of distribution with greater transparency, and decided to replace the old agreement. The county council thought that it was time for the government to provide greater funding for ALF. Negotiations have taken a long time, but we are beginning to see the form of the new agreement.
The new agreement will probably not be as advantageous for SU. It would have been best for us, of course, if we had been able to keep the previous ALF agreement. Since this was not possible, I think we should realise the opportunities that will be open to us when the new agreement comes into force.
One important innovation is the appearance of bibliometry when ALF funds are to be distributed among the university hospitals. Thus, publications in clinical research will, in some way, be used as a benchmark to determine how much money we are to receive. And I find this to be completely reasonable. Measuring the quality of clinical research not only gives the government a way to determine the results obtained from the money invested, it will also stimulate us to reinforce research at the hospitals.
Sahlgrenska University Hospital has many advantages over several other university hospitals and faculties of medicine. I am, of course, mainly thinking about the healthy climate of cooperation between SU and the Academy, but there is another important difference that gives us a head start over others: the large volume of patient material.
Region Västra Götaland still has, in contrast to many other county councils, a unified healthcare system. There’s nothing wrong with private healthcare. In the short term, patients benefit from being able to choose their GP freely. For clinical research, however, the system of free health choice has led to fragmentation. This is what has happened in, for example, Stockholm, Uppsala and Skåne. The superb patient material that we have access to gives us the opportunity to plan clinical studies that are not otherwise possible. These will lead to high-quality publications, which generate in turn a larger slice of the ALF pie.
Conducting the ALF negotiations has been like running a marathon, and it’s a great feeling that we are now finally sprinting to the finishing line. Even though it seems that everyone is agreed on the major principles, some fine details remain to be sorted out before we can put pen on paper.”
