Coping with Excess
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Coping with Excess

How Organizations, Communities and Individuals Manage Overflows

Edited by Barbara Czarniawska and Orvar Löfgren

What does a stockbroker in Istanbul navigating the rush of incoming trading figures have in common with a mother in Stockholm trying to organize a growing pile of baby clothes? They are both coping with excess or overflow. This book explores the ways in which institutions, corporations and individuals define and manage situations of ‘too much’ – too much information, too many choices, too many commodities or too many tasks.
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Chapter 5: Management of and by overflow: the example of primary healthcare

Lars Norén


The flow of patients into the healthcare system has long been regarded as overflow, generating healthcare problems in many countries. As Jönsson et al. (2004) described the problem in Sweden:In order to match increasing opportunities and requirements, increasing health care resources are needed. Despite available resources there are requirements that can not be met because resources are limited. It is not possible to fully meet limited resources with greater efficiency and rationalizations. The requirements for health care will probably always be larger than available resources. (Jönsson et al., 2004: 119; translation LN) Healthcare costs in Sweden have traditionally been strictly controlled (Diderichsen, 1995), rendering it impossible to increase resources to deal with the overflow of increasing requirements. The prevalent method of managing the problem of an ever-increasing flow of patients is to prioritize, and queues have come to be seen as an inevitable part of Swedish healthcare. The overflow of patients can also be described in a positive way, however, as a consequence of new and better treatment methods, improved pharmaceuticals, improved methods for diagnosis and the fact that people live longer. People who come from the baby boom generation also want more healthcare, which tends to strain the loyalty of the taxpayers. Something else seems to have happened during the past few decades, however: politicians no longer accept long queues for healthcare and are determined to shorten them.

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