Prioritization and patients' rights: analysing the effect of a reform in the Norwegian hospital sector.
The right to equal treatment, irrespective of age, gender, ethnicity, socio-economic status and place of residence, is an important principle for several health care systems. A reform of the Norwegian hospital sector of 2002 may be used as a relevant experiment for investigating whether centralization of ownership and management structures will lead to more equal prioritization practices over geographical regions. One concern was variation in waiting times across the country. The reform was followed up in subsequent years by some other policy initiatives that also aimed at reducing waiting lists. We measure prioritization practice by a method that takes departure in recommended maximum waiting times from medical guidelines. We merge the information from the guidelines with individual patient data on actual waiting times for the period 1999-2005. This way we can monitor whether each patient in the available register of actual hospital visits has waited shorter or longer than what is considered medically acceptable by the guideline. The results indicate no equalization between the five new health regions, but we find evidence of more equal prioritization within four of the health regions. Our method of measuring prioritizations allows us to analyse how prioritization practice evolved over time after the reform, thus covering some further initiatives with the same objective. The results indicate that an observed reduction in waiting times after the reform have favoured patients of lower prioritization status, something we interpret as a general worsening of prioritization practices over time.
Health Economics Bergen and Rokkansenteret, University of Bergen, Norway.
Jan Erik
JE
Askildsen
Tor Helge
TH
Holmås
Oddvar
O
Kaarboe
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D017408:Guidelines as Topic; D015276:Health Care Rationing / Q000706:statistics & numerical data; D018166:Health Care Reform / Q000706:statistics & numerical data*; D019981:Health Care Sector / Q000706:statistics & numerical data*; D006292:Health Priorities / Q000706:statistics & numerical data* / Q000639:trends; D006304:Health Status; D006783:Hospitals, State / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009664:Norway; D028701:Patient Rights; D018579:Patient Selection; D014850:Waiting Lists; D055815:Young Adult