Prioritization and Patients' Rights: Does the Hospital Reform Lead to More Equal Practises Among Hospitals?

Abstract:     
The Norwegian health care system gives patients with a diagnostic description meeting certain criteria concerning seriousness of the illness, prospects of treatment, and cost-effectiveness of relevant treatment, a prioritised right to treatment in the specialised health care system within a set time frame. This maximum waiting time will vary for different diagnoses. However, the operationalisation of these criteria varies quite dramatically over health care trusts and among hospitals within the health care trusts. This was the case before the government take-over of hospitals in 2002, and it is tills the case. In relation to objectives of equal access to health care for everyone, this variation is of considerable public concern. We raise the question whether the reduction in number of owners resulting from the governmental take-over of hospitals and merging smaller hospitals into a regional health care trusts, has resulted in a more equal prioritization practice. We compare the practise of giving the right to treatment among health care trusts, and among hospitals within the heath care trusts, before and after the reform. We use individual level observations for all patients within several diagnoses that differ in the maximum acceptable waiting time for treatment. Patients within these diagnoses are grouped into five groups, which differ according to maximum waiting time. We control for several other variables affecting treatment intensities, thus isolating a reform effect in terms of changes in geographical variation of waiting time for the patients in the five priority groups. The results show a significant tendency for more homogenous practises at the level of health care trusts, whereas the picture is mixed for actual waiting times among patients within the regional health care trusts.

Keywords: prioritization, evaluation, health care reform

working papers series