The 2015 hospital treatment choice reform in Norway: continuity or change?

In several European countries, including Norway, polices to increase patient choice of hospital provider have remained high on the political agenda. The main reason behind the interest in hospital choice reforms in Norway has been the belief that increasing choice can remedy the persistent problem of long waiting times for elective hospital care. Prior to the 2013 General Election, the Conservative Party campaigned in favour of a new choice reform: “the treatment choice reform”. This article describes the background and process leading up to introduction of the reform in the autumn of 2015. It also provides a description of the content and discusses possible implications of the reform for patients, providers and government bodies. In sum, the reform contains elements of both continuity and change. The main novelty of the reform lies in the increased role of private for-profit healthcare providers

Are waiting times for hospital admissions affected by patients' choices and mobility?

Background Waiting times for elective care have been considered a serious problem in many health care systems. A topic of particular concern has been how administrative boundaries act as barriers to efficient patient flows. In Norway, a policy combining patient's choice of hospital and removal of restriction on referrals was introduced in 2001, thereby creating a nationwide competitive referral system for elective hospital treatment. The article aims to analyse if patient choice and an increased opportunity for geographical mobility has reduced waiting times for individual elective patients. Methods A survey conducted among Norwegian somatic patients in 2004 gave information about whether the choice of hospital was made by the individual patient or by others. Survey data was then merged with administrative data on which hospital that actually performed the treatment. The administrative data also gave individual waiting time for hospital admission. Demographics, socio-economic position, and medical need were controlled for to determine the effect of choice and mobility upon waiting time. Several statistical models, including one with instrument variables for choice and mobility, were run. Results Patients who had neither chosen hospital individually nor bypassed the local hospital for other reasons faced the longest waiting times. Next were patients who individually had chosen the local hospital, followed by patients who had not made an individual choice, but had bypassed the local hospital for other reasons. Patients who had made a choice to bypass the local hospitals waited on average 11 weeks less than the first group. Conclusion The analysis indicates that a policy combining increased opportunity for hospital choice with the removal of rules restricting referrals can reduce waiting times for individual elective patients. Results were robust over different model specifications

Political support in the five Yugoslav successor states in the mid-1990s : a comparative analysis

Popular support for the political system is thought of as one of the basic pillars of democratic systems. Concerns about political support may be even more important for systems moving from an authoritarian to a democratic form of government. This thesis draws upon the theoretical work of David Easton on the concept of political support. We use, however, a new fivefold conceptualisation of political support proposed by the contributors to Critical Citizen edited by Pippa Norris. Thus we distinguish between support for the political community, the regime principles, the political regime, the political institutions, and the political actors. This framework is used to describe and explore political support in the mid-1990s in the five Yugoslav successor states: Slovenia, Croatia, Bosnia and Herzegovina, The Federal Republic of Yugoslavia, and Macedonia. First the overall level of support in the five countries is described. We then investigate, by using regression analysis, the sources of political support across the five countries at the micro-level. Finally, we test macro-level theories developed for explaining between-country differences in support. The results show a high level of support for the political community and the democracy as an ideal form of government in all five countries. This is contrasted with a low to medium support for the current political regime, the political institutions, and the political actors. The analyses at the micro-level show that the most important sources of support for the political community and the regime principles were individual socialisation. When measuring support for the regime, the institutions, and the incumbent authorities, socialisation was less important than current evaluations of government performance. The results of the macro-level analyses confirmed that economic, political and social policy outputs all were related to support in the five countries. The importance of the macro-level performance indicators varied, however, according to the level of support under consideration. Most importantly, howevere, is that social policy outputs have to be included into the analyses as they seem to have a significant impact upon the aggregated level of support in the five countries

Introducing patient choice of hospital in National Health Systems – a comparison of the UK and Norway

Background: During 2001-2005, a number of radical legislative moves expanded patient choice in Norway. A similar reform path was followed in the UK, what provides a relatively controlled context and conjuncture. Both countries have National Health Systems (NHS), and are engaged in mutual policy learning. Those shared structural and policy attributes facilitate comparative analysis, and make further policy transfers likely. In this paper we compare the development and impact of patient choice reforms in Norway and the UK during the 1990s and 2000s. Our main focus is on the 2000s reforms. Objectives: Coherent with this, the paper has five main objectives, each addressed in a separate subsection. First, we analyze the evolution of choice reforms in both countries, and its ´goodness of fit´ within broader reform packages. Second, we study the main trends in patient mobility before and after the reforms were approved. Third, we analyze the micro-level incentives and other policy instruments aimed at making choice happen. Fourth, we examine the available evidence on the impact of pro-choice reforms, based on individual micro-data for Norway. Fifth, we discuss some policy proposals which could help advancing patient choice and improving its system impact. Conclusion: The analysis carried out in this paper has tried to cast new light on the issue of choice by formulating new analytical and policy proposals based on a comparative analysis of recent data on Norway and the UK. The comparative method helps us to isolate intervening mechanisms and analyse impact. In order to make choice happen and have the expected results, expanded capacity and incentives to increase activity are required in overloaded NHS systems such as Norway and the UK. Moreover, complementary tools would be required to make the most out of hospital choice, e.g. strengthened powers and capacity at the primary care level and new information transfer tools. The two countries differ, in the period under consideration, in choice of policy instruments. In Norway the main focus has been on (a) the nation-wide introduction of ABF, and (b) the development of complementary measures to expand capacity such as allowing patient choice also to include private and foreign hospitals in 2000-2002. In the UK more emphasis has been put on (c) developing information tools and (d) introducing GP advice. Our study shows that both countries could offer policy lessons to others within the area of patient choice

Norway

Healthcare in Norway has been seen as a public responsibility since the end of the Second World War. The overarching aim has been to ensure "equal access to healthcare of good quality." Taxation and public sources account for almost all health expenditure. Healthcare delivery is semi-decentralized. Responsibility for specialist care lies with the state. The municipalities are responsible for primary care. Since the beginning of the millennium emphasis has been given to structural changes in delivery and organization, and to policies intended to empower patients and users. Quality and patient safety have, over the past few years, emerged on the health policy agenda, as well as efforts to improve coordination between healthcare providers. The chapter aims to describe how the Norwegian healthcare system has developed in relation to quality and patient safety issues.11 page(s