5 research outputs found
The Impact of Different Prioritisation Policies on Waiting Times: A Comparative Analysis of Norway and Scotland
We compare the distributional consequences of two different waiting times initiatives. The primary focus of Scotland’s recent waiting time reforms has been on reducing maximum waiting times through the imposition of high profile national targets. In Norway, the focus has been on appropriate prioritisation of referrals to hospital based on disease severity, the expected benefit of the treatment and cost-effectiveness. We use large, national administrative datasets from before and after each of these reforms and assign priority groups based on the maximum waiting times stipulated in Norwegian medical guidelines. To equalise case-mix over time, we use Exact Matching to weight the pre-reform patients to the patient composition in the post-reform period. We regress patient-level waiting times on patient characteristics and on a post-reform indicator interacted with the patient’s priority group. The analysis shows that the least-prioritised patients benefited most from both reforms. This was at the cost of longer waiting times for patients that should have been given higher priority in Norway, while Scotland’s high priority patients remained unaffected. This comparative analysis indicates that blanket waiting times initiatives may be more effective in reducing waiting times while preserving prioritisation between patients with different health needs.Waiting times; prioritisation; Norway; Scotland
Norwegian Priority Setting in Practice – an Analysis of Waiting Time Patterns Across Medical Disciplines
Background: Different strategies for addressing the challenge of prioritizing elective patients efficiently and fairly
have been introduced in Norway. In the time period studied, there were three possible outcomes for elective patients
that had been through the process of priority setting: (i) high priority with assigned individual maximum waiting
time; (ii) low priority without a maximum waiting time; and (iii) refusal (not in need for specialized services). We
study variation in priority status and waiting time of the first two groups across different medical disciplines.
Methods: Data was extracted from the Norwegian Patient Register (NPR) and contains information on elective
referrals to 41 hospitals in the Western Norway Regional Health Authority in 2010. The hospital practice across
different specialties was measured by patient priority status and waiting times. The distributions of assigned
maximum waiting times and the actual ones were analyzed using standard Kernel density estimation. The
perspective of the planning process was studied by measuring the time interval between the actual start of healthcare
and the maximum waiting time.
Results: Considerable variation was found across medical specialties concerning proportion of priority patients
and their maximum waiting times. The degree of differentiation in terms of maximum waiting times also varied by
medical discipline. We found that the actual waiting time was very close to the assigned maximum waiting time.
Furthermore, there was no clear correspondence between the actual waiting time for patients and their priority
status.
Conclusion: Variations across medical disciplines are often interpreted as differences in clinical judgment and
capacity. Alternatively they primarily reflect differences in patient characteristics, patient case-mix, as well
as capacity. One hypothesis for further research is that the introduction of maximum waiting times may have
contributed to push the actual waiting time towards the maximum. The finding that the actual waiting time was
very close to the maximum waiting time supports this. The lack of clear correspondence between the actual waiting
time for patients and their priority status may imply that urgency, described in the referral letter, and severity of
illness, according to guidelines, are two separate entities
Norwegian Priority Setting in Practice – an Analysis of Waiting Time Patterns Across Medical Disciplines
Background: Different strategies for addressing the challenge of prioritizing elective patients efficiently and fairly
have been introduced in Norway. In the time period studied, there were three possible outcomes for elective patients
that had been through the process of priority setting: (i) high priority with assigned individual maximum waiting
time; (ii) low priority without a maximum waiting time; and (iii) refusal (not in need for specialized services). We
study variation in priority status and waiting time of the first two groups across different medical disciplines.
Methods: Data was extracted from the Norwegian Patient Register (NPR) and contains information on elective
referrals to 41 hospitals in the Western Norway Regional Health Authority in 2010. The hospital practice across
different specialties was measured by patient priority status and waiting times. The distributions of assigned
maximum waiting times and the actual ones were analyzed using standard Kernel density estimation. The
perspective of the planning process was studied by measuring the time interval between the actual start of healthcare
and the maximum waiting time.
Results: Considerable variation was found across medical specialties concerning proportion of priority patients
and their maximum waiting times. The degree of differentiation in terms of maximum waiting times also varied by
medical discipline. We found that the actual waiting time was very close to the assigned maximum waiting time.
Furthermore, there was no clear correspondence between the actual waiting time for patients and their priority
status.
Conclusion: Variations across medical disciplines are often interpreted as differences in clinical judgment and
capacity. Alternatively they primarily reflect differences in patient characteristics, patient case-mix, as well
as capacity. One hypothesis for further research is that the introduction of maximum waiting times may have
contributed to push the actual waiting time towards the maximum. The finding that the actual waiting time was
very close to the maximum waiting time supports this. The lack of clear correspondence between the actual waiting
time for patients and their priority status may imply that urgency, described in the referral letter, and severity of
illness, according to guidelines, are two separate entities