Hospital waiting time in Norway: What is the role of organizational change?

Abstract

Background: During the last five years the Norwegian hospital sector has experienced massive reorganization efforts. The aim of this study is to establish whether two such initiatives — the introduction of ring fencing of elective surgery and activity-based budgets at department level — have had any effects on one of the most profiled objectives on the health political agenda: reduction in waiting time. Methods: The sample studied includes 41 hospitals observed at two points of time, 1999 and 2001. Waiting time is expected to be a result of imbalance between demand and supply. Measures representing the supply side (ring fencing, activity-based budgets at departmental level, physician rate, share of emergency admissions, technical efficiency, and hospital type) and the demand side (living conditions and share of persons aged 67 or older) are included in the operationalized model. The model is estimated via stepwise OLS regression. Results: The results document a negative relationship between ring fencing and waiting time, with the estimated waiting time reduction amounting to 22 days. Both the demand side variables also exert significant effects on waiting time. Conclusion: Although information on ring fencing, living conditions, and age distribution renders possible some predictions concerning waiting time, the current research topic should be revisited when a longer time period has elapsed. When the organizational changes have become more thoroughly embedded in the hospitals, more refined conclusions regarding hospital organizations' behaviour and effects of reorganization can be drawn.

Keywords

Hospital reform Norwegian healthcare organisational change somatic hospitals waiting time

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References

NOU Hvor nært skal det være? Tilknytningsformer for offentlige sykehus [How close should it be? Types of relations for public hospitals]. Oslo; 1999.

NOU Sykehustjenesten i Norge. Organisering og finansiering. [Hospital services in Norway. Organization and financing]. Oslo; 1987.

NOU Pasienten først! Ledelse og organisering i sykehus [The patient first! Leadership and organization in hospitals]. Oslo; 1997.

Iversen T. A theory of hospital waiting lists. J Health Economics 1993;12:55—71.

Kjekshus LE , Nerland SM , Hagen TP , Botten GS De somatiske sykehusenes interne organisering. En kartlegging av 58 somatiske sykehus i Norge, 1999 og 2001 [The somatic hospitals' internal organization. A mapping of 58 somatic hospitals in Norway, 1999 and 2001]. HERO paper 2002 :1. Oslo : Health Economics Research Programme, the University of Oslo; 2002.

Hagen TP , Kaarbøe OM The Norwegian Hospital Reform of 2002: Central government takes over ownership of public hospitals. Working paper 2004:1. Oslo: Health Organisation Research Norway; 2004.

Lægreid P. , Opedal S. , Stigen IM The Norwegian Hospital Reform — Balancing Political Control and Enterprise Autonomy. Working paper 2003: 23. Bergen: Stein Rokkan Centre for Social Studies; 2003.

Ministry of Health. Ot. prp. nr. 66 (2000—2001). Om lov om helseforetak m.m. [On the health enterprise law etc.]. Oslo; 2001.

Aaserud M. , Trommald M. , Boynton J. Elektiv kirurgi — strykninger, skjerming og effektivitet [Elective surgery — cancellations, ring fencing and efficiency]. J Norwegian Med Assoc 2001;121:2516—19.

10.

Kjekshus LE , Hagen TP Ring fencing of elective surgery: Does it affect hospital efficiency? Working paper 2004: 4. Oslo: Health Organization Research Norway ; 2004.

11.

Ministry of Health and Social Affairs. Tilgjengelighet og faglighet. Om sykehus og annen spesialisthelsetjeneste [Accessibility and professionality. On hospitals and other specialist services]. Stortingsmelding nr. 24 (1995—1996). Oslo: Ministry of Health and Social Affairs; 1996 .

12.

Martinussen PE , Midttun L.

Day surgery and hospital efficiency: empirical analysis of Norwegian hospitals, 1999— 2001

Health Policy 2003;68:183—96.

13.

Dahlen K. , Kindseth O. , Lie TA , Mogseth E. , Petersen S. Ventelistene ved helseforetakene i Midt-Norge våren 2002 [Waiting lists in health enterprises in Mid-Norway spring 2002]. SINTEF report. Trondheim: SINTEF Health Services Research ; 2002.

14.

Biørn E. , Hagen TP , Iversen T. , Magnussen J. The effect of activity-based financing on hospital efficiency: a panel data analysis of DEA efficiency scores. Working paper 2002: 8. Oslo: Health Economics Research Programme, University of Oslo; 2002.

15.

Aase A. , Storm-Furre I. , Nilsen S. Nasjonatlas for Norge. Helse [National Atlas for Norway. Health]. Oslo: Statens Kartverk; 1996.

16.

Rognerud M. , Stensvold I. Oslohelsa.

Utredningen om helse, miljø og sosial ulikhet i bydelene [The Oslo health. The review of health, environment and social inequalities in the communities]. Ullevål Hspital, Department of

Preventive Medicine; 1997.

17.

Huseby BM , Kalseth B. Levekår, tilgjengelighet til sykehustjenester og bruk av sykehus i norske kommuner [Living conditions, accessibility to specialized health care and hospital use in Norwegian municipalities]. SINTEF Report. Trondheim: SINTEF Health Services Research; 2001.

18.

Mackenbach JP , Kunst AE , Cavelaars F. , Groenhof F. , Geursts JJ Socioeconomic inequalities in morbidity and mortality in Western Europe. Lancet 1997;349: 1655—9.

19.

Botten GS , Hagen TP , Waaler HT Sprekere eldre, rimeligere eldreomsorg? [Healthier elderly people, less expensive care?] Working paper 2000: 6. University of Oslo: Health Economics Research Programme; 2000.

20.

Halsteinli V. Kapasitet innenfor institusjonsbasert omsorg og eldres forbruk av sykehustjenester — om forskjeller mellom Oslo og Akershus [Capacity within institutional-based care and elderly people's consumption of hospital care — differences between Oslo and Akershus county]. SINTEF report. Trondheim: SINTEF Health Services Research; 1996.

21.

Hammervold R. , Jørgensen S. Regionale variasjoner i bruk av sykehus. Somatiske sykehustjenester i 1986 og de eldres bruk av sykehus/kommunehelsetjeneste [Regional variations in hospital use. Somatic hospital services in 1986 and elderly people's hospital use/use of primary health care]. SINTEF Report. Trondheim: Norwegian Institute of Hospital Research ; 1989.

22.

Nerland SM Er liggetid betinget av finansieringsordninger? En analyse av paneldata fra 63 norske somatiske sykehus i årene 1976—1999 [Is length of stay dependent upon financing systems? — An analysis of panel data from 63 Norwegian somatic hospitals during the period 1976—1999]. Working paper 2001: 13. University of Oslo: Health Economics Research Programme; 2001.