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Maximum Waiting-time Guarantee - an attempt to reduce waiting lists in Sweden
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine. (Socialmedicinsk epidemiologi)
1996 (English)In: Health Policy, ISSN 0168-8510, Vol. 36, no 1, 17-35 p.Article in journal (Refereed) Published
Abstract [en]

In Sweden, as in most countries with publicly financed health services, long waiting lists for some surgical procedures have been a serious quality problem on the health policy agenda. To reduce waiting lists, the Swedish Government and the Federation of County Councils, agreed on an initiative to offer a maximum waiting-time guarantee for 12 procedures during 1992. Patients awaiting procedures are guaranteed a waiting time no longer than 3 months from the physician's decision to treat/operate. The initial agreement was to be in force for 1 year, and a grant of 500 million SEK (USD 70 million) was appropriated for the initiative. The guarantee has been prolonged by annual decisions to be in force 1993 through 1995. However, no extra resources were set aside for these years. This article describes the background and the introduction of the guarantee, and discusses some of the major results during the first 2 years. Generally, waiting lists decreased substantially during 1991 and 1992. By the end of 1992 only a few departments were unable to serve patients within 3 months. During 1993 the reduction in the waiting lists ceased, and waiting lists for some procedures showed a tendency to increase by the end of the year. The overall successful result, in terms of waiting lists and waiting times, seems to have been achieved mainly by increased production, improved administration of the waiting lists, and a change in attitudes toward waiting lists. The expectation that the guarantee would lead to a more even use of resources across the country has not been realised since it appears that hospital departments chose to expand their own activities rather than use the new opportunity offered by the guarantee to refer patients to other hospitals.

Place, publisher, year, edition, pages
1996. Vol. 36, no 1, 17-35 p.
Keyword [en]
Waiting lists, Healthcare reform, Follow-up, Evaluation, Quality, Sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology
URN: urn:nbn:se:uu:diva-93077DOI: 10.1016/0168-8510(95)00791-1PubMedID: 10172629OAI: oai:DiVA.org:uu-93077DiVA: diva2:166445
Available from: 2005-04-27 Created: 2005-04-27 Last updated: 2009-11-04Bibliographically approved
In thesis
1. Maximum Waiting-time Guarantee - a remedy to long waiting lists?: Assessment of the Swedish Waiting-time Guarantee Policy 1992-1996
Open this publication in new window or tab >>Maximum Waiting-time Guarantee - a remedy to long waiting lists?: Assessment of the Swedish Waiting-time Guarantee Policy 1992-1996
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Lengthy waiting times have been a problem in Swedish health services for many years. In 1992, Sweden implemented a national maximum waiting-time guarantee (MWG) through an agreement between the Swedish Government and the Federation of Swedish County Councils. The “guarantee” assured patients that the waiting time between the decision-to-treat and the treatment itself would not exceed three months. The national MWG covered twelve different treatments/interventions and remained in force for five years. This dissertation describes the genesis of the MWG, its implementation, and its effects.

Four papers serve as a foundation for the dissertation. Paper I describes how the guarantee was implemented during the first two years. Paper II studies the impact that the MWG had on cataract surgery. Paper III uses the results of two questionnaire surveys of department heads to explain why the MWG, although successfully launched, became increasingly difficult to maintain. Paper IV analyses data from the national cataract register to determine how production and waiting times in cataract surgery were affected by termination of the MWG.

This dissertation confirms that waiting time for health care is a complex phenomenon resulting from multiple causes. “Guarantees” are of particular interest because they define what constitutes too long in reference to waiting times. Beyond that, they are only a framework for developing a plan of action. The positive effects of the MWG were transient and based on rationalisation, introduction of new technology, and stricter prioritisation. The MWG contributed towards empowering patients and slowing the expansion of treatment indications, but it was unsuccessful in levelling out the wide regional variations in surgical rates.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2005. 106 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 41
Health services research, Health Services Research, Waiting lists, Health Policy, Evaluation, Maximum Waiting-time Guarantee, Hälso- och sjukvårdsforskning
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
urn:nbn:se:uu:diva-5805 (URN)91-554-6255-3 (ISBN)
Public defence
2005-05-19, Fåhreaussalen, Rudbecklaboratoriet (ingång C 5), Dag Hammarskiölds väg 20, Uppsala, 13:15
Available from: 2005-04-27 Created: 2005-04-27Bibliographically approved

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