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Assessment of the Maximum Waiting time Guarantee for Cataract Surgery: The Case of a Swedish Policy
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine. (Socialmedicinsk epidemiologi)
1998 (English)In: International Journal of Technology Assessment in Health Care, ISSN 0266-4623, Vol. 14, no 1, 180-193 p.Article in journal (Refereed) Published
Abstract [en]

Cataract is the most common reason for visual problems in old age. The introduction of intraocular lens (IOL) implantation revolutionized cataract surgery. Since the IOL technique was established in Sweden in the early 1980s, the demand for surgery has been increasing, leading to lengthy waiting lists. To shorten some of the most troublesome waiting lists, national and local governments (county councils) in Sweden introduced a maximum waiting time guarantee in 1992. The assessment of the guarantee made in this article shows that ophthalmic surgery units vary in their adoption of the guarantee, leading to different levels of goal achievement in waiting times for their patients. The less successful units could be divided into two groups: one where the units have a low operation rate, and one where the units chose not to follow the recommendations in priority setting made in the guarantee.

Place, publisher, year, edition, pages
Cambridge U.P. , 1998. Vol. 14, no 1, 180-193 p.
National Category
Public Health, Global Health, Social Medicine and Epidemiology
URN: urn:nbn:se:uu:diva-93078PubMedID: 9509805OAI: oai:DiVA.org:uu-93078DiVA: diva2:166446
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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