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Maximum waiting time - a threat to clinical freedom?: Implementation of a policy to reduce waiting times
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
2000 (English)In: Health Policy, ISSN 0168-8510, Vol. 52, no 1, 15-32 p.Article in journal (Refereed) Published
Abstract [en]

This article focuses on physicians as implementers of health policy reforms. In 1992, a maximum waiting-time guarantee was introduced in Sweden. Initially the policy was a successful way to come to terms with long waiting times. However, after 2 years the waiting lists started to increase. To understand this development it is important to look at the reactions to the policy among the implementers, i.e. the physicians. Three questions are addressed: Did the implementers understand the intentions and the goals of the reform? Were they able to fulfil the guarantee? And, did they approve of the initiative? The study subjects were chief physicians at the hospital departments involved with the guarantee. Their attitudes towards the policy were ascertained by two surveys. Other material, such as statistics on waiting times, was also used. The study shows that the physicians approved of the guarantee initially. The measures taken in the first years were effective and did not conflict with earlier practice. However, increased demand in combination with economic restraints necessitated new priorities among patient groups. These changes of clinical practice did not coincide with the physicians’ professional values and hence they became more critical to the initiative and finally chose to abandon the intentions in the guarantee.

Place, publisher, year, edition, pages
2000. Vol. 52, no 1, 15-32 p.
Keyword [en]
Waiting lists, Health care reform, Implementation of health policy, Evaluation, Sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:uu:diva-93079DOI: 10.1016/S0168-8510(00)00060-9PubMedID: 10899642OAI: oai:DiVA.org:uu-93079DiVA: diva2:166447
Available from: 2005-04-27 Created: 2005-04-27 Last updated: 2010-06-23Bibliographically 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.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 41
Keyword
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
Identifiers
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
Opponent
Supervisors
Available from: 2005-04-27 Created: 2005-04-27Bibliographically approved

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