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Waiting fo Cataract Surgery - Effects of Maximum Waiting-time Guarantee policy
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. (Socialmedicinsk epidemiologi)
2007 (English)In: Journal of Health Services Research and Policy, ISSN 1355-8196, Vol. 12, no 1, 5-10 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To evaluate the effects of the Maximum Waiting-time Guarantee (MWG) policy for cataract surgery on volume, indications, waiting times and priority setting in Sweden. Methods: Comparison between 1993 and 1994, when the guarantee had been in force for one year, and 1998 and 1999, when the policy had been terminated for one year. Data from the National Cataract Registry covering 156,657 cataract operations for the years studied. Results: The number of operations increased by 43% between the two study periods. Of this increase, 61% were patients with a visual acuity above 0.5 in the better eye, i.e. low-priority patients. Waiting times were longer for all patient categories in the later period and differences in waiting times between patients with differing priority diminished. Variations among the units in priority setting and waiting times were substantial, and increased after the Guarantee was terminated.

Conclusions: The Guarantee with its explicit indications was an effective policy instrument to limit waiting times and improve access for patients with the greatest need. It is unlikely that the Guarantee caused any 'crowding out' of other patient groups. When the Guarantee was not in force, indications for surgery widened. This, however, resulted in longer waiting times for all patient groups. After the Guarantee was terminated, the already substantial differences in access and indications among ophthalmic units became even greater.

Place, publisher, year, edition, pages
2007. Vol. 12, no 1, 5-10 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-93080DOI: 10.1258/135581907779497503OAI: oai:DiVA.org:uu-93080DiVA: diva2:166448
Available from: 2005-04-27 Created: 2005-04-27 Last updated: 2010-03-17Bibliographically 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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