Are waiting times for hospital admissions affected by patients' choices and mobility?

Abstract

BackgroundWaiting times for elective care have been considered a serious problem in many health care systems. A topic of particular concern has been how administrative boundaries act as barriers to efficient patient flows. In Norway, a policy combining patient's choice of hospital and removal of restriction on referrals was introduced in 2001, thereby creating a nationwide competitive referral system for elective hospital treatment. The article aims to analyse if patient choice and an increased opportunity for geographical mobility has reduced waiting times for individual elective patients.MethodsA survey conducted among Norwegian somatic patients in 2004 gave information about whether the choice of hospital was made by the individual patient or by others. Survey data was then merged with administrative data on which hospital that actually performed the treatment. The administrative data also gave individual waiting time for hospital admission. Demographics, socio-economic position, and medical need were controlled for to determine the effect of choice and mobility upon waiting time. Several statistical models, including one with instrument variables for choice and mobility, were run.ResultsPatients who had neither chosen hospital individually nor bypassed the local hospital for other reasons faced the longest waiting times. Next were patients who individually had chosen the local hospital, followed by patients who had not made an individual choice, but had bypassed the local hospital for other reasons. Patients who had made a choice to bypass the local hospitals waited on average 11 weeks less than the first group.ConclusionThe analysis indicates that a policy combining increased opportunity for hospital choice with the removal of rules restricting referrals can reduce waiting times for individual elective patients. Results were robust over different model specifications.

4. Migrants’ Consumption of Healthcare Services in Norway: Inclusionary and Exclusionary Structures and Practices

“…For example, a study among Somali women in Norway shows that despite the women's good knowledge of diabetes and risk factors such as sedentary lifestyle and unhealthy diet, they faced barriers to being physically active, such as time pressure, a lack of financial affordability for training facilities, and an absence of a tailored physical activity environment, such as training facilities not being gender-exclusive (Gele, Torheim, Pettersen, & Kumar, 2015). A similar study on barriers to outdoor physical activity among Somali youth, pointed out financial barriers such as expensive outdoor clothing, lack of time because of parents' work and children having afterschool jobs (Rothe et al, 2010). In light of this, to gain a fuller picture of migrants' healthcare consumption, financial barriers should include consideration of both direct and indirect costs that prevent access to healthcare.…”

“…There seems to be a need for evidence-based knowledge about the different migrant groups' propensity to use healthcare services based on cultural and socioeconomic background, but we also need to know about the quality of healthcare individual persons with migrant backgrounds receive. For example, there is evidence of longer waiting times for hospital treatment for patients with low levels of education and/or income than for groups higher up the socioeconomic scale (Monstad, Engesaeter, & Espehaug, 2014;Ringard & Hagen, 2011). All the same, although many of the newly arrived migrants from non-Western countries fit the general description, there is need for a differentiated research on various groups of migrants -from labour migrants to refugees and 'illegal' migrants.…”

“…The term 'healthy migrant effect' is often used to describe how migrants who succeed in reaching their destinations will generally be the healthiest. Nevertheless, some studies suggest an 'exhausted migrant effect,' which is in line with the social and economic inequalities that have been shown to play a large role in the declining health profile of populations, both in Norway and internationally (Dahl, Bergli, & Wel, 2014;Marmot & Wilkinson, 2006;Rognerud, Naess, & Strand, 2007). This way, ethnicity and socioeconomic status may intertwine with and influence the process of migration and healthcare consumption.…”

Assessing physician productivity following Norwegian hospital reform: A panel and data envelopment analysis

“…In 2001, all patients were granted free choice of hospitals combined with the removal of county border barriers. This primarily aimed to reduce long waiting times, and previous research has shown that both the introduction of ABF and the expansion of hospital budgets have been factors in reducing waiting time for elective patients (Hagen & Kaarboe, 2006;Ringard & Hagen, 2011). Although these two initiatives may also have influenced the hospitals' operational performance, we conclude that physician productivity did not improve during our study period, irrespective of these reforms.…”

Tolerance intervals for autoregressive models, with an application to hospital waiting lists

“…This is an important ongoing issue, especially for publicly funded institutes. Although extensive research and discussion have been put forth, there is no panacea for this dynamic issue. If the length of waiting lists can be forecasted by reasonable statistical summaries, then hospitals may be able to better prepare and improve their service performance.…”