Norwegian Priority Setting in Practice – an Analysis of Waiting Time Patterns Across Medical Disciplines

Abstract

Background: Different strategies for addressing the challenge of prioritizing elective patients efficiently and fairly have been introduced in Norway. In the time period studied, there were three possible outcomes for elective patients that had been through the process of priority setting: (i) high priority with assigned individual maximum waiting time; (ii) low priority without a maximum waiting time; and (iii) refusal (not in need for specialized services). We study variation in priority status and waiting time of the first two groups across different medical disciplines. Methods: Data was extracted from the Norwegian Patient Register (NPR) and contains information on elective referrals to 41 hospitals in the Western Norway Regional Health Authority in 2010. The hospital practice across different specialties was measured by patient priority status and waiting times. The distributions of assigned maximum waiting times and the actual ones were analyzed using standard Kernel density estimation. The perspective of the planning process was studied by measuring the time interval between the actual start of healthcare and the maximum waiting time. Results: Considerable variation was found across medical specialties concerning proportion of priority patients and their maximum waiting times. The degree of differentiation in terms of maximum waiting times also varied by medical discipline. We found that the actual waiting time was very close to the assigned maximum waiting time. Furthermore, there was no clear correspondence between the actual waiting time for patients and their priority status. Conclusion: Variations across medical disciplines are often interpreted as differences in clinical judgment and capacity. Alternatively they primarily reflect differences in patient characteristics, patient case-mix, as well as capacity. One hypothesis for further research is that the introduction of maximum waiting times may have contributed to push the actual waiting time towards the maximum. The finding that the actual waiting time was very close to the maximum waiting time supports this. The lack of clear correspondence between the actual waiting time for patients and their priority status may imply that urgency, described in the referral letter, and severity of illness, according to guidelines, are two separate entities. Keywords: Waiting Lists, Prioritization, Healthcare Sector Copyright: © 2016 by Kerman University of Medical Sciences Citation: Gangstøe JJ, Heggestad T, Norheim OF. Norwegian priority setting in practice -an analysis of waiting time patterns across medical disciplines.

Long Waiting Times for Elective Hospital Care – Breaking the Vicious Circle by Abandoning Prioritisation

“…This seems to be the case in our region, where patients' actual waiting times often are very close to the assigned maximum. 37 This indicates a need for new performance indicators.…”

“…Waiting lists and waiting times are in this study evaluated based on data from one department only. Planning profiles 37 and waiting times 1 seem to differ between specialties, and as mentioned above, much research goes into developing and improving prioritisation based policies (example papers [21][22][23][24][25][26][27] ).…”

Patient prioritisation methods to shorten waiting times for elective surgery: a systematic review of how to improve access to surgery

“…Gangstoe (33) reported a cross-sectional study of the variation in priority status and waiting times across different medical disciplines for elective patients admitted to specialized services in Norway, in 2010. Considerable variation was found across medical specialties, with causes for variation often interpreted as differences in clinical judgment and capacity.…”

“…The main outcome variable of interest for this review is a time-to-event measurement, which required the follow up of a cohort of patients and various time measurements in these study participants. We applied the CASP checklist for cohort studies to six included studies (10, 27, 28, 33, 36, 38) and the CASP checklist for Qualitative studies to two studies (31, 34). The two systematic reviews were assessed using the CASP checklist for systematic reviews.…”

“…First, is the generic approach that could be used as a universal prioritisation criterion for all types of elective surgeries (10, 39, 45). Secondly, the prioritisation criteria were specifically based on measures related to the particular clinical status and recommended for managing the queue for a particular surgery or surgical specialty: orthopaedic surgery (27, 30, 35-37), general surgery (29), neurosurgery (33, 34), bariatric surgery (38, 42), eye surgery (32) and plastic surgery (31).…”