Prioritering, styring og likebehandling: Utfordringer i norsk helsetjeneste

Aasen, Henriette Sinding; Bringedal, Berit; Bærøe, Kristine; Magnussen, Anne-Mette

doi:10.23865/noasp.33

Cited by 3 publications

(1 citation statement)

References 93 publications

(117 reference statements)

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“…Våre data er hentet fra Legeforskningsinstituttets panelsurvey 1 , som gjennomføres annethvert år blant leger som er yrkesaktive i Norge (Bringedal & Carlsen, 2018). I 2016-undersøkelsen (LEFO, 2016) var bruttoutvalget 1605 leger, og svarprosenten var 73 prosent.…”

Section: Metode Og Datagrunnlagunclassified

Prioriteringsveiledere i spesialisthelsetjenesten

Aase-Kvåle¹,

Magnussen²,

Nilssen³

2019

TFV

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Artikkelen setter søkelys på forholdet mellom rettslig regulering og medisinskfaglig skjønnsutøvelse ved prioritering av spesialisthelsetjenester i Norge. På bakgrunn av en surveyundersøkelse blant 449 sykehusleger diskuteres det hvorvidt skriftlige prioriteringsveiledere ansvarliggjør sykehuslegene når det gjelder overordnede prioriteringshensyn. Med utgangspunkt i et analytisk skille mellom epistemiske og strukturelle ansvarliggjøringsmekanismer diskuteres det hvorvidt veilederne kan fungere demokratisk-rettslig og/eller profesjonelt ansvarliggjørende. Artikkelen viser at en kombinasjon av god kjennskap til prioriteringsveilederen og en positiv vurdering av den forutgående revisjonens konsekvenser for veiledernes relevans har avgjørende betydning for i hvilken grad veilederne får innvirkning på legenes prioriteringspraksis. Nøkkelord rettslig regulering, faglig skjønnsutøvelse, spesialisthelsetjenesten, prioritering, ansvarliggjøring

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Section: Metode Og Datagrunnlagunclassified

Prioriteringsveiledere i spesialisthelsetjenesten

Aase-Kvåle¹,

Magnussen²,

Nilssen³

2019

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Successfully changing the mode of regulation in clinical priority setting: how organisational factors contributed to establishing the Norwegian priority guidelines for specialist health care services

Aase-Kvåle

2023

HEPL

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This article investigates factors that contributed to the successful introduction of 33 priority guidelines for Norwegian specialist health care from 2008 to 2012. The guidelines constituted an important step in changing the regulation of clinical priority setting from largely self-regulation by medical professionals to a more centralised and hierarchical form, and therefore, resistance from the medical profession was expected. My focus is on organisational factors within the project that developed the guidelines, using policy documents and project documents as the main source of data. I find that the project was characterised by a high level of autonomy in terms of how it was organised and the actors included, with significant capacity for action in terms of both structure and personnel, and a broad inclusion of affected actors. The priority guideline project was dominated by medical professionals, and its organisation did not represent a radical break with established traditions of medical professional self-regulation. Although organisational autonomy, action capacity and broad inclusion were clearly of importance, the project's compliance with historical traditions and norms of medical governance stands out as the key factor in understanding the successful establishment of the priority guidelines.

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Law and medical practice: A comparative vignette survey of cardiologists in Norway and Denmark

2020

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Objective: This article explores the implications of legal regulation for medical discretion and decision-making in Norway and Denmark. Methods: The article is based on a cross-national cross-sectional survey exploring cardiologists’ assessments of patient eligibility for specialist health care. Forty-two cardiologists in Norway and 48 in Denmark were presented with two standardized case vignettes in the form of patient referrals and were asked to assess whether the patient was eligible for treatment by a specialist, and if so, what waiting time would be assigned to the patient. Results: Primarily based on descriptive statistics, our findings indicate interesting similarities and variations. While there was only minor variation across the countries in cardiologists’ professional assessments about a patient with a more severe condition, judgements of eligibility for specialist treatment varied for a patient with a less severe medical condition. Moreover, Danish cardiologists distinguished between the more severe and less severe conditions to a much lesser extent when assessing eligibility for specialist treatment. For waiting times, there was considerable variation at the general level, from 1 week to 6 months. The assigned waiting times were on average double those for Norwegian cardiologists compared with their Danish counterparts. Denmark’s legal standardization of waiting times appears to lead to shorter waiting times than those prescribed by Norway’s legal regulations. Conclusion: For a single clear overall intention with a new policy, simpler legal regulations may be more effective than very detailed and specific requirements. If policymakers’ overall intention is for medical doctors to make complex decisions involving the prioritization of patients, then more individualized regulations seem to be a better tool.

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Prioritering, styring og likebehandling: Utfordringer i norsk helsetjeneste

Cited by 3 publications

References 93 publications

Prioriteringsveiledere i spesialisthelsetjenesten

Prioriteringsveiledere i spesialisthelsetjenesten

Successfully changing the mode of regulation in clinical priority setting: how organisational factors contributed to establishing the Norwegian priority guidelines for specialist health care services

Law and medical practice: A comparative vignette survey of cardiologists in Norway and Denmark

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