Hospital waiting time in Norway: What is the role of organizational change?

Midttun, Linda; Martinussen, Pål E.

doi:10.1080/14034940510005950

Cited by 12 publications

(11 citation statements)

References 7 publications

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“…The introduction of ring fencing in Norwegian healthcare must be seen in relation to the parallel increase in the use of day surgery during the same period, since the activity in ring fencing units most commonly will be day-surgical procedures. Empirical evidence from Norway suggests that the use of ring fencing may increase hospital efficiency (Kjekshus & Hagen, 2004) and that it reduces hospital waiting time (Midttun & Martinussen, 2005). The introduction of ring fencing could therefore serve as an additional explanation to the results presented here, since patients eligible for procedures performed in ring fenced units can expect to wait shorter than patients that are treated in ordinary units.…”

Section: Resultsmentioning

confidence: 74%

“…planned), and, secondly, whether inpatient admissions with 0 days length of stay should be defined as day surgery. Building on the common approach of several other Norwegian studies (Huseby, 2002;2004;Martinussen, 2005;Martinussen & Midttun, 2004;Midttun & Martinussen, 2005), day surgery is in the following defined rather widely, including all surgical treatment with 0 days length of stay, independent of whether the patient is admitted to an inpatient ward or day treatment ward, and independent of whether the operation is planned or not. Given such a definition, day surgery now constitutes almost 50 per cent of all surgery in Norway, and 61 per cent of all elective surgery.…”

Section: Day Surgery In Norwegian Healthcarementioning

confidence: 99%

“…The underlying assumption is therefore that this mode of delivering surgery will ultimately increase the efficiency of hospitals as well as the quality of the patient treatment. Whereas the studies of day surgery have addressed aspects such as patient satisfaction (Roberts et al, 1995;Kangas-Saarela et al, 1998;Mitchell, 1999;Lau et al, 2000), clinical outcomes (Pineault et al, 1985), cost efficiency (Russel et al, 1977;Pineault et al, 1985;Ancona-Berk & Chalmers, 1986;Keithley et al, 1989;Heath et al, 1990;Hollmann et al, 1994;Janeke, 1994;Clarke, 1996;Weale, 2002), hospital efficiency (Martinussen & Midttun, 2004) and waiting time (Midttun & Martinussen, 2005), little attention has been paid to patient priorities.…”

Section: Introductionmentioning

confidence: 99%

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Reimbursement systems, organisational forms and patient selection: Evidence from day surgery in Norway

Martinussen

Hagen

2009

HEPL

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Cream skimming can be defined as the selective treatment of patients that demand few resources while providing high economic refunds. We test whether cream skimming occurs after the introduction of DRG-based activity-based financing (ABF) in Norway in 1997 and if the problem further increased after the 2002 organizational reform when hospitals were turned into trusts. The DRG-system offers the same economic reimbursement for patients classified within day-surgical DRGs irrespective of whether the patient receives same-day treatment or in-patient care over several days. This provides potential for cream skimming and allows us to investigate cream skimming within the actual diagnoses. Patient data from the period 1999-2005 is analyzed. Waiting times are used as indicators of patient selection and analyzed as a function of severity within each diagnosis, controlling for age and gender of the patient, as well as institutional and time-dependent variables. The analysis gives some evidence of cream skimming in the first period of ABF, in particular within the lighter orthopaedic diagnoses. However, cream skimming does not increase after the 2002 organizational reform but is stable, and for some DRGs even reduced. The study indicates that cream skimming may occur if reimbursement systems are not particularly sophisticated. Softening of budget constraints after the hospital reform of 2002 may explain why cream skimming does not increase after the reform. However, further investigation into this mechanism is needed.

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Section: Resultsmentioning

confidence: 74%

Section: Day Surgery In Norwegian Healthcarementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Reimbursement systems, organisational forms and patient selection: Evidence from day surgery in Norway

Martinussen

Hagen

2009

HEPL

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“…Industrial techniques include computer simulations to help visualize the impact of patient arrivals at peak hours, using existing space more efficiently and implementing tracking systems to improve patient flow. Hospitals can also resort to ring fencing, defined as separating elective from emergency operations in parallel production lines to reduce waiting time [50]. They can also streamline triage to reduce in-hospital delays, adopt tiered staffing, e.g.…”

Section: Emergency Department Re-engineeringmentioning

confidence: 99%

Cost Reduction Strategies for Emergency Services: Insurance Role, Practice Changes and Patients Accountability

Simonet

2008

Health Care Anal

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Progress in medicine and the subsequent extension of health coverage has meant that health expenditure has increased sharply in Western countries. In the United States, this rise was precipitated in the 1980s, compounded by an increase in drug consumption which prompted the government to re-examine its financial support to care delivery, most notably in hospital care and emergencies services. In California for example, 50 emergency service providers were closed between 1990 and 2000, and nine in 1999-2000 alone. In that State, only 355 hospitals (out of 568) have maintained emergency services departments (Darves, WebMB, 2001). Reforming hospital Emergency Department (ED) operations requires caution not only because the media pay a lot of attention to ED operations, but also because it raises ethical issues: this became more apparent with the enactment of the EMTALA which stipulates that federally funded hospitals are required to give emergency aid in order to "stabilize" a patient suffering from an "emergency medical condition" before discharging or transferring that patient to another facility. While in essence the law aims to preserve patient access to care, physicians assert that the EMTALA leads to more patients seeking care for non-urgent conditions in EDs (GAO, Report to Congressional Committees, 2001), leading to overcrowding, delayed care for patients with true emergency needs, and forcing hospitals to divert ambulances to other facilities resulting in further delays in urgent care. Also, fewer physicians are willing to be on-call in emergency departments because the EMTALA law requires on-call physicians to provide uncompensated care. Thus there is a need to find a balance between appropriate care to be provided to ED patients, and low costs since uncompensated care is not covered by state or federal funds. This concerns, first and foremost, hospitals that provide a greater amount of uncompensated care (e.g. hospitals serving communities with a higher population of illegal immigrants). Looking at the intrinsic causes of high ED costs, the paper first explains why costs of care provided in EDs are high, and look at a major cause of high ED costs: overcrowding and ED users' characteristics. This is followed by a discussion on a much-debated factor: the use of EDs for non-emergency conditions, a practice which has often been accused of disproportionately raising costs. We look at various mechanisms used either to divert or prevent the patient from using ED: these include triage services; and the role of HMOs in the ED chain of care: though the US government has increasingly relied on Managed Care organizations to contain costs (e.g. Medicaid and Medicare Managed Care), do HMOs make a difference when it comes to ED costs? Of particular interest is the family physician acting as a gatekeeper, and the legislation that was enacted to protect those who bypass the referral system. We then look at the other end of the ED chain (i.e. the recipient): the financial responsibility of ED users has increased. Alternativ...

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“…Therefore, we endorse that pharmacy's role as a health care provider holds promise for improving public health ( Jeet et al, 2017 ). This may be particular advantageous in rural areas and areas with low population density, where physicians and centralized hospitals are less easily accessible for all ( Midttun and Martinussen, 2005 ).…”

Section: Strengths and Limitationsmentioning

confidence: 99%

A randomized controlled trial in Norwegian pharmacies on effects of risk alert and advice in people with elevated cardiovascular risk

Svendsen

Telle-Hansen

Mørch-Reiersen³

et al. 2018

Preventive Medicine Reports

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We investigated if alerting subjects to elevated total cholesterol (TC), hemoglobin A1c (HbA1c) and blood pressure (BP) (cardiovascular disease (CVD) risk factors that are usually asymptomatic), and if providing advice would result in reduced risk. We conducted a multicenter (50 community pharmacies) parallel three-arm 8-week randomized controlled trial (RCT) with a 52-week follow-up visit. During six days of screening, TC, HDL- and LDL-cholesterol, triglycerides, HbA1c, BP and body mass index (BMI) were assessed in 1318 individuals. Of these, 582 with a measured and predefined elevated ad hoc CVD risk score were randomized to either Alert/advice (n = 198) (immediately alerted of their screening result and received healthy lifestyle-advice), Advice-only (n = 185) (received only advice) or Control (n = 199) (not alert, no advice). Changes in risk score and self-reported health-related behaviors (diet, alcohol, physical activity) were assessed in pharmacies after 8 weeks (N = 543; 93%). Although the primary analysis showed no significant difference between groups, the Control group had the largest reduction in risk score of 14%. The total (uncontrolled) sample (N = 543) reduced the risk score by 3.2% beyond estimated regression towards the mean and improved their health-related behaviors. Among the 65% (n = 377) who returned 52 weeks after baseline, 14% reported started using CVD preventive medication after the screening. The study demonstrated that while assessing risk factors and behaviors in pharmacies proved efficient and possibly led to a small risk decrease, alerting people to their screening result did not seem to be more effective than a self-directed approach. ClinicalTrials.gov identifier: NCT02223793.

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Hospital waiting time in Norway: What is the role of organizational change?

Cited by 12 publications

References 7 publications

Reimbursement systems, organisational forms and patient selection: Evidence from day surgery in Norway

Reimbursement systems, organisational forms and patient selection: Evidence from day surgery in Norway

Cost Reduction Strategies for Emergency Services: Insurance Role, Practice Changes and Patients Accountability

A randomized controlled trial in Norwegian pharmacies on effects of risk alert and advice in people with elevated cardiovascular risk

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