Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-20T03:36:48.387Z Has data issue: false hasContentIssue false
  • English
  • Français

Patient reactions to hospital choice in Norway, Denmark, and Sweden

Published online by Cambridge University Press:  01 April 2007

KARSTEN VRANGBÆK ,
KATARINA ØSTERGREN ,
HANS OKKELS BIRK  and
ULRIKA WINBLAD
KARSTEN VRANGBÆK
Affiliation:
University of Copenhagen, Denmark
KATARINA ØSTERGREN*
Affiliation:
Norwegian School of Economics and Business Administration, Norway
HANS OKKELS BIRK
Affiliation:
Roskilde County and University of Copenhagen, Denmark
ULRIKA WINBLAD
Affiliation:
Uppsala University, Sweden
*
*Corresponding author: Katarina Østergren, Norwegian School of Economics and Business Administration, Department of Accounting, Auditing and Law, Helleveien 30, Bergen, N-5045, Norway. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

This article is a comparative study of three Scandinavian countries – Norway, Denmark, and Sweden – all of which have provided the individual patient with extensive rights to choose the hospital where he/she wishes to receive treatment. In the paper, we present an analysis of the utilization of the opportunity to choose between hospitals in these three countries. The analysis addresses two questions: (i) How many patients are exercising the right to choose between hospitals in these countries and who is making use of this opportunity? (ii) How can we explain the observed utilization pattern? The results of the study reveal clear similarities between the three countries and suggest that few patients have actually chosen their hospital. However, a gradual increase can be observed over the years. Few formal, legislative, or economic barriers exist for patients. Instead, limited knowledge amongst patients regarding reforms, combined with insufficient support from GPs and limited information, can explain why few patients choose to receive care outside of their local region.

Type
Articles
Information
Health Economics, Policy and Law , Volume 2 , Issue 2 , April 2007 , pp. 125 - 152
Copyright
Copyright © Cambridge University Press 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Anell, A. and Rosén, P. (1995), ‘Valfrihet i vården, En empirisk undersökning av preferenser hos allmänhet och vårdpersonal’ [An empirical study of preferences among the public and healthcare personnel], IHE arbetsrapport 1995:4, Lund: Institutet för hälso- och sjukvårdekonomi.Google Scholar
Birk, H.O. and Henriksen, L.O. (2003), Brugen af det frie sygehusvalg inden for tre amter, 1991–1999 [The use of the right to choose freely between hospitals in three different counties, 1991–1999], Ugeskr Laeger, 165: 3613–3616.Google ScholarPubMed
Birk, H.O. and Henriksen, L.O. (2006), Why do not all hip- and knee-patients facing long waiting times accept re-referral to a hospital with short waiting time? Questionnaire study, Health Policy, 77: 318–325.CrossRefGoogle Scholar
Carlsen, B. and Norheim, O.F. (2003), ‘Legens doble rolle som advokat og portvakt i Fastlegeordningen – Evaluering av fastlegereformen’ [The GP’s dual role as advocate and gatekeeper. Evaluation of the GP reform], Stein Rokkan Senter for flerfaglige samfunnsstudier og Universitetet i Bergen, Notat-19.Google Scholar
Christensen, Ø. and Hem, K.G. (2004), ‘Fritt sykehusvalg i Norge’ [The right to choose between hospitals in Norway], SINTEF Report number STF78 A044514.Google Scholar
Dansk Hysterektomi Database Aarsrapport [Danish Hysterectomy Database – annual report] (2004), available in Danish from http://www.kliniskedatabaser.dk/doks/Hysterektomi/DHD_aarsrapport_2004.pdf, accessed 24 July 2006.Google Scholar
EfB [Enheden for Brugerundersøgelser, Unit for Patient Evaluation] (2001), Patienters vurdering af landets sygehuse [Patient assessments of Danish hospitals].Google Scholar
EfB (2003), Patienters vurdering af sygehusafdelinger i Roskilde Amt 2002 [Patient assessments of hospital departments in Roskilde County 2002].Google Scholar
EfB (2005), Patienters oplevelser på landets sygehuse 2004 [Patient experiences in Danish hospitals 2004], an abstract in English is available from http://www.efb.kbhamt.dk/emnekatalog/pdf/English/Survey_20041.pdf, accessed 20 July 2006.Google Scholar
Godager, G. and Iversen, T. (2004), Hvem bruker retten til fritt sykehusvalg? Resultater fra Samordnet levekårsundersøkelse 2002 [Who utilizes the right to choose between hospitals? Results from the integrated study of living conditions 2002], Økonomisk Forum, 58 (4/5): 49–56.Google Scholar
Hansen, T.B. (1994), Hvilke faktorer har betydning for valg af sygehus ved tilskadekomst? [What factors affect choice of hospital in cases of trauma? A study of conditions in the county of Ringkøbing], Ugeskrift for Læger, 156: 652–655.Google Scholar
Huseby, B.M. (2004a), ‘Tabeller over pasientstrømmer mellom helseregionene 1999–2002 etter høyspesialiserte funksjoner ICD-10’ [Tables illustrating patient flow between 1999–2002 – highly specialized treatment], SINTEF-notat.Google Scholar
Huseby, B.M. (2004b), ‘Pasientstrømmer’ [Patient flows], SAMDATA somatikk sektorrapport 1/04, www.samdata.sintef.no.Google Scholar
Kjerstad, E. and Kristiansen, F. (2005), ‘Free choice, waiting time and length of stay in Norwegian hospitals’, Working paper, SNF.Google Scholar
Kristiansen, F. and Sunnevåg, K.J. (2003), ‘Statlig politikk ovenfor helsesektoren – regionale virkninger’ [Government policy – healthcare sector], SNF-rapport nr 39/03.Google Scholar
Landstingsförbundet (2001), www.lf.se/nyheter/nyhet 2001-01-11.Google Scholar
Landstingsförbundet (2003), ‘Att vänta på vård. En analys av tillgängligheten i svensk hälso- och sjukvård’ [Waiting for care. An analysis of the accessibility of Swedish healthcare], Stockholm: EO print.Google Scholar
Landstingsförbundet (2004), Vårdbarometern, www.vardbarometern.nu, accessed 15.6.2004.Google Scholar
Landstingsvärlden (2004), ‘Allt fler utnyttjar det fria vårdvalet’ [More and more people exercise their free choice], nr 20.Google Scholar
Ministry of Health and Social Affairs (1993–1994), ‘Samarbeid og styring. Mål og virkemidler for en bedre helsetjeneste’ [White paper: Goals and means to improve the hospital sector], St. meld. nr. 50, Norway.Google Scholar
Ministry of Health and Social Affairs, Ot.prp.nr. 66 (2000–2001), ‘Om lov om helseforetak’ (Helsereformen) [Health Act], Stortinget, Norway.Google Scholar
Ministry of Health and Social Affairs, Ot.prp.nr.63 (2002–2003), ‘Om lov om endringer i lov 2 juli 1999 nr.63 om pasientrettigheter (pasientrettighetsloven) med mer' [Proposed amendments to the Patient Rights Act], Norway.Google Scholar
Ministry of Health and Social Affairs, Besl. O. nr 23 (2003–2004) ‘Endring i lov 2 juli 1999 nr. 63 om pasientrettigheter’ [Amendment to Patient Rights Act], Norway.Google Scholar
Ministry of Health and Social Affairs, Innstilling Storting, Nr 165 (1994–95), ‘Mål og virkemidler for en bedre helsetjeneste’ [Goals and means for improving the hospital sector], Stortinget, Norway.Google Scholar
Ministry of Health and Social Affairs, Innstilling, O.nr 91 (1998–99), ‘Lov om pasientrettighetsloven’ [In Norwegian: Patient Rights Act], Stortinget, Norway.Google Scholar
Ministry of Health and Social Affairs, Ot.prp.nr.12 (1998–99) ‘Lov om pasientrettighetsloven’ (Forslag til patientrettighetsloven) [Proposal for Patient Rights Act], Stortinget, Norway.Google Scholar
Ministry of the Interior and Health (2005), ‘Sundhedssektoren i tal 2002/2003’ [The healthcare sector in numbers], Copenhagen, only available from http://www.im.dk/publikationer/sundhedssektoren%20i%20tal/index.htm, accessed 20 July 2006.Google Scholar
National Board of Health (2006), ‘Det udvidede frie sygehusvalg 2004 og 2005 (foreløbig opgørelse)’ [Extended freedom of choice 2004 and 2005 (provisional report on utilization)], The National Health Board, Copenhagen, available from: http://www.sst.dk/publ/tidsskrifter/nyetal/pdf/2006/15_06.pdf, accessed 26 July 2006.Google Scholar
Nordgren, L. (2005), ‘Dekonstruktion av det fria vårdvalet och vårdgarantin i den svenska sjukvårdsdiskursen’ [Deconstruction of free choice and the guarantee of limited waiting period in the Swedish healthcare discourse], Conference paper presented at the NFF conference in 2005 in Århus.Google Scholar
NOU (1992), ‘Lov om pasientrettigheter’ [Working committee’s report on patient rights], Norwegian Official Report, 1992:8, Norway.Google Scholar
Østergren, K. (2006), The institutional construction of consumerism – a study of implementing quality indicators in the Norwegian health care sector, Financial Accountability and Management, 22 (2): 179–205.CrossRefGoogle Scholar
PLS Consult (1999), ‘Det umuliges kunst – om prioriteringer i velfaerdsstaten belyst ved sygehusvaesenet’ [The art of the impossible – on priority setting in the welfare states; case: the hospital sector].Google Scholar
Ringard, Å.Rico, A., and Hagen, T.P. (2005), ‘Expanded patient choice in Norway and the UK: Will it succeed?’, Conference paper presented at the NFF conference in 2005 in Århus.Google Scholar
SINTEF-Helse (2005), ‘Patient flows’, www.sintef.no/cgi-bin, 6 December, accessed 10 August 2006.Google Scholar
Socialstyrelsen (2001), ‘Hälso- och sjukvårdsrapport 2001’ [Healthcare Report 2001], Linköping: LTAB, Linköpings tryckeri.Google Scholar
Socialstyrelsen (2005), ‘Var vårdas patienten? Analys av patientströmmar i Sverige: Studie omfattande patientregistret 1998–2002’ [Where is the patient treated? Analysis of patient mobility in Sweden: Study including the patient registry 1998–2000].Google Scholar
Sperling, L. S.Henriksen, T.B.Ulrichsen, H.Hedegard, M.Moller, H.Hansen, V.Ovlisen, B., and Secher, N.J. (1994), Indications for caesarean section in singleton pregnancies in two Danish counties with different caesarean section rates, Acta Obstet Gynecol Scand, 73: 129–135.CrossRefGoogle Scholar
Stockholms Läns, Landsting (1993) ‘Landstingsrevisorerna. Analys av vårdkedjan i Stockholmsmodellen: Valfrihet för patienten’ [Analysis of the patients’ care path in the Stockholm Model: Free patient choice], Rapport nr 3/93.Google Scholar
Sveriges Kommuner och Landsting [Association of Local Authorities and Regions] (2006), ‘Vård av patienter från andra landsting samt EU-vård. 2006-02-20’ [Care of patients from other counties and EU-care].Google Scholar
Swedish Federation of County Councils (2001), www.lf.se/nyheter/nyhet 2001-01-11.Google Scholar
Swedish Federation of County Councils (2004), www.lf.se/vantetider.Google Scholar
Tessier, G.Contandiopolous, A.P., and Dionne, G. (1985), Patient mobility for elective surgical interventions, Social Science and Medicine, 20(12): 1307–1302.CrossRefGoogle ScholarPubMed
The Danish Vascular Registry (2005), ‘Landsregistret Karbase’, Annual Report 2004, available from www.karbase.dk, accessed 20 July 2005.Google Scholar
Vejle Amt (1999), ‘Patienttilfredshedsundersoegelse: Heldoegn, Efteraaret 1998’ [Survey of patients’ experience: in-patients, Autumn, 1998].Google Scholar
Vrangbaek, K. and Bech, M. (2004), County level responses to the introduction of DRG rates for ‘extended choice’ hospital patients in Denmark, Health Policy 67: 25–37.CrossRefGoogle Scholar
Vrangbæk, K. and Østergren, K. (2006), Patient empowerment and the introduction of hospital choice in Denmark and Norway, Health Economics, Policy and Law, 1(4) October.CrossRefGoogle ScholarPubMed
Vrangbæk, K. (1999), ‘Markedsorientering i sundhedssektoren?’ [Markets in Danish healthcare], Ph.D. study, Institute of Political Science, University of Copenhagen, Copenhagen:.Google Scholar
Winblad Spångberg, U. (2003), ‘Från beslut till verklighet. Läkarnas roll vid implementeringen av valfrihetsreformer i hälso- och sjukvården’ [From decision to practice. The role of the physician in implementing patient choice in Swedish healthcare], Ph.D. study, Avhandling, Acta Universitatis Upsaliensis, Uppsala.Google Scholar