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The Impact of Different Prioritisation Policies on Waiting Times: A Comparative Analysis of Norway and Scotland

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Author Info

  • Januleviciute, Jurgita

    ()
    (University of Bergen)

  • Askildsen, Jan Erik

    ()
    (Uni Research - Department of Economics, University of Bergen)

  • Holmås, Tor Helge

    ()
    (Institute for Research in Economics and Business Administration)

  • Kaarbøe, Oddvar

    ()
    (University of Bergen)

  • Sutton, Matt

    ()
    (University of Manchester)

Abstract

We compare the distributional consequences of two different waiting times initiatives. The primary focus of Scotland’s recent waiting time reforms has been on reducing maximum waiting times through the imposition of high profile national targets. In Norway, the focus has been on appropriate prioritisation of referrals to hospital based on disease severity, the expected benefit of the treatment and cost-effectiveness. We use large, national administrative datasets from before and after each of these reforms and assign priority groups based on the maximum waiting times stipulated in Norwegian medical guidelines. To equalise case-mix over time, we use Exact Matching to weight the pre-reform patients to the patient composition in the post-reform period. We regress patient-level waiting times on patient characteristics and on a post-reform indicator interacted with the patient’s priority group. The analysis shows that the least-prioritised patients benefited most from both reforms. This was at the cost of longer waiting times for patients that should have been given higher priority in Norway, while Scotland’s high priority patients remained unaffected. This comparative analysis indicates that blanket waiting times initiatives may be more effective in reducing waiting times while preserving prioritisation between patients with different health needs.

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Bibliographic Info

Paper provided by University of Bergen, Department of Economics in its series Working Papers in Economics with number 07/10.

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Length: 30 pages
Date of creation: 01 Jun 2010
Date of revision:
Handle: RePEc:hhs:bergec:2010_007

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Postal: Institutt for økonomi, Universitetet i Bergen, Postboks 7802, 5020 Bergen, Norway
Phone: (+47)55589200
Fax: (+47)55589210
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Web page: http://www.uib.no/econ/en
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Keywords: Waiting times; prioritisation; Norway; Scotland;

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References

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  1. Stefano Iacus & Gary King & Giuseppe Porro, . "cem: Software for Coarsened Exact Matching," Journal of Statistical Software, American Statistical Association, vol. 30(i09).
  2. Gravelle, Hugh & Siciliani, Luigi, 2008. "Ramsey waits: Allocating public health service resources when there is rationing by waiting," Journal of Health Economics, Elsevier, vol. 27(5), pages 1143-1154, September.
  3. Askildsen, Jan Erik & Holmås, Tor Helge & Kaarboe, Oddvar, 2010. "Prioritization and patients' rights: Analysing the effect of a reform in the Norwegian hospital sector," Social Science & Medicine, Elsevier, vol. 70(2), pages 199-208, January.
  4. Jeremy Hurst & Luigi Siciliani, 2003. "Tackling Excessive Waiting Times for Elective Surgery: A Comparison of Policies in Twelve OECD Countries," OECD Health Working Papers 6, OECD Publishing.
  5. Carol Propper & Matt Sutton & Carolyn Whitnall & Frank Windmeijer, 2008. "Incentives and Targets in Hospital Care: Evidence from a Natural Experiment," The Centre for Market and Public Organisation 08/205, Department of Economics, University of Bristol, UK.
  6. Sofia Dimakou & David Parkin & Nancy Devlin & John Appleby, 2009. "Identifying the impact of government targets on waiting times in the NHS," Health Care Management Science, Springer, vol. 12(1), pages 1-10, March.
  7. Magnussen, Jon & Hagen, Terje P. & Kaarbøe, Oddvar M., 2006. "Centralized or decentralized? A case study of Norwegian hospital reform," Working Papers in Economics 02/06, University of Bergen, Department of Economics.
  8. Hugh Gravelle & Luigi Siciliani, 2008. "Is waiting-time prioritisation welfare improving?," Health Economics, John Wiley & Sons, Ltd., vol. 17(2), pages 167-184.
  9. Hagen, Terje P. & Kaarboe, Oddvar M., 2006. "The Norwegian hospital reform of 2002: Central government takes over ownership of public hospitals," Health Policy, Elsevier, vol. 76(3), pages 320-333, May.
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Cited by:
  1. Silviya Nikolova; & Arthur Sinko; & Matt Sutton;, 2012. "Do maximum waiting times guarantees change clinical priorities? A Conditional Density Estimation approach," Health, Econometrics and Data Group (HEDG) Working Papers 12/07, HEDG, c/o Department of Economics, University of York.

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