Prioritization and patients' rights: Analysing the effect of a reform in the Norwegian Hospital Sector

The right to equal treatment, irrespective of age, gender, ethnicity, socio-economic status and place of resident, is an important principle for several health care systems. A reform of the Norwegian hospital sector may be used as a relevant experiment for investigating whether centralization of ownership and management structures will lead to more equal prioritization practices over geographical regions. One concern was variation in waiting times across thecountry. The reform was followed up in subsequent years by some other policy initiatives that also aimed at reducing waiting lists. Prioritization practice is measured by a method that takes departure in recommended maximum waiting times from medical guidelines. We merge the information from the guidelines with individual patient data on actual waiting times. This way we can monitor whether each patient in the available register of actual hospital visits has waited shorter or longer than what is considered medically acceptable by the guideline. The results indicate no equalisation between the five new health regions, but we find evidence of more equal prioritization within four of the health regions. Our method of measuring prioritizations allows us to analyse how prioritization practice evolved over time after the reform, thus covering some further initiatives with the same objective. The results indicate that an observed reduction in waiting times after the reform have favoured patients of lower prioritization status, something we interpret as a general worsening of prioritization practices over time.