Extended free choice of hospital

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Abstract

The present report focuses on an evaluation published in February 2004, assessing the impact of the waiting time guarantee policy introduced in July 2002. The purpose of policy initiative was to strengthen the incentive of the counties and their hospitals to reduce waiting times for treatment, increase responsiveness and competition among public hospitals giving a larger role to private providers.

Purpose of health policy or idea

As of July 1st 2002, the waiting time guarantee was changed to two months. If the home county of a patient is unable to provide treatment the patients have an extended right to seek treatment at private hospitals in Denmark or in another country (with whom the Association of counties has established a contract). The home county is obliged to pay for the treatment.

The initial policy initiative dating from 1992 originated with the central government as does the extended "free choice.". The objective was and is to provide the counties with an incentive to reduce waiting times for treatment within their own hospitals as the counties otherwise will have to pay for, perhaps more expensive, treatment outside the public system. The question is whether this effect will prevail or there will remain an incentive for the counties to speculate in the possibility that waiting times will strengthen their position vis-à-vis the central government when negotiating budgets. 

The present government has made it explicit that the extended "free choice" scheme serves also to introduce and increase a competitive element in the Danish health care sector and to give private provider a larger role to play.

For a more thorough description of the initial initiative please see previous reports. The present report focuses on a recently (February, 2004) published evaluation.

Type of incentives

To reduce waiting times for treatment/increase the systems responsiveness.

Groups affected

Patients, Counties and their hospitals, Private hospitals

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral

Political and economic background

The evaluation is part of an on-going process. Proposals for minor changes are presented as part of the evaluation. There are no major changes proposed.

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Origins of health policy idea

The approach follows an earlier scheme as it is an extension of an existing "free choice"/voucher scheme. The extension was put into effect on July 1st 2002 by the Liberal government that took office in Fall 2001.

Approach of idea

The approach of the idea is described as:
amended:

Stakeholder positions

No specific policy-paper was produced. It was part of the then incoming governments policy program. Remarkably the idea was conceived by the central government and passed by Parliament; i.e. it was not an initiative taken by the counties. However, this difference in approach was also the case when the initial "free choice" scheme was put into place in 1992. The scenario is thereby an example of the ongoing process of a game being played between the central government and the counties.

Influences in policy making and legislation

It has been implemented and has now reached an evaluation phase.

Legislative outcome

success

Adoption and implementation

It was implemented without major opposition. For this scheme to work, it was and is necessary to provide patients with better quality information than has been achieved previously. As noted below in the summary of the evaluation results there is still a lack of relevant information, and also a problem with lacking incentives to provide patients with information.

The government has recently (see report on The government announces its new strategy for the health care sector 1/2004) given the scheme a market-oriented interpretation stressing the competitive aspect.

Monitoring and evaluation

The policy initiative "Extended free choice of hospital" has now been evaluated in an official report published by various government agencies and the Association of Counties. To this date, an evaluation by analysts other than stake-holders has not been produced.

 The main results of the official report are:

• Generally satisfaction among stake holders (patients, counties and their hospitals, private hospitals) with the scheme.
• High satisfaction among patients with treatment in private hospitals (at same level og sligtly higher than patients satisfaction with public hospitals).
• Among private hospitals some dissatisfaction with the level of information that public hospitals and/or the counties provide to patients regarding their possibility to choose treatment in private hospitals.
• The counties (i.e. payers) are generally satisfied but inicate a need for some changes in the contracts with the private hospitals.
• Most counties (i.e. payers) have no wish to extend the treatments covered by the scheme, while a few do see a need for an extension.
• Though the public hospitals are obliged to provide information to patients about their possibility to chooce private providers, in a non negligible extent the public hospitals fail to provide this information.
• Approximately 55 percent of patients waiting for treatment (in a rather small sample used in the evaluation) knew of the "extended free choice"; 65 percent knew of the original "free choice" scheme.
• As experienced in the original "free choice" scheme the number of patients actually using the scheme is fairly limited (since July 1st 2002 and untill December 31st 2003 26.000 patients had used the scheme).
• Patients treated at a private hospital tends to experience longer waiting times for rehabilitation at public hospitals (rehabilitation is generally not offered at private hospitals so patients from private hospitals depend on subsequent rehabilitation from public hospitals.)
• The counties experience a tendency to cream-skimming among private hospitals.  

 

The evaluation concludes in a number of recommendations:

• Better information from the public hospitals to patients about the existence of the extended free choice scheme.
• Better information to patients on how to exercise the possibility of choosing a private provider.
• Generally better and systematically provision of information on expected waiting time in the public hospital that a patient has been referred to and similar information on other public hospitals.
• That the Ministry of Health and the Association of Counties work to secure adequate and homogenous  information to all patients across the country.
• To experiement with contracts that are less vulnerable to cream-skimming.
• That private hospitals involved in the scheme are made obliged to report data to clinical databases.

Expected outcome

It is conceivable that the policy will function as a step in the direction of a more market-oriented system. Should this be the case all the traditional questions and engaged opinions on this specific issue will come into play. 

The evaluation does not address these issues in a precise and quantitative way, and an assessment now will be very speculative. So I refrain from making one. 

References

Sources of Information

An official evaluation with the Danish title "Rapport fra arbejdsgruppen om evaluering af det udvidede frie sygehusvalg" published by the Association of Counties, the Copenhagen Hospital Corporation, the Ministry of Finance and the Ministry of the Interiour and Health. Available from www.im.dk (Ministry of Health homepage, all material in Danish only).

Author/s and/or contributors to this survey

Michael O. Appel

Empfohlene Zitierweise für diesen Online-Artikel:

Michael O. Appel. "Extended free choice of hospital". Health Policy Monitor, 04/04. Available at http://www.hpm.org/survey/dk/a3/5