|Implemented in this survey?|
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.
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.
To reduce waiting times for treatment/increase the systems responsiveness.
Patients, Counties and their hospitals, Private hospitals
|Medienpräsenz||sehr gering||sehr hoch|
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.
|Implemented in this survey?|
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.
The approach of the idea is described as:
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.
It has been implemented and has now reached an evaluation phase.
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.
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:
The evaluation concludes in a number of recommendations:
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.
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).
Michael O. Appel