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The Office of the Auditor General’s investigation into the free choice of hospital system

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Summary

Background and goal of the investigation
The purpose of the investigation was to examine the extent to which the authorities achieve the goals of the free choice of hospital system.

The right to choose a hospital was introduced at the national level through the entry into force of the Patients' Rights Act in 2001. The right to free choice of hospital was seen as one of the most important rights in relation to achieving the objective of the Patients' Rights Act. The objective was to improve patients' opportunity to participate in decision-making and to guarantee equal access to health services for the whole population. The right to free choice of hospital is intended to help to even out the considerable differences in waiting times between hospitals. The free choice of hospital scheme means that available capacity in a hospital in one part of the country can be utilised by patients from other parts of the country.

Method
The investigation is based on a user survey of 6,000 patients, a questionnaire survey of 1,000 GPs, analyses of register data from the Norwegian Patient Register, interviews and document analysis of information about the scheme provided to 300 patients by the hospitals.

Results
There is a great potential for reducing waiting times for many patients by increasing the use of the right to free choice of hospital. The free choice of hospital system helps to even out waiting times between hospitals. Patients who utilise the scheme experience shorter waiting times.

The Patients' Rights Act puts the patients in focus. The health service has a responsibility for providing patients with information about the system and adapting the information to each patient, as well as for guiding and advising the patient as required. The investigation shows that the main reason why patients exercise their right to free choice of hospital is that their GP has informed them about the scheme. Nearly half the patients were not given this information by their regular GPs. The investigation also shows that the patients are not given adequate information by hospitals about the possibility of shortening waiting times by changing hospitals – despite the fact that many hospitals have long waiting times for many types of treatment. This results in a risk that many patients, and particularly the patients with least resources at their disposal, will not make us of the free choice of hospital system.

The system is used most by patients with high incomes and higher education who are in employment.

The investigation shows that, in order to ensure that patients have a better basis for decisions concerning choice of hospital, the scheme's website – www.frittsykehusvalg.no – needs to be improved with more reliable, up-to-date, relevant and realistic information.

The Ministry of Health and Care Services has overall responsibility for ensuring that the free choice of hospital scheme functions as intended. In the Office of the Auditor General’s opinion, the Ministry should consider whether the website should contain information about waiting times that is also relevant to patients with a right to necessary health care, and not just to the patients with lowest priority. The free choice of hospital system could thereby underpin the national priorities in the health service.

Moreover, the Ministry must ensure that GPs and hospitals make more active use of the free choice of hospital system in order to achieve health policy goals. More information and guidance from the health service could contribute to the Patients' Rights Act’s provisions on free choice of hospital combining the goals of increased patient participation in decision-making and equal access to health services. At the same time, increased utilisation of the free choice of hospital system can help to improve utilisation of the specialist health service's capacity.

Ministry/ministries:

Riksrevisjonen, Storgata 16, P.O. Box 8130 Dep, 0032 Oslo, Norway

Phone: +47 22 24 10 00

Org.nr: 974 760 843