Waiting list ‘tricks’ under probe

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Frustrated patients in Oslo who find themselves stuck on hospital waiting lists have clearly discovered that the squeaky wheel gets the grease. Their success at demanding their rights and jumping the queue has set off an ethical dilemma and yet another political uproar for Health Minister Anne-Grete Strøm-Erichsen.

The latest controversy erupted late last week, when TV2 reported how patients aware of their rights to obtain treatment within a certain time frame managed to gain priority ahead of others on the waiting list. By threatening to seek treatment at another hospital anywhere in the country, or even at private clinics, the state-run hospitals to which they’re assigned faced higher costs since they’d have to pay for the off-site treatment anyway.

The patients could then suddenly be granted the operation or treatment they’d been demanding at their local hospital, albeit at the expense of fellow patients in the queue but at a significant cost-savings to society as a whole. One clinic boss at Oslo University Hospital has claimed the so-called “tricks” used by patients and hospital administrators to get around waiting lists is economically responsible because it saves money.

Ethical problem
“When we have to transfer a patient to a private institution (to meet care guarantees), it’s all of us who must pay for the NOK 250,000 it can cost,” Olav Røise of Oslo University Hospital told TV2. “For the same amount of money, we can operate on three patients at their own hospital.”

He admitted it’s an ethical problem, since other patients who are unaware of their rights and haven’t complained can be overlooked, and because the nature of the medical problem may not be evaluated either. “But we’re not certain this is an illegal practice,” Røise said.

Opposition politicians in Parliament seized on the issue as another example of the Labour-led government’s poor management of Norway’s public health care. They’ve been blasting Strøm-Erichsen since TV2’s story broke on Thursday, when several hospital employees stepped forward with reports of how waiting lists are subject to “systematic tricks.” The goal is to save money, they all say, but the practice is viewed as inherently unfair.

‘Lack of respect’
On Monday, newspaper Aftenposten reported that the letters sent by hospitals to patients, advising them of their rights and their place on waiting lists, are so poorly written that many don’t understand them. “My experience confirms that employees and managers at Oslo hospitals have a lack of understanding and respect for patients’ rights,” said Anne-Lise Kristensen, the health and social ombudsman in Oslo.

Michael Tetzschner, a Member of Parliament for the Conservative Party (Høyre), has been among the most vocal, criticizing Strøm-Erichsen for initially saying she was unfamiliar with the practice instead of being willing to investigate it. Bjørn Erikstein, new chief executive of the huge and controversially consolidated Oslo University Hospital, has since said his management team will examine the practice.

At the very least, Erikstein worries that patients who haven’t complained and remain on waiting lists may now feel tricked themselves. “I think the majority of patients are confident that we’re giving them good treatment within deadlines,” he told newspaper Aftenposten. “But it’s clear this kind of publicity doesn’t increase confidence in us.”

Views and News from Norway/Nina Berglund

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