Norway Health Ministry: CSC Helps Put the Choice in 'Free Hospital Choice'

Norway is making major changes in its hospital system. In addition to changing the way hospitals are administered and financed, the Ministry of Health has launched a program to improve the collection of data on hospital care.

What's more, the Free Hospital Choice program is making that information available to patients and family doctors nationwide, on the Web and through a call center. The program has not only been a hit with the public, but has increased the quality of health care by stimulating competition among hospitals.

Choosing a hospital

When a family doctor in Norway decides a patient needs hospital care, the next step is to choose a hospital. Under the single-payer health insurance system, Norwegians have "free hospital choice," meaning they can choose treatment in any hospital in the country, only paying a small traveling fee. To choose a hospital, patients need to know which has the best reputation for the kind of treatments prescribed for them and which has the shortest waiting times.

In practice, however, this information was incomplete. For decades, hospitals were administered by the country's 19 counties, which in turn were divided into five health regions (South, East, West, Mid and North). Patient advisers in the regions were responsible for collecting information from the hospitals and anyone could get that information by calling a toll-free telephone number. Patients relied partly on this information and partly on recommendations from their general practitioners—recommendations based on informal reports from colleagues within their county or region.

The Ministry of Health launched the Free Hospital Choice program to make free choice a genuinely national program. Working with CSC, the Ministry consolidated the regional call centers and integrated them with a Web portal.

Implementing a national program

The Health Ministry-CSC team began by conducting a workshop for the patient advisers from all five regions. The team soon discovered the advisers were not all collecting the same information and that even when they were, they weren't using the same measurements. One region might have been collecting data on 20 of the treatments provided by its hospitals, while patient advisers in another region might have been tracking 70 treatments.

Even when all regions were tracking the same treatments, the information did not give the health ministry a truly national perspective. As in other countries, hospitals tend to specialize in certain treatments. A hospital that specializes in hip replacements, for example, will not only have higher quality rankings for that treatment, but will be able to provide good care at less cost.

If the team was going to give patients the data they needed to choose among all Norwegian hospitals, they had to come up with national standards for measuring the quality of care. A standard way of measuring cost was also important, because under the recently implemented "activity-based funding," half of a hospital's revenue is based on what it costs to provide treatments.

The team worked with the hospitals, the regional patient advisers and the national medical association to develop national definitions of treatments and standard ways of measuring cost, quality and waiting periods. The next steps, rolled out in two stages in 2003, were to create a national call center where patient advisers had information on hospitals in all regions and integrate it with a Web portal.

The Web portal was launched in 2003 and provides:

• The ability to compare waiting times at each participating hospital for 90 different treatments
  
• Quality indicators for each participating hospital
  
• News and information about treatments and procedures, patient rights, laws and the free choice of hospitals
  
• Help in using the Web site
  
• Access to online tools for administrators and patient advisers, who update waiting times, quality indicators and other information.

In addition to information about waiting times and quality indicators for public hospitals, the portal also includes information on private hospitals that have agreements to perform selected treatments.

The telephone service was organized as a separate process and a new design was developed in conjunction with the patient advisors.

Patients and hospitals benefit

The portal and the call center have been very popular. Calls to patient advisers have increased substantially since the national call center was established and general practitioners report that patients are now coming to them with recommendations for hospitals.

The telephone service received about 540 inquiries per week from May to December 2003. In the same period, the Web portal received approximately 430 unique visitors every weekday and 6,800 page views each day. (Some institutions are registered as one user, so the unique user number alone does not give an accurate indication of actual user levels.) The Web site had approximately 1.5 million page views in 2003 (May to December), 85,000 visits and 40,000 visitors.

Putting the choice in free hospital choice means that patients can now choose from among every hospital in Norway. Expanded choice means that patients are now more likely to choose hospitals that are not in their county or region. Although that means the Ministry spends more money on transportation, it also means that people get back to work earlier, reducing the amount spent on sick leave.

The hospitals have benefited, too, largely because they are now competing with each other for the best rankings on the new Web site. They are also doing better financially, because they are now able to attract more patients who need the treatments in which they specialize. Hospitals that specialize in heart surgery, for example, will not only have higher quality rankings for such procedures, but can perform them at less cost than other hospitals. The more patients they can attract, the more likely that their activity-based revenue will more than cover the costs of treating those patients. They are less likely to have unused capacity and can reduce waiting time.

The Ministry of Health decided to change the hospital system because it wanted to provide better care at less cost. As an important part of this reform, the Free Hospital Choice program has helped to attain that goal.