Maximum waiting-time guarantee--an attempt to reduce waiting lists in Sweden

In Sweden, as in most countries with publicly financed health services, long waiting lists for some surgical procedures have been a serious quality problem on the health policy agenda. To reduce waiting lists, the Swedish Government and the Federation of County Council agreed on an initiative to offer a maximum waiting-time guarantee for 12 procedures during 1992. Patients awaiting procedures are guaranteed a waiting time no longer than 3 months from the physician's decision to treat/operate. The initial agreement was to be in force for 1 year, and a grant of 500 million SEK (USD 70 million) was appropriated for the initiative. The guarantee has been prolonged by annual decisions to be in force 1993 through 1995. However, no extra resources were set aside for these years. This article describes the background and the introduction of the guarantee. and discusses some of the major results during the first 2 years. Generally, waiting lists decreased substantially during 1991 and 1992. By the end of 1992 only a few departments were unable to serve patients within 3 months. During 1993 the reduction in the waiting lists ceased, and waiting lists for some procedures showed a tendency to increase by the end of the year. The overall successful result, in terms of waiting lists and waiting times, seems to have been achieved mainly by increased production, improved administration of the waiting lists, and a change in attitudes toward waiting lists. The expectation that the guarantee would lead to a more even use of resources across the country has not been realised since it appears that hospital departments chose to expand their own activities rather than use the new opportunity offered by the guarantee to refer patients to other hospitals.