[Is regionalization disadvantageous for patients? A registration study based on ambulance transports in Oslo]

The number of transferrals between Oslo hospitals has been doubled since the hospital system was regionalized in 1982. Essentially, this development may be explained by the increased need to refer patients to the highly specialized hospitals because of recent years advances in medical technology. During a two month period in 1988, 4,841 admissions to hospitals in Oslo were registered, and 917 transferrals between hospitals. We found that patient-transport was adequate in 92% of the cases. However, ambulance personnel reported 389 cases (8%) of delayed admissions and unnecessary transferrals between the hospitals. In most cases, the real cause of the problems was a too rigid attitude among health workers. The inflexibility of the present system seems to be a major threat to the principle of regionalization. We propose a simple set of rules which will protect the principle and also the requests of the patients.