Lian O S, Kristiansen I S
Institutt for sosiologi, Det samfunnsvitenskapelige fakultet, Universitetet i Tromsø.
Tidsskr Nor Laegeforen. 1998 Oct 20;118(25):3921-6.
The traditional autonomy of the health professions is being eroded by external bureaucratic regulations of health care services, implemented to control costs and secure equitable access to services. This is an international trend. The guaranteed maximum waiting time in Norway is an example of such regulations. Introduced in 1990 and revised in 1997, it regulates the maximum waiting time for hospital admittance for patients who meet certain criteria. The regulation limits physicians' scope for setting priorities according to traditional criteria such as disease severity and admittance on a first come, first served basis. At issue here is whether the waiting time guarantee is compatible with established professional norms for setting priorities. We explored this issue of regulation versus professional norms through a postal survey among 152 physicians and nurses in charge of allocating patients to waiting lists. The results indicate that most respondents do not think that the reform has led to more equitable priorities. Health professionals seem to follow professional norms more than externally imposed rules. Difficulties in interpreting the rules and infringements of the guarantee in respondents' departments led to negative attitudes towards the guarantee. Physicians were more negative than nurses in their attitudes.
医疗保健服务的外部官僚法规正在侵蚀医疗行业传统的自主权，这些法规旨在控制成本并确保公平获得服务。这是一种国际趋势。挪威的保证最长等待时间就是此类法规的一个例子。该法规于1990年出台，并于1997年修订，它规定了符合某些标准的患者入院的最长等待时间。该法规限制了医生根据疾病严重程度和先到先得等传统标准确定优先顺序的范围。这里的问题是等待时间保证是否符合既定的确定优先顺序的专业规范。我们通过对152名负责将患者列入等候名单的医生和护士进行邮政调查，探讨了监管与专业规范这个问题。结果表明，大多数受访者认为改革并没有带来更公平的优先顺序。卫生专业人员似乎更遵循专业规范而非外部强加的规则。受访者所在部门在解释规则方面存在困难以及违反保证的情况导致了对该保证的负面态度。医生的态度比护士更消极。
