Currently, the payment system values ​​the treatment amount, regardless of impact.

In the hospital’s speech in January, the Minister of Health’s message was saving and reducing space in hospitals. Days later, the center manager at the hospital was quoted as saying that care should be good enough and healthy – “but maybe not always world class”. Now Kjerkol has announced a budget increase, but stressed the need for restructuring remains in force.

The Health Workforce Commission report indicates that there will not be enough resources to meet the growing demand. It must be prioritized. Then it is the benefits of treatment that must be promoted, at the expense of quantity. Currently, the payment system values ​​the treatment amount, regardless of impact.

Measure what is easy to calculate

It is very easy to measure the number of consultations and operations. When the quantity being measured is set aside, it becomes the driver of the right quantity.

An operated hernia has a certain risk of returning. In some Norwegian hospitals it happens much more often than in others, and you still get paid the same. The quantity-based financing system is one of the drivers of overtreatment (NOU: 2023:4, 11.2). But because it is better for patients and society with successful treatment, the focus of measurement must shift to asking: Does healthcare improve patient quality of life?

Practice makes perfect

Lovisenberg Diakonale Hospital has invested in a large number of planned surgeries in selected areas with well-documented beneficial treatment where there is a need.

This provides a large volume of operations per surgeon. Treatment outcomes and complications are recorded in the hospital’s quality register and show that practice is improving.

We believe that more division of labor between hospitals can ensure practitioners have sufficient practice and specialization. Well-organized departments that are not distracted by emergencies can provide priority services much more efficiently to the public. When the condition is not acute, quality is often more important than waiting times and travel routes.

Quality registers

We call our hernia patients a year after surgery and ask: Have you had a recurrence? Through quality work at Lovisenberg, the relapse rate dropped to 0.5 percent.

The national average for hernia recurrence is missing, because we don’t have a national register. In our neighboring countries, hernia registers have had a tremendous effect on improving outcomes. When Sweden introduced registers at the time, the recidivism rate was 14 percent. Improvements in the quality of work and methods have reduced this to 1 percent. We have seen similar developments in our local quality registers and hope the authorities will contribute to creating more quality lists, similar to the national joint prosthesis list.

Measuring and feedback on treatment outcomes is needed so that healthcare systems can do more of what works, less of what doesn’t work. Transparency about results creates trust and allows patients to make informed choices. Well-organized healthcare can become, or remain, world-class.