A system based on personal resources
The next two months on crutches, living in a block of flats without a lift and with icy pavements outside, taught me this about free choice of providers: the service might be efficient for me personally, but it is not necessarily efficient at a societal level because not everybody has the resources to benefit from it.
I had to make sure somebody was with me the first night after the operation. «What if I were on my own?» I asked the pleasant nurse who fed me coffee and biscuits to help me come round from the anaesthetic. «They would not have been able to offer you a service» was the reply. Safely home, I wondered who was responsible for me if something went wrong in a Norway closed over the Christmas holidays? The private provider was closed. My surgeon was on holiday and even though I had a phone number, I had no information regarding what she could do in case of an emergency. My GP operated Christmas holiday opening times. A precautionary Google search reported an absence of any appointment system and four-hour waiting times at the accident and emergency department, that they have no access to patient records from other services, and that it is recommended I bring the relevant papers myself. It was thus an advantage to be fit and to have good support at home.
The system of which my brilliant service was a part suddenly seemed less than user-friendly. I missed Scotland. There my GP would have been responsible for my follow-up even during holiday periods. In the event of an acute crisis, a member of an extended primary care team would have helped with advice and information, and if necessary arranged a hospital admission and ambulance. Outside surgery opening hours (8 a.m. to 6 p.m.) the emergency service is coordinated with the GP. A telephone call puts the patient in touch with somebody who can find the patient records electronically. Admission to hospital can be arranged without the patient having to attend for a consultation.
The time came for a two-month check-up. I needed X-rays from a private provider – an extra trip , in and out of a taxi, across icy pavements. I had to pay for the X-rays and take them along to the appointment myself. In Scotland an appointment with a specialist is coordinated with the X-ray department at the same hospital, under the same roof and on the same day. The X-rays are transferred electronically to the specialist immediately.