New treatment options mean less pain and shorter hospitalization for many patients. For the hospitals, new treatment strategies often require technological investments and organizational change. This thesis investigated trends in numbers of treatments in the area of vascular disease in Norway (2001-2014) and the related organizational decision-making processes at a regional and local health care level (2007-2019). There was an increase in total vascular surgery rates for intact abdominal aortic aneurysms while rates of ruptured abdominal aneurysms decreased. Total lower extremity revascularization rates increased. Open surgery rates decreased while endovascular procedure rates increased in all these groups. These trends showed regional variances. The number of vascular centers that performed abdominal aortic repairs decreased. Regions organized with few and large centers performed the highest percentages of endovascular aneurysm repairs. In patients with peripheral arterial disease, major amputation rates declined suggesting that a more aggressive revascularisation policy contributed to increased limb salvage.
In the decision-making processes, the managers and their professional advisers aimed to centralize the vascular treatments based on medical and economical scale advantages. Local groups of professionals, patients, lay people and politicians only wanted to adjust the existing systems. The managers had to review the power configuration. At the regional level, they revoked their centralizing plans. At the local level, the process developed into an “escalating process of indecisiveness”.