Tor Iversen

• Aars, Ole Kristian & Iversen, Tor (2026). Can nudging increase the uptake of recommended health services? PEC Innovation. 9. doi: 10.1016/j.pecinn.2026.100508. Full text in Research Archive Show summary

  Objective Type 2 diabetes (T2DM) represents a significant threat to global public health. When supported by their general practitioner (GP), patients who self-manage effectively can prevent or delay serious complications. This study examines whether an innovative information initiative can nudge members of the Norwegian Diabetes Association (NDA) with T2DM to schedule a comprehensive annual checkup with their GP. Methods We randomized 12,484 NDA members with T2DM into an intervention group with two subgroups and a control group with two subgroups. The intervention group received a message describing the health benefits of a comprehensive checkup, a link to an explanatory video, and a prompt to contact their GP to book an appointment. One intervention subgroup received an email followed by an SMS reminder 1 week later (Group 1); the other intervention subgroup received both messages by SMS (Group 2). The control group received no information. All groups were sent a questionnaire 4 weeks after the initial message. Results The overall effect of the intervention was 3.5 percentage points (p = 0.020). Participants in intervention Group 1 initiated a comprehensive annual checkup 4.2 percentage points (p = 0.024) more often than the control group. For Group 2, we did not find a statistically significant effect of the intervention. Conclusion This intervention nudging patients with T2DM to initiate a comprehensive annual checkup had a significant effect, particularly for the group that received initial information by email and a reminder by SMS. Innovation This study adds to the emerging literature on low-cost digital interventions by demonstrating that brief, scalable digital information can increase uptake of guideline-recommended preventive care among patients with T2DM. The findings suggest that such interventions may offer a cost-effective approach to increasing preventive-care uptake, which could in turn help reduce diabetes-related complications at the population level.

• Iversen, Tor (2026). Impact of Increased Capitation on Revenue Distribution Among General Practitioners: A Norwegian Case Study. Health Policy. ISSN 0168-8510. 172. doi: 10.1016/j.healthpol.2026.105692. Full text in Research Archive Show summary

  Background During recent years, many countries have moved from pure fee-for-service (FFS) systems toward mixed payment arrangements combining capitation and FFS components. In Norway, regular general practitioners (GPs) typically provide primary care under mixed capitation and FFS remuneration. ​Recently, increased proportion of capitation has been suggested. Objective This study investigates the impact of increasing the proportion of capitation on GP revenue distribution. Flat capitation and two types of risk adjusted capitation are examined. Methods Detailed data from Oslo, Norway are used to describe the differences in list composition among GPs. Increased capitation is calculated under the restriction of constant aggregated revenue to GPs. Risk adjusted capitation is calculated according to existing formulas and ordinary least squares regression. Results Increasing the capitation fee to 50% of total revenue benefits GPs with long lists, but it disadvantages those with a high proportion of patients with a need for long-term care (LTC) services. However, risk-adjusted capitation according to patient-adjusted capitation (PAC) and need for LTC favors GPs with high proportions of frail patients, ensuring a more equitable revenue distribution. Conclusion This study underscores the importance of risk adjustment in capitation systems in order to prevent adverse incentives for patient selection and to maintain equitable income distribution among GPs. ​ An equitable revenue distribution among GPs is a precondition for implementing reforms of the payment system. Medical associations are powerful organizations that can block reforms considered desirable by governments. The results have broader implications for health policy, particularly around managing the financial sustainability and the service quality of primary care for an aging population. Policymakers are advised to consider these findings when debating changes to the remuneration system, to ensure that GPs are incentivized to provide comprehensive care without compromising access for high-need patients.

• Snilsberg, Øyvind & Iversen, Tor (2025). The impact of team-based primary care on quality-related healthcare services and access to primary care: Norway's primary healthcare teams pilot program. Journal of Health Economics. ISSN 0167-6296. 101. doi: 10.1016/j.jhealeco.2025.102987. Full text in Research Archive Show summary

  This study evaluates Norway's Primary Healthcare Teams (PHT) pilot program, which introduced team-based care in general practice clinics to improve care for patients with complex conditions. Practices hired nurses and chose between an activity-based or block funding model. This analysis examines the activity-based funding model, which incorporated fee-for-service (FFS) for nurses. Using a difference-in-differences (DID) approach, the study assesses the program's impact on quality-related primary care services, out-of-hours care, hospitalizations, general practitioners’ (GPs’) working hours, and patient list length. The findings show that PHTs increased quality-related services for target groups (primarily provided by nurses) without affecting GP working hours or list length, suggesting that added nurse capacity was used to enhance care for target patients, not expand primary care access. There is little evidence of changes in healthcare utilization outside primary care, except a possible reduction in hospitalizations for type 2 diabetes patients with ambulatory care-sensitive conditions.

• Ge, Ge; Iversen, Tor; Kaarbøe, Oddvar Martin & Snilsberg, Øyvind (2024). Impacts of Norway's extended free choice reform on waiting times and hospital visits. Health Economics. ISSN 1057-9230. 33(4), p. 779–779. doi: 10.1002/hec.4801. Full text in Research Archive Show summary

  Norway's extended free choice (EFC) reform extends the patient's choice of publicly funded hospitals for treatment to authorized private institutions (EFC providers). We study the effects of the reform on waiting times, number of visits, and patients' Charlson Comorbidity Index scores in public hospitals. We use a difference-in-differences model to compare changes over time for public hospitals with and without EFC providers in the catchment area. Focusing on five prevalent somatic services, we find that the EFC reform did not exert pressure on public hospitals to stimulate shorter waiting times and more visits. Moreover, we do not find that the sum of public and private visits increased. When we compare patient comorbidity between public hospitals and EFC providers, we find that for non-invasive diagnostic services, patient comorbidity is lower in EFC providers. For surgical services, we detect no difference in patient comorbidities between public and EFC providers.

• Snilsberg, Øyvind; Iversen, Tor; Jenum, Anne Karen & Zhang, Yuting (2024). Effects of a national checklist on recommended procedures among patients with type 2 diabetes. BMC Health Services Research. 24(1). doi: 10.1186/s12913-024-11940-x. Full text in Research Archive Show summary

  Background Type 2 diabetes (T2D) is a common, potentially disabling, and costly chronic condition that requires consistent management. In 2008, Norway introduced a national checklist outlining services to include in an annual T2D exam, along with a reimbursement code for general practitioners (GPs) to bill upon completing it. This study investigates whether GP adoption of the checklist improves adherence to recommended services for T2D patients. Methods To investigate the impact of GP checklist adoption, we use Norwegian registry data from 2006 to 2021 and apply two difference-in-differences (DID) methods that account for staggered adoption timing: the two-way fixed effects (TWFE) estimator and Callaway and Sant’Anna’s DID method for variation in exposure timing (CSDID) (Callaway B. et al., J Econom 225:200–30, 2021). Results We find that installing the electronic form has modest effects on the use of some recommended procedures. Conclusions Our study suggests that using the electronic form can have a positive effect on recommended services. However, the modest impact indicates that installing the form does not necessarily translate into its active regular use. Keywords Checklist, National quality program, Physician incentives, Diabetes management, Norwegian Diabetes Register for Adults

• Sten-Gahmberg, Susanna; Pedersen, Kine; Harsheim, Ingrid gaarder; Løyland, Hanna Isabel; Snilsberg, Øyvind & Iversen, Tor [Show all 9 contributors for this article] (2024). Pragmatic randomized controlled trial comparing a complex telemedicine-based intervention with usual care in patients with chronic conditions. European Journal of Health Economics. ISSN 1618-7598. 25, p. 1275–1289. doi: 10.1007/s10198-023-01664-w. Full text in Research Archive Show summary

  This study evaluates a complex telemedicine-based intervention targeting patients with chronic health problems. Computer tablets and home telemonitoring devices are used by patients to report point-of-care measurements, e.g., blood pressure, blood glucose or oxygen saturation, and to answer health-related questions at a follow-up center. We designed a pragmatic randomized controlled trial to compare the telemedicine-based intervention with usual care in six local centers in Norway. The study outcomes included health-related quality of life (HRQoL) based on the EuroQol questionnaire (EQ-5D-5L), patient experiences, and utilization of healthcare. We also conducted a cost–benefit analysis to inform policy implementation, as well as a process evaluation (reported elsewhere). We used mixed methods to analyze data collected during the trial (health data, survey data and interviews with patients and health personnel) as well as data from national health registers. 735 patients were included during the period from February 2019 to June 2020. One year after inclusion, the effects on the use of healthcare services were mixed. The proportion of patients receiving home-based care services declined, but the number of GP contacts increased in the intervention group compared to the control group. Participants in the intervention group experienced improved HRQoL compared to the control group and were more satisfied with the follow-up of their health. The cost–benefit of the intervention depends largely on the design of the service and the value society places on improved safety and self-efficacy.

• Løyland, Hanna Isabel; Pedersen, Kine; Gahmberg, Susanna Sten; Harsheim, Ingrid Gaarder; Sæther, Erik Magnus & Iversen, Tor [Show all 8 contributors for this article] (2023). Effekter, gevinster og kostnader ved digital hjemmeoppfølging–en samfunnsøkonomisk analyse basert på et pragmatisk randomisert forsøk. Magma forskning og viten. ISSN 1500-0788. 26(5), p. 124–135. doi: 10.23865/magma.v26.1426. Full text in Research Archive Show summary

  Denne studien omhandler en utprøving av digital hjemmeoppfølging i helsetjenesten og omfatter seks lokale prosjekter i kommunene Stad, Bodø, Larvik, Oslo (med bydelene Sagene, Grünerløkka, Gamle Oslo og St. Hanshaugen), Ullensaker (i samarbeid med Gjerdrum) og Kristiansand (i samarbeid med flere Agder-kommuner). Utprøvingen ble gjennomført som en pragmatisk randomisert kontrollert studie. Målgruppen var personer med kroniske sykdommer, med middels til høy risiko for forverret helsetilstand, reinnleggelse på sykehus eller økt behov for helse-og omsorgstjenester. Pasientene i tiltaksgruppen fikk utarbeidet en egenbehandlingsplan, utførte selv avtalte målinger og svarte på spørsmål om sin helsetilstand på et nettbrett. Pasientene kunne følge med på egne resultater. I tillegg tok en sykepleier i oppfølgingstjenesten kontakt dersom målingene var utenfor pasientens normalverdier, for å avklare behov for helsejhelp. Samlet sett viser vår analyse at verdien av de prissatte nyttevirkningene av tiltaket (bedre helserelatert livskvalitet og endret ressursbruk i helsetjenesten) er lavere enn kostnadene ved å tilby digital hjemmeoppfølging. Tiltaket gir imidlertid også virkninger som det ikke har vært mulig å prissette. Vi finner at digital hjemmeoppfølging bidrar til at pasientene får økt forståelse og mestring av egen sykdom, og derigjennom føler seg tryggere og er mer fornøyd med oppfølging av egen helse. Fremover vil det være viktig å begrense ressursbruken i helsetjenesten, samtidig som man retter tilbudet mot personer som har særlig nytte av det. Dette innebærer at de som får digital hjemmeoppfølging, hverken må være for syke til at det er for sent å forebygge forverring og økt bruk av helsetjenester, eller for friske til å dra nytte av tjenesten. Brukt riktig kan digital hjemmeoppfølging være et godt verktøy i tilbudet til pasienter med kroniske sykdommer og særlige behov.

• Pedersen, Kine; Løyland, Hanna Isabel; Magnus, Sæther Erik; Gahmberg, Susanna Sten; Abelsen, Birgit & Snilsberg, Øyvind [Show all 7 contributors for this article] (2023). Primærhelseteam – en mer teambasert fastlegetjeneste. Magma forskning og viten. ISSN 1500-0788. 26(5), p. 73–83. doi: 10.23865/magma.v26.1421. Full text in Research Archive Show summary

  Primærhelseteam (PHT) er en ny arbeidsform i fastlegetjenesten der lege, sykepleier og helsesekretær jobber sammen i team. Teamet skal tilby gode tjenester og arbeide systematisk med pasientsikkerhet og kvalitetsforbedring. Målgruppene for primærhelseteam er listeinnbyggere med kronisk sykdom, psykiske lidelser og rusavhengighet, skrøpelige eldre, og brukere med utviklingshemming og funksjonsnedsettelser. Et nasjonalt forsøk med primærhelseteam startet i 2018. Forsøket følges av en evaluering. I denne artikkelen forsøker vi å svare på spørsmålene: Hvordan jobber legekontorene i PHT-forsøket som team, og hvilke effekter gir det? Videre belyser vi hvordan funnene kan brukes i utformingen av en mer teambasert fastlegetjeneste. Vi bygger på datainnsamlingen og hovedfunnene fra evalueringen av PHT, og utdyper tolkningen av funnene i lys av internasjonal litteratur. Vi finner at personellet på legekontorene opplever at teamarbeid gir gode resultater – både for pasientene og for dem selv i form av økt arbeidstrivsel. Teameffektiviteten på legekontorene avhenger av struktur (som møter, maler og prosedyrer) og felles arbeidsmåter, kontinuitet i personellgruppen, grad av engasjement for teamarbeid samt tydelig ledelse av og fastlegenes individuelle tilfredshet med teamarbeidet. Vi finner at PHT-sykepleierne i større grad har bidratt til bedre oppfølging av pasienter i målgruppene enn til å avlaste fastlegen. Resultatet samsvarer med effektmålene for forsøket, der vekten er lagt på kvalitetsforbedring og ikke produktivitetsforbedring på fastlegekontoret. Evalueringen viser at det er ressurs- og tidkrevende å utvikle teamarbeid. For å lykkes med en eventuell videre implementering av en tverrfaglig, teambasert fastlegeordning, må det være en klar interesse for dette blant fastlegene.

• Forster, Rachel Bedenis; Strandberg, Ragnhild Bjarkøy; Tibballs, Katrina Louise Bø; Nøkleby, Kjersti; Berg, Tore Julsrud & Iversen, Tor [Show all 15 contributors for this article] (2022). Cohort profile: Outcomes & Multi-morbidity In Type 2 diabetes (OMIT) - a national registry-based observational cohort with focus on care and treatment of key high-risk groups in Norway. BMJ Open. 12(5). doi: 10.1136/bmjopen-2021-054840. Full text in Research Archive Show summary

  Purpose The ‘Outcomes & Multi-morbidity in Type 2 Diabetes’ (OMIT) is an observational registry-based cohort of Norwegian patients with type 2 diabetes (T2D) established to study high-risk groups often omitted from randomised clinical trials. Participants The OMIT cohort includes 57 572 patients with T2D identified via linkage of Norwegian Diabetes Register for Adults and the Rogaland-Oslo-Salten-Akershus-Hordaland study, both offering data on clinical patient characteristics and drug prescriptions. Subsequently these data are further linked to the Norwegian Prescription Database for dispensed medications, the Norwegian Population Register for data on death and migration, Statistics Norway for data on socioeconomic factors and ethnicity and the Norwegian Directorate of Health for data on the general practices and clinical procedures involved in the care of cohort patients. OMIT offers large samples for key high-risk patient groups: (1) young-onset diabetes (T2D at age <40 years) (n=6510), (2) elderly (age >75 years) (n=15 540), (3) non-Western ethnic minorities (n=9000) and (4) low socioeconomic status (n=20 500). Findings to date On average, patient age and diabetes duration is 67.4±13.2 and 12.3±8.3 years, respectively, and mean HbA1c for the whole cohort through the study period is 7.6%±1.5% (59.4±16.3 mmol/mol), mean body mass index (BMI) and blood pressure is 30.2±5.9 kg/m2 and 135±16.1/78±9.8 mm Hg, respectively. Prevalence of retinopathy, coronary heart disease and stroke is 10.1%, 21% and 6.7%, respectively. Future plans The OMIT cohort features 5784 subjects with T2D in 2006, a number that has grown to 57 527 in 2019 and is expected to grow further via repeated linkages performed every third to fifth year. At the next wave of data collection, additional linkages to Norwegian Patient Registry and Norwegian Cause of Death Registry for data on registered diagnoses and causes of death, respectively, will be performed.

• Iversen, Tor & Ma, Ching-To Albert (2021). Technology adoption by primary care physicians. Health Economics. ISSN 1057-9230. 31(3), p. 441–451. doi: 10.1002/hec.4447. Full text in Research Archive Show summary

  We study primary care physicians' prevention and monitoring technology adop-tion. Physicians' adoption decisions are based on benefits and costs, which de-pend on payment incentives, educational assistance, and market characteris-tics. The empirical study uses national Norwegian register and physician claims data between 2009 and 2014. In 2006, a new annual comprehensive checkup for Type 2 diabetic patients was introduced. A physician collects a fee for each checkup. In 2013, an education assistance program was introduced in two Nor-wegian counties. We estimate adoption decisions by fixed-effect regressions, and two-part and hazard models. We use a difference-in-difference model to estimate the education program impact. Fixed-effect estimations and separate analyses of physicians who have moved between municipalities support a peer effect. The education program has a strongly positive effect, which is positively associated with a physician's number of diabetic patients, and the fraction of physician-adopters in the same market.

• Bannenberg, Normann; Førland, Oddvar; Iversen, Tor; Karlsson, Martin & Øien, Henning (2021). Preventive Home Visits. American Journal of Health Economics. ISSN 2332-3493. 7(4), p. 457–496. doi: 10.1086/714988. Full text in Research Archive Show summary

  This paper evaluates the introduction of preventive home visits (PHV) for older people in Norway. Their purpose is to support autonomy and independence as well as to prevent disability and nursing home admissions. Wecontribute to the literature by exploiting a natural experiment in Norwegian municipalities. Our results show that the introduction of a PHV program significantly changes the use of local public resources away from nursing homes, while increasing the utilization of home-based care. Further, PHVs lead to a decline in hospital admissions by 7 percent—whereas treatments for mental health conditions remain unaffected. Mortality is reduced by more than 4 percent in the age group 80 and above.

• Aas, Eline; Iversen, Tor & Kaarbøe, Oddvar Martin (2021). The Economic Sustainability of the Norwegian Healthcare System. In Baltagi, Badi H. & Moscone, Francesco (Ed.), The Sustainability of Health Care Systems in Europe. Emerald Group Publishing Limited. ISSN 9781839094996. p. 81–101. doi: 10.1108/S0573-855520210000295010. Full text in Research Archive Show summary

  The Norwegian health care system is semi-decentralized. Primary care and long-term care (LTC) are the responsibilities of the municipalities. Specialist care is the responsibility of the central government and is organised through four Regional Health Authorities (RHA). Resource use, health outcomes and severity are the three main pillars for priority setting, regularly applied in reimbursement decisions for pharmaceuticals. The sustainability of health care is challenged in Norway. The main factors are a growing elderly population with high need of complex, coordinated services, an increasing demand for newly approved drugs and advanced technology and a potential shortage of health care personnel. We present recent trials and policy reforms in Norway aimed at improving care pathways combined with cost containment. Reforms in the pharmaceutical market, both with regard to market access and reimbursement(cost-effectiveness), and regulation of prices, have resulted in cost containment. The primary care sector awaits reform initiatives to recruit and retain physicians as general practitioners. No reform in the hospital sector has had cost containment as a main focus. The sector is characterized with low productivity growth, and expenditures that have increased more than the GDP growth. Waiting times are long, and coordination between sub-sectors of health care has been poor, although the Coordination reform of 2012 has alleviated some of the challenges related to intersectoral coordination. Still, the divided responsibility for health care between the central government and the municipalities creates tensions between national ambitions and local decisions in the financing and provision of health services.

• Iversen, Tor; Skjeflo, Sofie Waage; Westberg, Nina Bruvik & Øien, Henning (2021). Statlige ambisjoner og lokale beslutninger i omsorgspolitikken. Samfunnsøkonomen. ISSN 1890-5250. p. 29–44. Full text in Research Archive Show summary

  Staten har ambisiøse mål for det lokale velferdstilbudet. Siden kommunene organiserer og finansierer tilbudet, vil måloppnåelsen avhenge av lokalpolitiske prioriteringer. For å påvirke de lokale prioriteringene innfører Stortinget ofte øremerkede tilskudd. Ett eksempel på dette er investeringstilskudd til heldøgns omsorgsboliger og sykehjemsplasser. Et hovedmål med investeringstilskuddet er å øke antall plasser innen heldøgnsomsorg. I denne artikkelen undersøker vi kommunenes tilpasning til investeringstilskuddet. Vi finner verken at antallet plasser eller kommunale driftsutgifter til omsorgstjenester har økt. Vi finner at kvaliteten har økt i form av flere enerom. Artikkelen illustrerer dermed spenningene mellom nasjonale ambisjoner og kommunale beslutninger.

• Hsu, John; Iversen, Tor; Price, Mary; Moger, Tron Anders; Tevis, Delaney & Hagen, Terje P. [Show all 7 contributors for this article] (2021). Myocardial infarction care among the elderly: Declining treatment with increasing age in two countries. Health Affairs. ISSN 0278-2715. 40(9), p. 1483–1490. doi: 10.1377/hlthaff.2021.00108. Full text in Research Archive Show summary

  The elderly account for the majority of medical spending in many countries, raising concerns about potentially unnecessary spending, especially during the final months of life. Using a well-defined starting point (hospitalization for an initial acute myocardial infarction) with evidence-based postevent treatments, we examined age trends in treatments in the US and Norway, two countries with high levels of per capita medical spending. After accounting for comorbidities, we found marked decreases within both countries in the use of invasive treatments with age (for example, less use of percutaneous coronary interventions and surgery) and the use of relatively inexpensive medications (for example, less use of anticholesterol [statin] drugs for which generic versions are widely available). The treatment decreases with age were larger in Norway compared with those in the US. The less frequent treatment of the oldest of the old, without even use of basic medications, suggests potential age-related bias and a disconnect with the evidence on treatment value. Hospital organization and payment in both countries should incentivize greater equity in treatment use across ages.

• Godager, Geir; Iversen, Tor & Snilsberg, Øyvind (2021). Betalingsmåter for teamarbeid i primærhelsetjenesten. In Botten, Grete Synøve (Eds.), Mangfold og engasjement i ti år. Institutt for helse og samfunn ved Universitetet i Oslo 2010-2020.. Norwegian Medical Society. ISSN 9788292871768. p. 100–109. Full text in Research Archive
• Wang, Jian; Iversen, Tor; Hennig-Schmidt, Heike & Godager, Geir (2020). Are patient-regarding preferences stable? Evidence from a laboratory experiment with physicians and medical students from different countries. European Economic Review. ISSN 0014-2921. 125. doi: 10.1016/j.euroecorev.2020.103411. Full text in Research Archive Show summary

  We quantify patient-regarding preferences by fitting a bounded rationality model to data from an incentivized laboratory experiment, where Chinese medical doctors, German medical students and Chinese medical students decide under different payment schemes. We find a remarkable stability in patient-regarding preferences when comparing subject pools and we cannot reject the hypothesis of equal patient-regarding preferences in the three groups. The results suggest that a health economic experiment can provide knowledge that reach beyond the student subject pool, and that the preferences of decision-makers in one cultural context can be of relevance in a very different cultural context.

• Heldal, Kristian; Midtvedt, Karsten; Lønning, Kjersti; Iversen, Tor; Hernæs, Kjersti Helene & Tsarpali, Vasiliki [Show all 8 contributors for this article] (2019). Kidney transplantation: an attractive and cost-effective alternative for older patients?—a cost–utility study. Clinical Kidney Journal (CKJ). ISSN 2048-8505. 12(6), p. 888–894. doi: 10.1093/ckj/sfz018. Full text in Research Archive Show summary

  In the elderly, kidney transplantation is associated with increased survival and improved health-related quality of life compared with dialysis treatment. We aimed to study the short-term health economic effects of transplantation in a population of elderly kidney transplant candidates. Self-perceived health, quality-adjusted life years (QALYs) and costs were evaluated and compared 1 year before and 1 year after kidney transplantation in patients included in a single-centre prospective study of 289 transplant candidates ≥65 years of age. Self-perceived health and QALYs both significantly improved after transplantation. At 1 year, the costs per QALY were substantially higher for transplantation (€88 100 versus €76 495), but preliminary analyses suggest a favourable long-term health economic effect. Kidney transplantation in older kidney transplant recipients is associated with improved health but also with increased costs the first year after engraftment when compared with remaining on the waiting list. Any long-term cost-effectiveness needs to be confirmed in studies with longer observation times.

• Aas, Eline; Iversen, Tor; Holt, Tonje; Ormhaug, Silje Mørup & Jensen, Tine Kristin (2019). Cost-Effectiveness Analysis of Trauma-Focused Cognitive Behavioral Therapy: A Randomized Control Trial among Norwegian Youth. Journal of Clinical Child & Adolescent Psychology. ISSN 1537-4416. 48(1), p. S298–S311. doi: 10.1080/15374416.2018.1463535. Full text in Research Archive Show summary

  Traumatic events by young people can adversely affect their psychological and social well-being when left untreated. This can result in high costs for society. In this study, we aimed to evaluate whether trauma-focused cognitive behavioral therapy (TF-CBT) is a cost-effective alternative to therapy as usual (TAU). Individual-level data were collected from 2008 to 2013, as part of a randomized control trial in Norwegian youth, 10–18 years of age, presenting with symptoms of posttraumatic stress (N = 156). Health outcomes, costs, and patient and family characteristics were recorded. Health-related quality of life (HRQoL) was measured with the 16D instrument, and quality-adjusted life-years (QALYs) were derived; total costs included the costs of therapy, and last we calculated the incremental cost-effectiveness ratio (ratio of differences in costs and QALYs gained). We performed nonparametric bootstrapping and used the results to draw a cost-effectiveness acceptability curve depicting the probability that TF-CBT is cost-effective. HRQoL increased in both treatment groups, whereas no significant differences in QALYs were observed. Resource use measured in minutes per session was significantly higher in the TF-CBT group; however, total minutes of therapy and costs were not significantly different between the two groups. In addition, use of resources, such as psychological counseling services, welfare services, and medication, was lower in the TF-CBT group posttreatment. The likelihood of TF-CBT being cost-effective varied from 91% to 96%. TF-CBT is likely to be a cost-effective alternative to standard treatment and should be recommended as the guideline treatment for youth with posttraumatic stress disorder.

• Iversen, Tor & Øien, Henning (2019). Tilpasning til brukerbetaling for omsorgstjenester. Samfunnsøkonomen. ISSN 1890-5250. 133(6), p. 68–77. Full text in Research Archive
• Karlsson, Martin; Iversen, Tor & Øien, Henning (2018). Aging and Health Care Costs. In Hamilton, Jonathan (Eds.), Oxford Research Encyclopedias: Economics and Finance. Oxford University Press. ISSN 9780190625979. doi: 10.1093/acrefore/9780190625979.013.24. Full text in Research Archive Show summary

  An open issue in the economics literature is whether health care expenditure (HCE) is so concentrated in the last years before death that the age profiles in spending will change when longevity increases. The seminal article “Ageing of Population and Health Care Expenditure: A Red Herring?” by Zweifel and colleagues argued that that age is a distraction in explaining growth in HCE. The argument was based on the observation that age did not predict HCE after controlling for time to death (TTD). The authors were soon criticized for the use of a Heckman selection model in this context. Most of the recent literature makes use of variants of a two-part model and seems to give some role to age as well in the explanation. Age seems to matter more for long-term care expenditures (LTCE) than for acute hospital care. When disability is accounted for, the effects of age and TTD diminish. Not many articles validate their approach by comparing properties of different estimation models. In order to evaluate popular models used in the literature and to gain an understanding of the divergent results of previous studies, an empirical analysis based on a claims data set from Germany is conducted. This analysis generates a number of useful insights. There is a significant age gradient in HCE, most for LTCE, and costs of dying are substantial. These “costs of dying” have, however, a limited impact on the age gradient in HCE. These findings are interpreted as evidence against the “red herring” hypothesis as initially stated. The results indicate that the choice of estimation method makes little difference and if they differ, ordinary least squares regression tends to perform better than the alternatives. When validating the methods out of sample and out of period, there is no evidence that including TTD leads to better predictions of aggregate future HCE. It appears that the literature might benefit from focusing on the predictive power of the estimators instead of their actual fit to the data within the sample.

• Iversen, Tor & Sommeno, Tigist Woldetsadik (2018). How social capital arises in areas. In Folland, Sherman & Nauenberg, Eric (Ed.), Elgar Companion to Social Capital and Health. Edward Elgar Publishing. ISSN 9781785360701. p. 29–46. doi: 10.4337/9781785360718.00010. Full text in Research Archive
• Iversen, Tor & Häkkinen, Unto (2018). Comparative treatment costs for patients with acute myocardial infarction between Finland and Norway. Nordic Journal of Health Economics. ISSN 1892-9729. 6(2), p. 58–79. doi: 10.5617/njhe.5543. Full text in Research Archive Show summary

  Previous studies on patients with acute myocardial infarction have found that Finland has higher hospital costs per patient than Norway for the first hospital episode (HEP), while Norway has higher costs during the first year after the initial admission. In this paper, we analyze the variation in treatment costs between Finland and Norway in detail by introducing novel explanatory variables. We find that the distance from the patient’s home to the hospital increases hospital costs at a declining scale and one-year hospital costs are higher for low-income patients. The higher one-year hospital costs in Norway are accompanied by a comparatively lower mortality rate. While for HEP, the introduction of new explanatory variables does not explain the greater costs in Finland compared with Norway, for one-year costs, the additional variables explain the greater one-year costs in Norway compared to Finland.

• Iversen, Tor & Godager, Geir (2017). Fastlegen som portvakt. Michael. ISSN 1893-9651. 14(19), p. 43–59. Full text in Research Archive Show summary

  I denne artikkelen viser vi hvordan en ordning med primærlegen som portvakt til spesialisthelsetjenesten kan medføre mer effektiv bruk av samfunnets ressurser. Siden primærlegen oftest har bedre diagnostiske kunnskaper enn pasientene, vil primærlegen kunne være bedre enn pasientene til å sortere hvilke pasienter som bør henvises til spesialisthelsetjenesten og hvilke pasienter primærlegen kan diagnostisere og behandle selv. En portvaktordning vil slik kunne bidra til en mer effektiv arbeidsdeling i helsesektoren. I situasjoner der et mindretall av pasientene trenger behandling i spesialisthelsetjenesten, vil primærlegen kunne bidra til å identifisere de tilfeller der behandling i spesialisthelsetjenesten er ønskelig for samfunnet. Om portvaktordningen faktisk medfører bedre bruk av samfunnets ressurser, vil da både avhenge av pasientenes egne kunnskaper, fastlegenes diagnostiske dyktighet, samt tida det tar å utføre portvaktfunksjonen. Vi beskriver teoretiske og empiriske studier som viser at avlønningsordningen for primærleger har betydning for hvor strengt portvaktrollen utøves. Et sentralt resultat fra litteraturen er at per capita avlønning medfører høyere henvisningsrate enn ytelsesbaserte takster og utvidet budsjettansvar. Et viktig spørsmål for framtidig forskning er om det finnes avlønningssystemer som oppmuntrer til en passe høy henvisningsrate vurdert ut fra kravet om god bruk av helsesektorens samlede ressurser.

• Klitkou, Søren Toksvig; Iversen, Tor; Stensvold, Hans Jørgen & Rønnestad, Arild Erlend (2017). Use of hospital-based health care services among children aged 1 through 9 years who were born very preterm - a population-based study. BMC Health Services Research. 17:571(571), p. 1–13. doi: 10.1186/s12913-017-2498-3. Full text in Research Archive Show summary

  Background Very preterm (VPT) children, with a birth weight below 1500 g or delivered before 32 weeks of gestational age, are at increased risk of poorer long-term health outcomes and higher rates of hospitalization in childhood. However, considerable variation exists in the need for in-hospital care within this population. We assessed the utilization and distribution of hospital-based care from ages 1 through 9 years for a nationwide population. Methods This was a population-based cohort of VPT children born in the period 2001–2009. We evaluated their utilization of hospital care in 2008–2010, when aged 1–9 years old. Outcomes were the incidence of hospital admissions and outpatient visits. We used Poisson regression models with multiple imputation of missing data. Results Children born VPT had more hospital admissions compared with the general population of children aged 1–9 years. The rates of hospital admissions and outpatient visits were strongly related to clinical characteristics of the child at birth and age at admission/outpatient visit but to only a variable and minor degree to characteristics pertaining to maternal health, the sociodemographic factors, and geographical proximity to hospital services. Conclusions Prior to this study, hospital utilization during the period 5–9 years old has been poorly documented. We found that excess utilization of hospital resources on average declines with increasing age. We also noted substantial differences in the use of hospital care across age groups and clinical factors for VPT children. The added information from the health status of mothers, social background, and geographic measures of access was limited.

• Aas, Eline; Iversen, Tor & Hoff, Geir (2017). The effect of education on health behavior after screening for colorectal cancer. In Bolin, Kristian (Eds.), Human Capital and Health Behavior. Advances in Health Economics and Health Services Research. Emerald Group Publishing Limited. ISSN 9781786354662. p. 207–242. doi: 10.1108/S0731-219920170000025007. Full text in Research Archive Show summary

  Misinterpretation of a negative test results in health screening may initiate less preventive effort and more future lifestyle-related disease. We predict that misinterpretation occurs more frequently among individuals with a low level of education compared with individuals with a high level of education. The empirical analyses are based on unique data from a randomized controlled screening experiment in Norway, NORCCAP (NORwegian Colorectal Cancer Prevention). The dataset consists of approximately 50,000 individuals, of whom 21,000 were invited to participate in a once only screening with sigmoidoscopy. For all individuals, we also have information on outpatient consultations and inpatient stays and education. The result of health behaviour is mainly measured by lifestyle-related diseases, such as COPD, hypertension and diabetes type 2, identified by ICD-10 codes. The results according to intention-to-treat indicate that screening does not increase the occurrence of lifestyle related diseases among individuals with a high level of education, while there is an increase for individuals with low levels of education. These results are supported by the further analyses among individuals with a negative screening test.

• Iversen, Tor; Anell, Anders; Häkkinen, Unto; Kronborg, Christian & Olafsdottir, Thorhildur (2016). Coordination of care in the Nordic countries. Nordic Journal of Health Economics. ISSN 1892-9729. 4(1), p. 41–55. doi: 10.5617/njhe.2846. Full text in Research Archive
• Olsen, Kim Rose; Anell, Anders; Häkkinen, Unto; Iversen, Tor; Olafsdottir, Thorhildur & Sutton, Matt (2016). General practice in the Nordic countries. Nordic Journal of Health Economics. ISSN 1892-9729. 4(1), p. 56–67. doi: 10.5617/njhe.2801. Full text in Research Archive
• Iversen, Tor (2016). Primary Care: Effectiveness and Costs. In Scheffler, Richard M. (Eds.), World Scientific Handbook of Global Health Economics and Public Policy. World Scientific. ISSN 9789814612319. p. 231–268. Full text in Research Archive
• Hagen, Terje P.; Iversen, Tor & Moger, Tron Anders (2016). Risikojustering ved måling av predikert dødelighet etter hjerteinfarkt. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 136(5), p. 423–427. doi: 10.4045/tidsskr.13.1292. Full text in Research Archive
• Iversen, Tor; Øien, Henning & Schou, Arild (2016). Fastlegene i samhandlingsreformen. Tidsskrift for omsorgsforskning. ISSN 2387-5976. 2(2), p. 107–116. doi: 10.18261/ISSN.2387-5984-2016-02-05. Full text in Research Archive Show summary

  Fastlegene utfører en vesentlig del av diagnostikk og behandling i primærhelsetjenesten i Norge. Likevel er det ingen virkemidler i samhandlingsreformen som er rettet direkte mot fastlegene. Artikkelen beskriver ved hjelp av regresjonsanalyser bruken av fastlegetjenester og spesialisthelsetjenester i perioden 2009−2014 for et utvalg av kronikere og en sammenligningsgruppe. Vi finner ikke noe skift i fordelingen mellom de to typene tjenester etter at samhandlingsreformen ble introdusert fra 1. januar 2012.

• Øien, Henning; Iversen, Tor; Helgesen, Marit Kristine & Schou, Arild (2016). Fallforebygging I samhandlingsreformen. Tidsskrift for omsorgsforskning. ISSN 2387-5976. 2(3), p. 177–188. doi: 10.18261/issn.2387-5984-2016-03-04. Full text in Research Archive Show summary

  Et hovedmål i samhandlingsreformen er å styrke det forebyggende helsearbeidet i kommunehelsetjenesten, blant annet fordi dagens helsetjeneste kritiseres for å prioritere ressurskrevende og spesialisert behandling fremfor å forebygge helseproblemer. I denne artikkelen spør vi om samhandlingsreformen har ført til økt fokus på forebyggende helsearbeid i kommunehelsetjenesten, og vi evaluerer om fallforebyggende tiltak, som et utvalg av kommuner utviklet som en oppfølging av samhandlingsreformen, har en sammenheng med hoftebruddsinsidens (antall nye tilfeller per år). Ved hjelp av en spørreundersøkelse finner vi at 119 kommuner har utviklet fallforebyggende tiltak. Ved å benytte data om hoftebruddsinsidens på kommunenivå fra Norsk pasientregister (NPR) finner vi at årlig hoftebruddsinsidens i kommuner som har gjennomført slike tiltak har gått ned med 0.09 hoftebrudd per 1 000 innbyggere relativt til kommunene som ikke har gjennomført slike tiltak, i perioden fra før til etter samhandlingsreformen. Sammenhengen er ikke statistisk signifikant. Når vi ser på hoftebruddsinsidens fordelt etter kjønn, finner vi at årlig hoftebruddsinsidens for kvinner har gått ned signifikant, mens det for menn er en positiv, men usikker, sammenheng.

• Guo, Na; Iversen, Tor; Lu, Mingshan; Wang, Jian & Shi, Luwen (2016). Does the new cooperative medical scheme reduce inequality in catastrophic health expenditure in rural China? BMC Health Services Research. 16(1). doi: 10.1186/s12913-016-1883-7. Full text in Research Archive Show summary

  Background In 2003, the New Cooperative Medical Scheme (NCMS) was introduced in China to re-establish health insurance for the country’s vast rural population. In addition, the coverage of NCMS has been expanding after the new health care reform launched in 2009. This study aims to examine whether the NCMS and its recent expansion have reached the goal of reducing the risk and inequality of catastrophic health spending for rural residents in China. Methods We conducted a face-to-face household survey in three counties of the Shandong province in 2009 and 2012. Using this unique panel data, we examined the changes in the incidence and intensity of catastrophic health expenditures (CHEs) before and after NCMS reimbursement. We used concentration index (CI) and decomposition method to study the changes in inequality in CHEs. Results We found that NCMS reimbursement played a role of reducing both the incidence and intensity of CHEs, and that this impact was stronger after the new health care reform was launched. After reimbursement, the concentration indices for CHEs were 0.073 and 0.021 in 2009 and 2012, indicating that the rich had a greater tendency to incur CHEs and there existed less inequality in the incidence of CHEs after reimbursement in 2012 compared with 2009. The decomposition analysis results suggested that changes in CHE inequality between 2009 and 2012 were attributed to changes in economic status and household size rather than reimbursement levels. Conclusions Our results indicated that inequality was shrinking from 2009 to 2012, which could be a result of fewer rich people having CHEs in 2012 compared with 2009. The impact of NCMS in alleviating the financial burden of rural residents was still limited, especially among the poor. Health care reform policies in China that aim to reduce CHEs must continue to place an emphasis on improving reimbursement, cost containment, and reducing income inequalities.

• Iversen, Tor & Mokienko, Anastasia (2016). Supplementing gatekeeping with a revenue scheme for secondary care providers. International Journal of Health Economics and Management. ISSN 2199-9023. 16(3), p. 247–267. doi: 10.1007/s10754-016-9188-2. Full text in Research Archive Show summary

  We study implications of a change in the payment scheme for radiology providers in Norway that was implemented in 2008. The change implies reduced fee-for-service and increased fixed budget for a contracted volume of services. A consequence of the change is that private providers have less incentive to conduct examinations beyond the contracted volume. Different from the situation observed before the change in 2008, the volume is no longer determined by the demand side, and a rationing of the supply occurs. We employ data on radiological examinations initiated by GPs’ referrals. We apply monthly data at the physician-practice level for 2007–2010. The data set is unique because it includes information about all GPs in the Norwegian patient-list system. The results indicate that private providers conducted fewer examinations in 2008–2010 compared with previous periods and that public hospitals did either the same volume or more. We find that GPs who operate in a more competitive environment experienced a greater reduction in magnetic resonance imaging, both performed by private providers and in total for their patients. We argue that this result supports a hypothesis that patients with lower expected benefits are rationed. Hence, rationing from the supply side might supplement GP gatekeeping

• Godager, Geir; Hennig-Schmidt, Heike & Iversen, Tor (2015). Does performance disclosure influence physicians’ medical decisions? An experimental study. Journal of Economic Behavior and Organization. ISSN 0167-2681. 131, p. 36–46. doi: 10.1016/j.jebo.2015.10.005. Full text in Research Archive
• Häkkinen, Unto; Rosenqvist, Gunnar; Iversen, Tor; Rehnberg, Clas & Seppälä, Timo T. (2015). Outcome, use of resources and their relationship in the treatment of AMI, stroke and hip fracture at European hospitals. Health Economics. ISSN 1057-9230. 24, p. 116–139. doi: 10.1002/hec.3270. Full text in Research Archive
• Godager, Geir; Iversen, Tor & Ma, Ching-To Albert (2015). Competition, gatekeeping, and health care access. Journal of Health Economics. ISSN 0167-6296. 39, p. 159–170. doi: 10.1016/j.jhealeco.2014.11.005. Full text in Research Archive
• Hagen, Terje P.; Iversen, Tor; Klitkou, Søren Toksvig; Moger, Tron Anders & Häkkinen, Unto (2015). Socio-economic inequality in the use of procedures and mortality among AMI patients: Quantifying the effects along different paths. Health Economics. ISSN 1057-9230. 24, p. 102–115. doi: 10.1002/hec.3269. Full text in Research Archive Show summary

  SOCIO-ECONOMIC INEQUALITY IN THE USE OF PROCEDURES AND MORTALITY AMONG AMI PATIENTS: QUANTIFYING THE EFFECTS ALONG DIFFERENT PATHS TERJE P. HAGEN a, * , UNTO HÄKKINEN a,b , TOR IVERSEN a , SØREN TOKSVIG KLITKOU a , TRON ANDERS MOGER a ON BEHALF OF THE EUROHOPE STUDY GROUP a Department of Health Management and Health Economics, University of Oslo, Oslo, Norway b Centre for Health and Social Economics (CHESS), National Institute for Health and Welfare (THL), Helsinki, Finland ABSTRACT

• Iversen, Tor; Aas, Eline; Rosenqvist, Gunnar & Häkkinen, Unto (2015). Comparative Analysis of Treatment Costs in EUROHOPE. Health Economics. ISSN 1057-9230. 24, p. 5–22. doi: 10.1002/hec.3262. Full text in Research Archive

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• Frich, Jan C; Iversen, Tor & Tjerbo, Trond (2017). Helsepolitikkens faglige premisser. Det norske medicinske Selskab. ISBN 9788292871874. 243 p. Full text in Research Archive
• Botten, Grete Synøve; Frich, Jan C; Hagen, Terje P.; Iversen, Tor & Nordby, Halvor (2014). Helsetjenestens nye logikk. Akademika forlag. ISBN 9788232103485. 343 p. Full text in Research Archive

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• Aas, Eline; Kinge, Jonas Minet; Burger, Emily Annika; Pedersen, Kine; Iversen, Tor & Godager, Geir [Show all 14 contributors for this article] (2025). Feil tallgrunnlag kan koste liv i helsetjenesten. Full text in Research Archive
• Iversen, Tor; Snilsberg, Øyvind; Jenum, Anne Karen & Zhang, Yuting (2025). Continuity and switching in primary care. Full text in Research Archive Show summary

  This paper investigates the dual impact of continuity and discontinuity in patient-GP relationships on quality related healthcare services, focusing on patients with Type 2 Diabetes (T2D) in Norway. It challenges the traditional dichotomy in the literature by exploring the apparent contradiction that both continuity and switching GPs can improve healthcare outcomes. The research utilizes a comprehensive dataset, encompassing all Norwegian T2D patients from 2018 to 2023, to examine the outcomes of recommended services by GPs. The study's primary contribution is its simultaneous analysis of both continuity and switching using consistent data and subjects. The medical literature finds that continuity is beneficial in primary care, enhancing diagnostic accuracy, treatment quality and patient satisfaction. The study affirms this, revealing significant benefits in healthcare service provision, particularly for eye exams after 4-5 years with the same GP, and other services after 15 years. The results manifest the positive correlation between longer patient-GP relationships and the probability of receiving recommended services. The analysis also reveals that switching GPs can yield advantages when a new GP offers a higher quality of care. For patients who after forced discontinuity, are switched to GPs with superior practice styles, the likelihood of receiving recommended services, such as annual checkups, increases significantly. This result supports the hypothesis of potential health gains from a GP switch, presenting a nuanced trade-off between continuity and improvement through switching. The paper breaks new ground by demonstrating these trade-offs analytically, showing that continuity and the quality of GP practice styles both significantly impact healthcare outcomes. It emphasizes that an additional year with the same GP enhances service likelihoods while switching to a higher-performing GP can surpass this continuity benefit. Robustness checks support the findings of positive effects of both continuity and switching. The study addresses a notable gap by integrating both continuity and switching dynamics into a unified framework, thus stimulating a more balanced view on GP-patient relationships in primary care.

• Iversen, Tor; Snilsberg, Øyvind; Jenum, Anne Karen & Zhang, Yuting (2025). Continuity and switching in primary care. Full text in Research Archive Show summary

  This paper investigates the dual impact of continuity and discontinuity in patient-GP relationships on quality related healthcare services, focusing on patients with Type 2 Diabetes (T2D) in Norway. It challenges the traditional dichotomy in the literature by exploring the apparent contradiction that both continuity and switching GPs can improve healthcare outcomes. The research utilizes a comprehensive dataset, encompassing all Norwegian T2D patients from 2018 to 2023, to examine the outcomes of recommended services by GPs. The study's primary contribution is its simultaneous analysis of both continuity and switching using consistent data and subjects. The medical literature finds that continuity is beneficial in primary care, enhancing diagnostic accuracy, treatment quality and patient satisfaction. The study affirms this, revealing significant benefits in healthcare service provision, particularly for eye exams after 4-5 years with the same GP, and other services after 15 years. The results manifest the positive correlation between longer patient-GP relationships and the probability of receiving recommended services. The analysis also reveals that switching GPs can yield advantages when a new GP offers a higher quality of care. For patients who after forced discontinuity, are switched to GPs with superior practice styles, the likelihood of receiving recommended services, such as annual checkups, increases significantly. This result supports the hypothesis of potential health gains from a GP switch, presenting a nuanced trade-off between continuity and improvement through switching. The paper breaks new ground by demonstrating these trade-offs analytically, showing that continuity and the quality of GP practice styles both significantly impact healthcare outcomes. It emphasizes that an additional year with the same GP enhances service likelihoods while switching to a higher-performing GP can surpass this continuity benefit. Robustness checks support the findings of positive effects of both continuity and switching. The study addresses a notable gap by integrating both continuity and switching dynamics into a unified framework, thus stimulating a more balanced view on GP-patient relationships in primary care.

• Snilsberg, Øyvind; Iversen, Tor; Jenum, Anne Karen & Zhang, Yuting (2025). Kontinuitet og diskontinuitet i fastlegeordningen. Full text in Research Archive Show summary

  Bakgrunn Flere norske undersøkelser viser at kontinuitet i forholdet mellom pasient og fastlege har stor betydning for oppfølging og helseutfall blant pasientene. Vi er ikke kjent med undersøkelser som både undersøker effekten av kontinuitet og diskontinuitet i form av bytte til ny fastlege Formål Vår hypotese er at kontinuitet er positivt for oppfølging og helseutfall. Samtidig kan også diskontinuitet være positivt hvis byttet av fastlege skjer til en fastlege som er bedre enn den forrige. I studien undersøker vi hvordan kontinuitet og diskontinuitet i pasient-fastlege-forholdet påvirker om fastlegen utfører anbefalte helsetjenester til pasienter med type 2-diabetes (T2D) i Norge. Metode Ved hjelp av norske landsomfattende registerdata på individnivå fra 2018 til 2023 analyserer vi hvordan kontinuitet påvirker hvorvidt en pasient med T2D mottar anbefalte tjenester som HbA1c-tester og årskontroll. Vi undersøker også hvordan bytte til en fastlege som i større grad leverer anbefalte tjenester, påvirker om pasienten selv mottar disse tjenestene. Diskontinuitet i våre data oppstår ved at fastlegen slutter som fastlege, for eksempel ved å pensjonere seg. Diskontinuiteten er dermed eksogen for pasienten. Resultat Vi finner at flere år med samme fastlege er assosiert med høyere sannsynlighet for å motta anbefalte tjenester, særlig etter mer enn ti år. Videre finner vi at bytte til en fastlege som oftere leverer anbefalte tjenester, medfører en betydelig økning i sannsynligheten for å motta disse tjenestene. Samlet sett antyder resultatene at både kontinuitet og fastlegens egenskaper er avgjørende for om en pasient med T2D får anbefalte tjenester. Konklusjon Mens politiske tiltak ofte vektlegger kontinuitet, tyder våre funn på at bytte også kan være fordelaktig når det innebærer en overgang til en bedre fastlege. Dette understreker viktigheten av å gjøre kvalitetsinformasjon på tvers av fastleger transparent

• Snilsberg, Øyvind; Aandahl, Emilie; Abelsen, Birgit; Fosse, Anette; Løyland, Hanna Isabel & Pedersen, Kine [Show all 8 contributors for this article] (2025). Kom primærhelseteam i fastlegetjenesten for å bli? Refleksjoner i forsøkets kjølvann. Utposten. ISSN 0800-5680. Full text in Research Archive Show summary

  Stortingsmeldingen om allmennlegetjenesten (1) argumenterer fortverrfaglige fastlegekontor og uttrykker dermed regjeringens ambisjonerom en teambasert og mer tverrfaglig fastlegetjeneste

• Iversen, Tor; Abelsen, Birgit; Pedersen, Kine; Sæther, Erik Magnus & Løyland, Hanna Isabell (2024). Utprøving av primærhelseteam har gitt verdifulle erfaringer. Full text in Research Archive
• Iversen, Tor (2024). Hvorfor fastlegenes basistilskudd bør avhenge av listesammensetningen. Praktisk Økonomi & Finans. ISSN 1501-0074. 40(2), p. 137–147. doi: 10.18261/pof.40.2.5. Full text in Research Archive Show summary

  Fastlegeordningen er en sentral del av det norske helsevesenet. Samtidig er det mange utfordringer i fastlegeordningen. Stor arbeidsbelastning og manglende rekruttering er to stikkord. Siden mer enn 80 prosent av fastlegene er næringsdrivende, har avlønningsordningen betydning for hvor attraktivt det er å være fastlege. For å oppmuntre fastlegene til å ta listeansvar har det blitt foreslått å øke tilskuddet fastlegene får per person på listen (basistilskuddet). Jeg argumenterer for at risikojustering av basistilskuddet da er ønskelig. Det er samtidig vanskelig å finne indikatorer som avhenger av behovet for fastlegetjenester uten at de blir utgiftsdrivende for staten.

• Zhang, Yuan; Øien, Henning & Iversen, Tor (2023). Norway - Handling the Pandemic and the Effects on Specialized Healthcare. Full text in Research Archive
• Zhang, Yuan & Iversen, Tor (2023). The development of digital consultations in Norway. Full text in Research Archive
• Iversen, Tor (2023). Patient composition, risk adjustment and GP revenue in a mixed capitation and fee for service system. Full text in Research Archive Show summary

  In Norway, regular general practitioners (GPs) provide primary care to the population. Each GP has a list of patients. About 75 percent of GPs are private practitioners. The remaining proportion are employed by the municipalities. The renumeration scheme is a combination of a capitation fee and fee-for-service. Presently, a gradual increase in the capitation fee relative to fee-for service is considered. With an increasing proportion of revenue from the capitation fee, the list composition becomes more important for a GP’s total revenue. Questions asked are: 1. What is the variation in list composition among GPs? Do GPs with long lists have a healthy list population who demands few services relative to the population of GPs with short lists? 2. What is the impact on revenue for different types of GPs if a flat capitation fee increases relative to fee-for-service? 3. What difference does it make for the revenue distribution among GPs to include utilization of long-term care at the patient level in a risk adjustment formula? We use detailed register data for GPs and the list population from 2016 in the city of Oslo to explore the questions. Data include information about long term care (LTC) recipients. We do not find support for the hypotheses that GPs with long lists have more healthy patients than GPs with short lists. The proportion of individuals above 80 years old is the same for GPs with long lists as it is for GPs with short lists. Also, the proportion of the list who receives LTC services is about the same. GPs with long lists have a smaller revenue from FFS than GPs with shorter lists. We suggest that GPs with long lists manage their lists by providing fewer services to their patients than their colleagues with shorter lists. We find that increasing the proportion of capitation to 50 percent of the total revenue has considerable effect on the revenue distribution among GPs. GPs with long lists benefit and GPs with a high proportion of LTC recipients lose. The change is mitigated by risk adjusting the capitation fee according to LTC recipients listed. Also compared with the initial smaller proportion of capitation, increased risk adjusted capitation favors GP with a high proportion of LTC recipients listed. 1

• Hagen, Terje P. & Iversen, Tor (2023). Helse­tjenestene – og det permanente endringsbehovet. Magma forskning og viten. ISSN 1500-0788. 26(5), p. 70–72. doi: 10.23865/magma.v26.1420. Full text in Research Archive
• Zhang, Yuan & Iversen, Tor (2022). Development of the composition of GP consultation services in Norway from 2019 to 2021. Full text in Research Archive
• Ge, Ge; Iversen, Tor; Kaarbøe, Oddvar Martin & Snilsberg, Øyvind (2022). The impacts of Norway’s extended free choice reform. Full text in Research Archive
• Ge, Ge; Iversen, Tor; Kaarbøe, Oddvar Martin & Snilsberg, Øyvind (2022). The impacts of Norway’s extended free choice reform. Full text in Research Archive
• Ge, Ge; Iversen, Tor; Kaarbøe, Oddvar Martin & Snilsberg, Øyvind (2022). The impacts of Norway’s extended free choice reform. Full text in Research Archive
• Ge, Ge; Iversen, Tor; Kaarbøe, Oddvar Martin & Snilsberg, Øyvind (2022). The impacts of Norway’s extended free choice reform. Full text in Research Archive
• Ge, Ge; Iversen, Tor; Kaarbøe, Oddvar Martin & Snilsberg, Øyvind (2021). The impacts of Norway’s extended free choice reform. Full text in Research Archive
• Iversen, Tor (2021). Presentation of the evaluation of primary care team in Norway. Full text in Research Archive
• Godager, Geir; Iversen, Tor & Snilsberg, Øyvind (2020). Norge er trolig alene om å innføre omvendt overtid for fastleger. Full text in Research Archive Show summary

  Norge er ikke det første landet som velger å betale større basistilskudd til allmennlegene – men trolig alene om å innføre omvendt overtid.

• Iversen, Tor; Hennig-Schmidt, Heike; Wang, Jian & Godager, Geir (2019). Are patient-regarding preferences stable? Evidence from a laboratory experiment with physicians and medical students from different countries. Full text in Research Archive
• Häkkinen, Unto; Iversen, Tor & Åsa, Ljungvall (2018). Editorial: Nordic health system performance comparison. Nordic Journal of Health Economics. ISSN 1892-9729. 6(2), p. 7–9. Full text in Research Archive
• Bolin, Kristian; Lindgren, Björn; Grossman, Michael; Gyrd-Hansen, Dorte; Iversen, Tor & Kaestner, Robert [Show all 7 contributors for this article] (2017). Introduction. Advances in Health Economics and Health Services Research. ISSN 0731-2199. 25, p. xiii–xvi. doi: 10.1108/S0731-219920170000025009. Full text in Research Archive
• Frich, Jan C; Iversen, Tor & Tjerbo, Trond (2017). Helsepolitikkens faglige premisser. Michael. ISSN 1893-9651. 14, p. 9–16. Full text in Research Archive
• Aas, Eline & Iversen, Tor (2016). The effect of human capital on health behaviour after screening for colorectal cancer. Full text in Research Archive
• Iversen, Tor (2016). Promising leads in health economics research on general practice. Full text in Research Archive
• Hagen, Terje P. & Iversen, Tor (2016). EuroHOPE – sammenligning av helseutfall og behandlingskostnader mellom sju europeiske land. BestPractice. p. 17–19. Full text in Research Archive
• Iversen, Tor (2016). Primary care capacity and utilization of specialized health care. Full text in Research Archive
• Iversen, Tor (2016). Health care financing - how to finance service production? Full text in Research Archive
• Hagen, Terje P.; Iversen, Tor & Moger, Tron Anders (2016). T.P. Hagen og medarbeidere svarer:. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 136(8), p. 690–690. doi: 10.4045/tidsskr.16.0331. Full text in Research Archive
• Häkkinen, Unto; Iversen, Tor; Peltola, Mikko; Rehnberg, Clas & Seppälä, Timo T. (2015). Towards explaining international differences in health care performance: Results of the EuroHOPE project. Health Economics. ISSN 1057-9230. 24, p. 1–4. doi: 10.1002/hec.3282. Full text in Research Archive
• Iversen, Tor (2015). Friskliv, læring og mestring – lønner det seg? Full text in Research Archive
• Wang, Jian; Godager, Geir; Hennig-Schmidt, Heike; Iversen, Tor & Jing, Lin (2015). The Impact of Payment Systems on Medical Students’ and Physicians’ Behavior – An Experimental Study in China. Full text in Research Archive
• Iversen, Tor (2015). Hvem har arbeidsgiverbetalt helseforsikring? Full text in Research Archive
• Iversen, Tor (2015). Primary care capacity and utilization of specialized health care for patients with chronic disease. Full text in Research Archive
• Iversen, Tor (2015). Primary care capacity and utilization of specialized health care. Full text in Research Archive
• Iversen, Tor (2015). Aflønning i almen praksis. Full text in Research Archive
• Iversen, Tor (2014). A comparative analysis of treatment costs in European countries. Full text in Research Archive
• Iversen, Tor (2014). Aktuelle utfordringer i helsesektorene i Norden. Full text in Research Archive
• Iversen, Tor (2014). Incentives in Health Care. Full text in Research Archive
• Godager, Geir; Iversen, Tor & Hennig-Schmidt, Heike (2014). Does performance disclosure influence physicians’ medical decisions? An experimental analysis. Full text in Research Archive
• Tyrihjell, Johannes Bjørnstad; Godager, Geir; Pedersen, Kine; Værnø, Susanne Gerda; Gundersen, Martine Bergh & Hustad, Mie [Show all 13 contributors for this article] (2025). Evaluering av tiltak i allmennlegetjenesten: Endelig evalueringsrapport (IV). Oslo Economics. Full text in Research Archive Show summary

  Dette er den fjerde og siste evalueringsrapporten for følgeevalueringen av tiltak i allmennlegetjenesten. Tiltakene virker å ha vært viktige for å bedre situasjonen, men har også medført store kostnader. Fremover ventes det økt etterspørsel etter allmennlegetjenester. Dette vil kreve mer effektiv bruk av ressursene, nye arbeidsformer, økt oppmerksomhet til kvalitetsarbeid, og tilrettelagte tiltak som sikrer lik tilgang og kvalitet i hele landet.

• Aandahl, Emilie; Abelsen, Birgit; Fosse, Anette; Godager, Geir; Iversen, Tor & Løyland, Hanna Isabel [Show all 9 contributors for this article] (2024). Evaluering av forsøk med primærhelseteam og alternative finansieringsordninger: Sluttrapport 2018 – 2023 (Statusrapport VI). Universitetet i Oslo. Full text in Research Archive Show summary

  Primærhelseteam (PHT) er tverrfaglige team som inkluderer fastlege, sykepleier og helsesekretær. Sentrale målgrupper for PHT er brukere med kronisk sykdom, brukere med psykiske lidelser og rusavhengighet, brukere som omtales som «skrøpelige eldre» og brukere med utviklingshemming og funksjonsnedsettelser, samt «svake etterspørrere». <p> <p>For å finne ut om PHT, med mer systematisk oppfølging av målgruppen, gir et bedre tilbud til listeinnbyggerne enn den vanlige fastlegeordningen, ble forsøk med PHT startet 1. april 2018 på 13 legekontor, mens fire nye legekontor kom til fra 2020. Forsøket prøver ut to ulike finansieringsmodeller;12 av legekontorene har valgt honorarmodellen og fem har valgt driftstilskuddsmodellen. Evalueringen bygger på analyser av data fra helseregistre og administrative registre, pasientjournaler, spørreundersøkelser, intervjuundersøkelser og dokumenter. Denne rapporten beskriver resultater for perioden 2018 – 2021.

• Tyrihjell, Johannes Bjørnstad; Godager, Geir; Pedersen, Kine; Værnø, Susanne Gerda; Gundersen, Martine Bergh & Nyen, Johanne elise [Show all 12 contributors for this article] (2024). Evaluering av tiltak i allmennlegetjenesten: Evalueringsrapport III. Oslo Economics. Full text in Research Archive
• Aandahl, Emilie; Abelsen, Birgit; Fosse, Anette; Godager, Geir; Iversen, Tor & Løyland, Hanna Isabel [Show all 9 contributors for this article] (2023). Evaluering av forsøk med primærhelseteam og alternative finansieringsordninger. Statusrapport V. Oslo Economics. Full text in Research Archive Show summary

  Primærhelseteam (PHT) er tverrfaglige team som inkluderer fastlege, sykepleier og helsesekretær. Sentrale målgrupper for PHT er brukere med kronisk sykdom, brukere med psykiske lidelser og rusavhengighet, brukere som omtales som «skrøpelige eldre» og brukere med utviklingshemming og funksjonsnedsettelser, samt «svake etterspørrere». <p> <p>For å finne ut om PHT, med mer systematisk oppfølging av målgruppen, gir et bedre tilbud til listeinnbyggerne enn den vanlige fastlegeordningen, ble forsøk med PHT startet 1. april 2018 på 13 legekontor, mens fire nye legekontor kom til fra 2020. Forsøket prøver ut to ulike finansieringsmodeller; 12 av legekontorene har valgt honorarmodellen og fem har valgt driftstilskuddsmodellen. Evalueringen bygger på analyser av data fra helseregistre og administrative registre, pasientjournaler, spørreundersøkelser, intervjuundersøkelser og dokumenter. I denne rapporten undersøker vi særlig: <p> <uli> <li>Pasienters erfaring med PHT</li> <li>Likheter og ulikheter mellom PHT-legekontor med ulike finansieringsmodeller</li> <li>Variasjon i teamarbeid og teameffektivitet ved et utvalg PHT-legekontor</li> <li>Samspill mellom PHT og øvrig helsetjeneste <</li> </uli>

• Pedersen, Kine; Godager, Geir; Tyrihjell, Johannes Bjørnstad; Værnø, Susanne Gerda; Gundersen, Martine Bergh & Iversen, Tor [Show all 11 contributors for this article] (2023). Evaluering av handlingsplan for allmennlegetjenesten 2020–2024: Evalueringsrapport II. Oslo Economics. Full text in Research Archive
• Pedersen, Kine; Pedersen, Kine; Godager, Geir; Rognlien, Hans David; Tyrihjell, Johannes Bjørnstad & Værnø, Susanne Gerda [Show all 12 contributors for this article] (2022). Evaluering av handlingsplan for allmennlegetjenesten 2020–2024: Evalueringsrapport I. Oslo Economics. Full text in Research Archive
• Abelsen, Birgit; Gaski, Margrete; Godager, Geir; Iversen, Tor; Løyland, Hanna Isabel & Pedersen, Kine [Show all 9 contributors for this article] (2022). Evaluering av pilotprosjekt med primærhelseteam og alternative finansieringsordninger: Sluttrapport for 2018-2021 (Statusrapport IV). Universitetet i Oslo. Full text in Research Archive Show summary

  Primærhelseteam (PHT) i fastlegekontor består av fastleger, sykepleiere og helsesekretærer, og teamet ledes av en fastlege. Formålet med organiseringen er å tilby bedre fastlegetjenester til pasienter som trenger det mest, blant annet i form av en mer systematisk oppfølging. Forsøket med PHT omfatter også utprøving av to nye finansieringsmodeller. Det er 17 legekontor som inngår i PHT-forsøket. Sluttrapport 2018 – 2021 oppsummerer evalueringens funn fram til utgangen av 2021.

• Abelsen, Birgit; Godager, Geir; Harsheim, Ingrid Gaarder; Iversen, Tor; Kristiansen, Ivar Sønbø & Løyland, Hanna Isabell [Show all 10 contributors for this article] (2022). Evaluering av utprøving av digital hjemmeoppfølging: Sluttrapport. Oslo Economics. Full text in Research Archive
• Kaarbøe, Oddvar Martin; Lindén, Tord Skogedal; Ervik, Rune; Holmås, Tor Helge; Iversen, Tor & Holter, Marianne Therese Smogeli [Show all 7 contributors for this article] (2021). Evaluering av fritt behandlingsvalg. Universitetet i Oslo. Full text in Research Archive
• Abelsen, Birgit; Gaski, Margrete; Godager, Geir; Iversen, Tor; Løyland, Hanna Isabell & Pedersen, Kine [Show all 9 contributors for this article] (2021). Evaluering av forsøk med primærhelseteam og alternative finansieringsordninger: Statusrapport III. Universitetet i Oslo. Full text in Research Archive
• Iversen, Tor & Ma, Ching-To Albert (2020). Technology adoption in primary health care. Health Economics Research Network at the University of Oslo. ISSN 9788277562698. Full text in Research Archive
• Abelsen, Birgit; Gaski, Margrete; Godager, Geir; Løyland, Hanna Isabel; Pedersen, Kine & Snilsberg, Øyvind [Show all 9 contributors for this article] (2019). Evaluering av pilotprosjekt med primærhelseteam og alternative finansieringsordninger. Statusrapport II. Helsedirektoratet. Full text in Research Archive
• Wang, Jian; Iversen, Tor; Hennig-Schmidt, Heike & Godager, Geir (2019). Are patient-regarding preferences stable? Evidence from a laboratory experiment with physicians and medical students from different countries. Universitetet i Oslo. ISSN 9788277562650. Full text in Research Archive
• Westberg, Nina Buvik; Skjeflo, Sofie Waage; Hveem, Ellen Balke; Pedersen, Simen; Øien, Henning & Sørvoll, Jardar [Show all 9 contributors for this article] (2019). Evaluering av investeringstilskudd til omsorgsboliger og sykehjem. Menon Economics. Full text in Research Archive
• Abelsen, Birgit; Gaski, Margrete; Godager, Geir; Iversen, Tor; Løyland, Hanna Isabel & Pedersen, Kine [Show all 8 contributors for this article] (2019). Evaluering av pilotprosjekt med primærhelseteam og alternative finansieringsordninger. Statusrapport I. Universitetet i Oslo. Full text in Research Archive Show summary

  Fra 1. april 2018 prøves primærhelseteam ut som en organisasjonsform med teamorganisering og to alternative finansieringsmodeller ved 13 fastlegekontor i ni kommuner. Forsøket administreres av Helsedirektoratet og skal pågå i tre år. Forsøket evalueres av en samarbeidskonstellasjon av forskere fra Universitetet i Oslo, Universitetet i Tromsø og Oslo Economics. I denne rapporten beskriver vi status ved starten av forsøket.

• Abelsen, Birgit; Gaski, Margrete; Godager, Geir; Iversen, Tor; Løyland, Hanna Isabel & Pedersen, Kine [Show all 7 contributors for this article] (2019). Evaluering av pilotprosjekt med primærhelseteam og alternative finansieringsordninger. Statusrapport 2. Universitetet i Oslo. Full text in Research Archive Show summary

  I evalueringens andre statusrapport har vi undersøkt hvordan arbeidet med primærhelseteam (PHT) foregår og fungerer ved alle legekontorene som inngår i forsøket. Arbeidet med PHT er godt i gang ved alle legekontorene, selv om oppstarten for mange har tatt tid. Antallet pasienter som omfattes av PHT er økende. Det er stor variasjon i organisering av teamarbeidet på legekontorene. Sykepleiernes innsats kommer både i tillegg til og i stedet for innsats fra fastlegen. Det er stor variasjon i sykepleiernes takstinntjening. Om lag halvparten av fastlegene og sykepleierne opplever at deres yrkesgruppe i noen grad arbeider proaktivt.

• Wang, Jian; Hennig-Schmidt, Heike; Iversen, Tor & Godager, Geir (2017). How Changes in Payment Schemes Influence Provision Behavior-Evidence from a lab experiment with physicians and medical students. Universitetet i Oslo. ISSN 9788277562612. Full text in Research Archive
• Godager, Geir & Iversen, Tor (2016). Brukernes erfaringer med fastlegeordningen 2001- 2015. Universitetet i Oslo. ISSN 9788277562582. Full text in Research Archive
• Godager, Geir; Iversen, Tor; Morken, Tone & Hunskaar, Steinar (2015). Fastlønn ved legevaktarbeid. NORCE Research AS. ISSN 9788292970911. Full text in Research Archive Show summary

  Det er en viktig målsetning i den nasjonale helsepolitikken at det skal være lik tilgang til helsetjenester, uavhengig av personlig økonomi og bosted. Dagens legevaktordning, der befolkningen tilbys et lokalt forankret akuttilbud organisert som en del av primærhelsetjenesten, er viktig for oppnåelsen av dette målet. Rammebetingelser i form av organisering, regulering og avlønningsordninger er aktuelle virkemidler myndighetene kan ta i bruk for å styre tjenesten. De avlønningsordninger som er mest aktuelle i legevakt, er ordninger med fast lønn, ordninger med aktivitetsbaserte takster, og eventuelle kombinasjoner av disse. I helsetjenesten er det ofte langt flere mål enn det er virkemidler. Dette er også tilfelle innen legevakt. Det er ønskelig at kombinasjonen av organisering og avlønningsform muliggjør og oppmuntrer klinikere til å levere trygge og gode tjenester på en effektiv måte, bidrar til ønsket prioritering av oppgaver og pasientgrupper, og samtidig sørger for tilfredsstillende rekruttering av leger – og da særlig fastleger – til legevakt. I kapittel 2 diskuterer vi egenskaper ved fastlønn og takstbaserte ordninger. En av de viktigste konklusjonene er at takstbaserte ordninger i større grad enn fastlønn vil kunne medføre prioriteringsvridninger hvis det er avvik mellom relative takster og relative kostnader. Slike prioriteringsvridninger vil i særlig grad kunne oppstå i tilfeller der det er stor heterogenitet blant pasientene og der det er stort mangfold i typer av arbeidsoppgaver. Vi fant videre at overgang til fastlønn kan tenkes å påvirke rekrutteringen til legevakt positivt siden inntektsusikkerheten som kombinasjonen av beredskapstilskudd og takster medfører, vil bortfalle. En slik virkning vil naturligvis ikke bare være betinget av avlønningens form men også av avlønningens nivå. Avlønning med kombinasjon av beredskapstilskudd og takster gir i dag vesentlig mindre inntekt per tidsenhet i mindre sentrale kommuner enn i sentrale kommuner. Nyere undersøkelser tyder på at yngre leger i større grad foretrekker fastlønn enn hva deres eldre kolleger gjør. Dersom inntekt til kommunen tillegges mindre vekt enn inntekt til en selv, vil nivået på legevaktens anstrengelser forventes å være mindre ved fastlønn enn ved takstavlønning. Alt annet likt vil vi dermed forvente at effektiviteten i form av antallet takstbaserte tjenester per tidsenhet vil være større ved takstbasert avlønning enn ved fastlønn. En ulempe ved takstbasert avlønning kan være at behandlingen blir for rask med fare for dårlig kommunikasjon og feilbehandling. Det vil dermed kunne være en avveining mellom gjennomstrømning av pasienter og kvalitet i behandlingen. Det er vanskelig, med utgangspunkt i en økonomisk analyse, å gi et entydig svar på om en overgang fra takstbasert avlønning til fastlønn generelt er å foretrekke. En viktig grunn til dette er store forskjeller mellom kommuner med hensyn til sentralitet, befolkningstetthet, geografi og reiseavstander. Lav befolkningstetthet i en del kommuner tilsier at legevaktene vil måtte utføre mer sammensatte oppgaver siden det er mindre rom for arbeidsdeling enn hva tilfellet er i de store byene. En hovedkonklusjon fra diskusjonen om økonomiske insentiver i legevakt er derfor at det er vanskelig å utforme et avlønningssystem for legevakt som passer like godt i alle landets kommuner. Det kommunale mangfoldet kan altså ha som implikasjon at det er fordelaktig med noe lokal tilpasning av avlønningssystemer. Dersom fastlønn skulle bli en viktig avlønningsform i framtidens legevaktordning, kan det være hensiktsmessig med lokal tilpasning av fastlønnen. Trolig vil det i enkelte områder være nødvendig med relativt høy fastlønn for å sikre rekrutteringen. For å skaffe systematisk kunnskap om bruk av alternative avlønningsformer ved legevaktsarbeid ble det i samarbeid med Nasjonalt kompetansesenter for legevaktmedisin gjennomført en spørreunder-søkelse der samtlige av landets 190 legevakter ble invitert til å delta. Kartleggingen ble gjennomført ved bruk av epost og et internettbasert skjema. Totalt deltok 133 (70 %) av legevaktene i første del av kartleggingen. Av disse svarte 44 % at det ikke ble benyttet noen form for fastlønn ved deres legevakt, mens 56 % svarte at de hadde fastlønnsordninger ved deres legevakt. I utvalget var det 38 % som svarte at de benytter fastlønnsordning der man følger SFS 2305, mens 19 % oppga at de benytter fastlønn som er forankret gjennom en lokal særavtale. For å innhente informasjon om erfaringer og vurderinger av fastlønn for legevaktsarbeid kontaktet vi i en oppfølgingsundersøkelse de legevaktene som svarte at de hadde ordninger med fastlønn til legevaktlege, og la fram totalt 18 påstander knyttet til ulike aspekter ved fastlønn som vi ba om respons på. Totalt var det 48 av de aktuelle 75 legevakter (64 %) som besvarte vurderingsspørsmålene. Tre påstander som respondentene mente omhandlet særlig viktige momenter var: Påstand (16): «Fastlønn legger til rette for en riktigere prioritering av pasienter, basert på medisinskfaglige (og ikke økonomiske) vurderinger». Her svarer 45,8 % at de er «Helt enig», mens kategoriene «Delvis enig» og «Helt enig» til sammen utgjør 62,5 % av respondentene. Påstand (3): «Fastlønn bidrar til å bedre kommunens styring med driften». Her svarer 45,8 % «Helt enig» mens 66,7 % svarte at de var enten «Delvis enig» eller «Helt enig». Påstand (12): «Legevaktleger med fastlønn kan også anvendes til å følge opp pasienter i kommunale akuttsenger». Hele 66,6 % av respondentene svarer at de er «Delvis enig» eller «Helt enig» i denne påstanden. Respondentene ble også bedt om å vurdere en påstand om hvorvidt alle typer legevaktarbeid bør være fastlønnet: Påstand (17): «Alle typer legevaktarbeid bør være fastlønnet». Her svarte flertallet av respondentene enten «Helt enig» (33,3 %) eller «Delvis enig» (29,2 %) I arbeidet med rapporten ble det søkt etter internasjonal litteratur om bruk av fastlønn i legevaktarbeid. Omfanget av internasjonal litteratur som tar for seg problemstillingen er svært begrenset. Det kan se ut til at aktivitetsbaserte takster er den vanligste formen for betaling i systemer der primærleger yter legevakttjenester. Vi fant ingen studier med metodekvalitet som gjør det mulig å trekke klare og robuste slutninger om kausale virkninger av å innføre fastlønn for legevaktarbeid. Dette skyldes blant annet den generelle utfordring som gjør seg gjeldende ved analyser av avlønningssystemer, nemlig at det vanligvis er vanskelig å gjennomføre kontrollerte forsøk med avlønningssystemer. De fleste gjennomførte studier av avlønningssystemer i helsetjenesten er derfor såkalte før-etter studier. Vi refererer til to case som baserer seg på endring i avlønningsordning fra fastlønn til aktivitetsbaserte takster, det ene i britisk allmennpraksis i 1967, det andre i forbindelse med den tyske gjenforeningen. De empiriske resultatene tyder i all hovedsak på at aktivitetsbasert avlønning er assosiert med et større volum. Den knappe litteraturen om avlønning i legevakt gjør at den mer generelle litteraturen om legers tilpasning til økonomiske insentiver kan være nyttig i diskusjonen. De tre vanligste måter å betale primærleger på er fastlønn, aktivitetsbaserte takster og per capita betaling. Resultater fra økonomisk analyse og empiriske studier tyder på at de alle tre har svakheter. Det synes å være konsensus i den helseøkonomiske litteraturen om at et virkemiddel for å ta hensyn til svakhetene ved de alternative betalingsformer er å bruke kombinasjoner av flere betalingsformer for å sikre at tjenestevolumet som blir levert er i tråd med samfunnets ønsker.

• Godager, Geir & Iversen, Tor (2014). Brukernes erfaringer med fastlegeordningen 2001 – 2012. Trender i bruk, tilgjengelighet og fornøydhet. HERO. ISSN 9788277562414. Full text in Research Archive

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