Privatisering av helsesektoren (avsluttet)

• Holom, Geir Hiller; Alexandersen, Nina; Goldhaber-Fieber, Jeremy D. & Hagen, Terje P. (2018). Which patients receive surgery in for-profit and non-profit hospitals in a universal health system? An explorative register-based study in Norway. BMJ Open. 8(6), s. 1–10. doi: 10.1136/bmjopen-2017-019780. Fulltekst i vitenarkiv Vis sammendrag

  Objectives To compare the socioeconomic status (SES) and case-mix among day surgical patients treated at private for-profit hospitals (PFPs) and non-profit hospitals (NPs) in Norway, and to explore whether the use of PFPs in a universal health system has compromised the principle of equal access regardless of SES. Design A retrospective, exploratory study comparing hospital types using the Norwegian Patient Register linked with socioeconomic data from Statistics Norway by utilising Norwegian citizens’ personal identification numbers. Setting The Norwegian healthcare system. Population All publicly-financed patients in five Norwegian metropolitan areas having day surgery for meniscus (34 100 patients), carpal tunnel syndrome (15 010), benign breast hypertrophy (6 297), or hallux valgus (2 135) from 2009–2014. Primary outcome measure Having surgery at a PFP or NP. Results Across four unique procedures, the adjusted odds ratios (aORs) for using PFPs were generally lower for the lowest educational level (0.77–0.87) and the lowest income level (0.68–0.89), though aORs were not always significant. Likewise, comorbidity and previous hospitalisation had lower aORs (0.62-0.95; 0.44-0.97, respectively) for having surgery at PFPs across procedures, though again aORs were not always significant. No clear patterns emerged with respect to age, gender, or higher levels of income and education. Conclusions The evidence from our study of four procedures suggests that equal access to PFPs compared to NPs for those patients at the lowest education and income levels may be compromised, though further investigations are needed to generalise these findings across more procedures and probe causal mechanisms and appropriate policy remedies. The finding that comorbidity and previous hospitalisation had lower odds of treatment at PFPs indicates that NPs play an essential role for more complex patients, but raises questions about patient preference and cream skimming.

• Tynkkynen, Liina-Kaisa; Alexandersen, Nina; Kaarbøe, Oddvar Martin; Anell, Anders; Lehto, Juhani S. & Vrangbæk, Karsten (2018). Development of Voluntary Private Health Insurance in Nordic Countries. An Exploratory Study on Country-specific Contextual Factors. Health Policy. ISSN 0168-8510. 122(5), s. 485–492. doi: 10.1016/j.healthpol.2018.03.008. Fulltekst i vitenarkiv Vis sammendrag

  The Nordic countries are healthcare systems with tax-based financing and ambitions for universal access to comprehensive services. This implies that distribution of healthcare resources should be based on individual needs, not on the ability to pay. Despite this ideological orientation, significant expansion in voluntary private health insurance (VPHI) contracts has occurred in recent decades. The development and role of VPHIs are different across the Nordic countries. Complementary VPHI plays a significant role in Denmark and in Finland. Supplementary VPHI is prominent in Norway and Sweden. The aim of this paper is to explore drivers behind the developments of the VPHI markets in the Nordic countries. We analyze the developments in terms of the following aspects: the performance of the statutory system (real or perceived), lack of coverage in certain areas of healthcare, governmental interventions or inability to reform the system, policy trends and the general socio-cultural environment, and policy responses to voting behavior or lobbying by certain interest groups. It seems that the early developments in VPHI markets have been an answer to the gaps in the national health systems created by institutional contexts, political decisions, and cultural interpretations on the functioning of the system. However, once the market is created it introduces new dynamics that have less to do with gaps and inflexibilities and more with cultural factors.

• Holom, Geir Hiller & Hagen, Terje P. (2017). Quality differences between private for-profit, private non-profit and public hospitals in Norway: a retrospective national register based study of acute readmission rates following total hip and knee arthroplasty. BMJ Open. doi: 10.1136/bmjopen-2016-015771. Fulltekst i vitenarkiv Vis sammendrag

  Objectives To compare the quality of care—using unplanned acute hospital readmissions as a quality measure—among patients treated at private for-profit hospitals (PFPs), private non-profit hospitals (PNPs) and public hospitals (PUBs) in Norway. Design A retrospective comparative study using the Norwegian Patient Register. Readmissions were evaluated by logistic regressions both using adjustment for various patient-level and other covariates, and a two-stage model using distance as an instrumental variable. Setting The Norwegian healthcare system. Population All publicly financed patients having primary total hip (37 897 patients) or primary total knee arthroplasty (25 802 patients) at one of the three hospital types from 2009 to 2014. Primary outcome measure 30-day unplanned acute hospital readmission rate. Results We found highest readmission rates among PUBs and lowest among PFPs, for both procedures. However, the patients were on average more than 2 years younger at PFPs. PFPs also treated the least severe patients, while PUBs treated the most severe. Using adjustment for various patient-level and other covariates, compared to PUBs, both PFPs and PNPs had lower odds of readmission following both procedures. However, using the instrumental variable method, the only significant difference found was a lower odds of readmission at PNPs among hip patients when compared with PUBs. No patients in our data set were readmitted to PFPs, those originally treated at PFPs were readmitted to either PNPs or PUBs, and PUBs received most of the readmitted patients across hospital types. Conclusions Quality differences between hospital types were small; however, PNPs had significantly lower readmission rates compared with PUBs among patients having total hip arthroplasty. PUBs received the larger part of the readmitted patients across hospital types and thus play an essential role in the care of more complex patients and for readmissions, regardless of any quality differences.

• Hagen, Terje P.; Holom, Geir Hiller & Ameyu, Kebebew Negera (2017). Outsourcing day surgery to private for-profit hospitals: the price effects of competitive tendering. Health Economics, Policy and Law. ISSN 1744-1331. 13, s. 50–67. doi: 10.1017/S1744133117000019. Fulltekst i vitenarkiv Vis sammendrag

  Setting prices for elective patient treatments in private for-profit (PFP) hospitals in traditional tax-funded health systems is challenging since both the organisation of these hospitals and the tasks they perform differ considerably from what we find in public hospitals. From the year 2000, Norway became one of a few countries to gradually implement a procurement system based on competitive tendering when outsourcing elective surgery. In this study we analyse the effect of introducing competitive tendering on the prices paid to PFP hospitals. Pricing data were collected from the formal contracts awarded to PFP hospitals and defined in terms of both absolute and relative prices. We found that PFP hospitals performed day surgeries at markedly lower prices than public hospitals and that competitive tendering triggered the price reduction. We speculate that the PFP hospitals’ lack of acute services, less severe patient population, reduced teaching responsibilities and ability to streamline production, as well as other factors, explain the lower prices at PFP hospitals.

• Alexandersen, Nina; Hagen, Terje P. & Kaarbøe, Oddvar Martin (2017). Hvilke bedrifter kjøper private helseforsikringer i Norge? Samfunnsøkonomen. ISSN 1890-5250. 1, s. 31–38. Fulltekst i vitenarkiv Vis sammendrag

  I underkant av 500 000 personer har private helseforsikringer i Norge, de fleste gjennom arbeidsgiverfinansierte kollektive ordninger. Forsikringene skal primært gi raskere tilgang til spesialisthelsetjenester. Vi bruker data fra en spørreundersøkelse supplert med registerdata fra Brønnøysundregistrene og analyserer sannsynligheten for å ha privat helseforsikring. Vi finner at sannsynligheten for private helseforsikringer øker med antall ansatte og med andel menn i bedriften, men reduseres med sykefravær på næringsnivå. Arbeidsgivers avgjørelse om å kjøpe private helseforsikringer er påvirket av ansattes preferanser og arbeidsgivers oppfatning om at private helseforsikringer kan brukes som rekrutteringsstrategi. I gjennomsnitt er bedriftene fornøyd/veldig fornøyd med det medisinske tilbudet som gis gjennom private helseforsikringer.

• Alexandersen, Nina; Anell, Anders; Kaarbøe, Oddvar Martin; Lehto, Juhani S.; Tynkkynen, Liina-Kaisa & Vrangbæk, Karsten (2016). The development of voluntary private health insurance in the Nordic countries. Nordic Journal of Health Economics. ISSN 1892-9729. 4(1), s. 68–83. doi: 10.5617/njhe.2718. Fulltekst i vitenarkiv

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• Hagen, Terje P. (2018). Privatisering av helsetjenester i Norden - hovedkonklusjoner. Fulltekst i vitenarkiv
• Vrangbæk, Karsten (2018). Litteraturreview - er private sygehuse mere effektive end offentlige. Fulltekst i vitenarkiv
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• Lehto, Juhani S. & Hagen, Terje P. (2018). HEALTH AND SOCIAL CARE SYSTEM REFORM IN FINLAND perspectives on private insurance and private hospitals. Fulltekst i vitenarkiv
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• Tynkkynen, Liina-Kaisa; Alexandersen, Nina; Kaarbøe, Oddvar Martin; Anell, Anders; Lehto, Juhani S. & Vrangbaek, Karsten (2017). Development of Voluntary Private Health Insurance in Nordic Countries – An Exploratory Study on Country-specific Contextual Factors. Fulltekst i vitenarkiv
• Hagen, Terje P. (2017). Privatisering på norsk. Anbudskonkurranser, seleksjon og kvalitet i en skattefinansiert helsetjeneste. Fulltekst i vitenarkiv
• Holom, Geir Hiller; Alexandersen, Nina & Hagen, Terje P. (2017). Which patients receive surgery in for-profit and non-profit hospitals in a universal Health system? An explorative register-based study. Fulltekst i vitenarkiv
• Alexandersen, Nina; Hagen, Terje P. & Kaarbøe, Oddvar Martin (2016). Hvilke bedrifter kjøper private helseforsikringer i Norge? Fulltekst i vitenarkiv
• Kaarbøe, Oddvar Martin (2016). Hvilke bedrifter kjøper private helseforsikringer i Norge? Fulltekst i vitenarkiv
• Kaarbøe, Oddvar Martin (2016). Location choice and quality competition in mixed hospital markets. Fulltekst i vitenarkiv
• Kaarbøe, Oddvar Martin (2016). Privata sjukvårdsförsäkringar i Norden – vilka är köparna och vilka effekter får dom? Fulltekst i vitenarkiv
• Kaarbøe, Oddvar Martin (2016). Location Choice and Quality Competition in Mixed Hospital Markets. Fulltekst i vitenarkiv
• Holom, Geir Hiller (2016). Big Data in Norway. Fulltekst i vitenarkiv
• Holom, Geir Hiller (2016). Patient selection in private for-profit, private non-profit, and public hospitals using Norwegian big data. Fulltekst i vitenarkiv
• Holom, Geir Hiller (2016). Which Patients Receive Surgery in For-Profit and Non-Profit Hospitals in a Universal Health System? Fulltekst i vitenarkiv
• Kaarbøe, Oddvar Martin (2015). Location choice and quality competition in mixed hospital markets. Fulltekst i vitenarkiv
• Kaarbøe, Oddvar Martin (2015). Location choice and quality competition in mixed hospital markets. Fulltekst i vitenarkiv
• Kaarbøe, Oddvar Martin; Hagen, Terje P. & Aleksandersen, Nina (2016). Hvilke bedrifter kjøper private helseforsikringer i Norge? 7Letras. Fulltekst i vitenarkiv

Se alle arbeider i NVA