Terje P. Hagen

• 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.  ISSN 2044-6055. 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.

• Swanson, Jayson O.; Vogt, Verena; Sundmacher, Leonie; Hagen, Terje P. & Moger, Tron Anders (2018). Continuity of care and its effect on readmissions for COPD patients: A comparative study of Norway and Germany. Health Policy.  ISSN 0168-8510. . doi: 10.1016/j.healthpol.2018.05.013
• Alexandersen, Nina; Hagen, Terje P. & Kaarbøe, Oddvar Martin (2017). Hvilke bedrifter kjøper private helseforsikringer i Norge?. Samfunnsøkonomen.  ISSN 1890-5250.  1, s 31- 38 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.

• 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.

• Hagen, Terje P. & Tingvold, Laila (2017). Planning future care services: Analyses of investments in Norwegian municipalities. Scandinavian Journal of Public Health.  ISSN 1403-4948. . doi: 10.1177/1403494817730996 Fulltekst i vitenarkiv. Vis sammendrag

  Aims: To analyse whether the Norwegian Central Government’s goal of subsidizing 12,000 places in nursing homes or sheltered housing using an earmarked grant was reached and to determine towards which group of users the planned investments were targeted. Methods: Data from the investment plans at municipal level were provided by the Norwegian Housing Bank and linked to variables describing the municipalities’ financial situation as well as variables describing the local needs for services provided by Statistics Norway. Using regression analyses we estimated the associations between municipal characteristics and planned investments in total and by type of care place. Results: The Norwegian Central Government reached its goal of giving subsidies to 12,000 new or rebuilt places in nursing homes and sheltered housing. A total of 54% of the subsidies (6878 places) were given to places in nursing homes. About 7500 places were available by the end of the planning period and the rest were under construction. About 50% of the places were planned for user groups aged <67 years and 23% of the places for users aged <25 years. One-third of the places were planned for users with intellectual disabilities. Investments in nursing homes were correlated with the share of the population older than 80 years and investments in sheltered houses were correlated with the share of users with intellectual disabilities. Conclusions: Earmarked grants to municipalities can be adequate measures to affect local resource allocation and thereby stimulate investments in future care. With the current institutional setup the municipalities adapt investments to local needs.

• 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.  ISSN 2044-6055. . 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.

• Johannessen, Karl-Arne; Kittelsen, Sverre A.C. & Hagen, Terje P. (2017). Assessing physician productivity following Norwegian hospital reform: A panel and data envelopment analysis. Social Science and Medicine.  ISSN 0277-9536.  175, s 117- 126 . doi: 10.1016/j.socscimed.2017.01.008 Fulltekst i vitenarkiv.
• Mishra, Vinod Kumar; Fiane, Arnt E; Winsnes, Benny Adam; Geiran, Odd; Sørensen, Gro; Hagen, Terje P. & Gude, Einar (2017). Cardiac Replacement Therapies: Outcomes and Costs for Heart Transplantation versus Circulatory Assist. Scandinavian Cardiovascular Journal.  ISSN 1401-7431.  51(1), s 1- 7 . doi: 10.1080/14017431.2016.1196826
• Tjerbo, Trond & Hagen, Terje P. (2017). The health policy pendulum: cost control vs. activity growth. International Journal of Health Planning and Management.  ISSN 0749-6753. . doi: 10.1002/hpm.2407 Fulltekst i vitenarkiv.
• Hagen, Terje P.; Iversen, Tor & Moger, Tron Anders (2016). Risikojustering ved måling av predikert dødelighet etter hjerteinfarkt. Tidsskrift for Den norske legeforening.  ISSN 0029-2001.  136(5), s 423- 427 . doi: 10.4045/tidsskr.13.1292
• Hagen, Terje P. & Melberg, Hans Olav (2016). Liggetider og reinnleggelser før og etter Samhandlingsreformen.. Tidsskrift for omsorgsforskning.  ISSN 2387-5976.  2(2), s 143- 158
• Swanson, Jayson O. J; Alexandersen, Nina & Hagen, Terje P. (2016). Førte opprettelsen av kommunale akutte døgnenheter til færre innleggelser ved somatiske sykehus?. Tidsskrift for omsorgsforskning.  ISSN 2387-5976.  2(2), s 125- 134 Vis sammendrag

  I Følge helse- og omsorgstjenesteloven av 2011 skal kommunene tilby heldøgns medisinsk akuttbehandling fra 1. januar 2016. Målet med tilbudet som er kalt kommunal øyeblikkelig hjelp døgnenheter (ØDH), er å redusere antall innleggelser ved sykehusene særlig for den eldre befolkningen. I notatet analyseres om etablering av ØDH-er faktisk har påvirket antall innleggelser ved sykehusene. Vi har hentet inn data om antall innleggelser fra Norske paientregister, data om demografiske variable og data om det kommunale tilbudet av tjeneste utover ØHD-ene fra Statistisk sentralbyrå og data om tidspunkt for etablering av ØHD-ene fra kommunene. Data er analysert som et panel med faste effekter for kommune. Konklusjonene er at innføring av ØDH-ene har hatt effekt, men også at effektene varierer betydelig med hvordan ØDH-ene er organisert. I gjennomsnitt finner vi effekter av innføring av ØDH-er på innleggelser for pasienter over 80 år på knapt (minus) 2%. Det ØDH-ene som er samlokalisert med legevekt og som har god legeberedskap som har effekter. ØDH-er som har annen organisering enn dette har i gjennomsnitt ingen effekt, men det er store variasjoner på kommunenivå.

• Swanson, Jayson O. J & Hagen, Terje P. (2016). Reinventing the community hospital: A retrospective population-based cohort study of a natural experiment using register data. BMJ Open.  ISSN 2044-6055.  6:e012892(12) . doi: 10.1136/bmjopen-2016-012892 Vis sammendrag

  Objectives To investigate whether implementation of municipal acute bed units (MAUs) resulting from the Norwegian Coordination Reform (2012) was associated with reductions in hospital admissions, particularly for the elderly. Design A municipality-based retrospective comparative cohort study using monthly population-based registry data analysed with fixed-effects log–log regressions. Setting Norwegian municipalities and hospitals. Population All patients admitted to secondary hospital care in Norway between 2010 and 2014, excluding psychiatric admissions, with additional focus on admission type and elderly age subgroups. Main outcome measures Monthly admission rates in total and by age group for all patients, patients admitted with acute conditions and with acute conditions at internal medicine departments. Results The introduction of MAUs was associated with a small yet significant overall negative effect on hospital admissions. The reduction in all admissions was significant for the entire population (−1.2%, 95% CI −2.0% to −0.0%) and slightly stronger for those aged 80 years and above (−1.9%, 95% CI −3.0% to −1.0%). The more detailed analysis of the elderly population aged 80 years and above revealed that effects were affected by the institutional characteristics of the MAUs. The significant effects ranged between −1.6% and −8.6%, depending on the availability of physicians on duty at the MAUs, the MAUs location or combinations thereof. Conclusions Introduction of MAUs following implementation of the Norwegian Coordination Reform in 2012 was associated with a significant reduction in hospital admissions primarily for the elderly. Our findings suggest that this type of intermediate care is a viable option in an effort to alleviate the burden on hospitals by reducing the acute secondary care admission volume. Further examinations focused on cost-effectiveness, health status of patients, number of patients treated at the MAUs and comparing other intermediate care alternatives would all add important perspectives to the issue.

• Yin, Jun; Dahl, Fredrik Andreas; Hagen, Terje P. & Lurås, Hilde (2016). The influence of changes in activity-based financing on hospital readmissions for the elderly. Nordic Journal of Health Economics.  ISSN 1892-9729.  4(2), s 72- 81 . doi: 10.5617/njhe.992
• Ambugo, Eliva Atieno & Hagen, Terje P. (2015). A multilevel analysis of mortality following acute myocardial infarction in Norway: Do municipal health services make a difference?. BMJ Open.  ISSN 2044-6055.  5(11) . doi: 10.1136/bmjopen-2015-008764
• Hagen, Terje P.; Belicza, Eva; Fatore, Giovanni; Goude, Fanny & Häkkinen, Unto (2015). Acute myocardial infarction, use of percutaneous coronary intervention, and mortality: A comparative effectiveness analysis covering Seven European Countries. Health Economics.  ISSN 1057-9230.  24, s 88- 101 . doi: 10.1002/hec.3263
• 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, s 102- 115 . doi: 10.1002/hec.3269 Vis sammendrag

  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

• Hagen, Terje P. & Tjerbo, Trond (2014). Helsetjenesteaksjonen av 2013: Hva er alternativene og hva blir effekten av forslagene?, I: Grete Synøve Botten; Jan C Frich; Terje P. Hagen; Tor Iversen & Halvor Nordby (red.),  Helsetjenestens nye logikk.  Akademika forlag.  ISBN 978-82-321-0348-5.  Kapittel 9.  s 107 - 116
• Johannessen, Karl-Arne & Hagen, Terje P. (2014). Physicians' engagement in dual practices and the effects on labor supply in public hospitals: Results from a register-based study. BMC Health Services Research.  ISSN 1472-6963.  14(1) . doi: 10.1186/1472-6963-14-299
• McArthur, David Philip; Gregersen, Fredrik Alexander & Hagen, Terje P. (2014). Modelling the cost of providing ambulance services. Journal of Transport Geography.  ISSN 0966-6923.  34, s 175- 184 . doi: 10.1016/j.jtrangeo.2013.12.004
• Grundtvig, Morten; Hagen, Terje P.; Amrud, Elin S & Reikvam, Åsmund (2013). Reduced life expectancy after an incident hospital diagnosis of acute myocardial infarction - Effects of smoking in women and men. International Journal of Cardiology.  ISSN 0167-5273.  167(6), s 2792- 2797 . doi: 10.1016/j.ijcard.2012.07.010
• Grundtvig, Morten; Hagen, Terje P.; Amrud, Elin S & Reikvam, Åsmund (2013). Reduced life expectansy after an incident hospital diagnosis of acute myocardial infarction - effect of smoking in women and men. International Journal of Cardiology.  ISSN 0167-5273. . doi: 10.1016/j.ijcard.2012.07.010
• Johannessen, Karl-Arne & Hagen, Terje P. (2013). Individual and hospital-specific factors influencing medical graduates' time to medical specialization. Social Science and Medicine.  ISSN 0277-9536.  97, s 170- 175 . doi: 10.1016/j.socscimed2013.08.026
• McArthur, David Philip; Tjerbo, Trond & Hagen, Terje P. (2013). The role of young users in determining long-term care expenditure in Norway. Scandinavian Journal of Public Health.  ISSN 1403-4948.  41(5), s 486- 491 . doi: 10.1177/1403494813482839
• Tjerbo, Trond & Hagen, Terje P. (2013). Historien om da Kostnadskontroll spiste New Public Management til middag, I: Noralv (red.) Veggeland (red.),  Reformer i norsk helsevesen : veier videre.  Akademika forlag.  ISBN 978-82-321-0291-4.  kapittel 3.  s 65 - 77
• Yin, Jun; Lurås, Hilde; Hagen, Terje P. & Dahl, Fredrik Andreas (2013). The effect of activity-based financing on hospital length of stay for elderly patients suffering from heart diseases in Norway. BMC Health Services Research.  ISSN 1472-6963.  13 . doi: 10.1186/1472-6963-13-172
• Dahle, Gry; Rein, Kjell Arne; Fiane, Arnt E; Fosse, Erik; Kushi, Ishtiaq; Hagen, Terje P. & Mishra, Vinod Kumar (2012). Innovative technology-transcatheter aortic valve implantation: Cost and reimbursement issues. Scandinavian Cardiovascular Journal.  ISSN 1401-7431.  46(6), s 345- 352 . doi: 10.3109/14017431.2012.724177
• Defechereux, Thierry; Paolucci, Francesco; Mirelman, Andrew; Youngkong, Sitaporn; Botten, Grete Synøve; Hagen, Terje P. & Niessen, Ludwig (2012). Health care priority setting in Norway a multicriteria decision analysis. BMC Health Services Research.  ISSN 1472-6963.  12 . doi: 10.1186/1472-6963-12-39
• Johannessen, Karl-Arne & Hagen, Terje P. (2012). Variations in labor supply between female and male hospital physicians: Results from a modern welfare state. Health Policy.  ISSN 0168-8510.  107(1), s 74- 82 . doi: 10.1016/j.healthpol.2012.05.009
• Mishra, Vinod Kumar; Fiane, Arnt E; Geiran, Odd; Sørensen, Gro; Khushi, Ishtiaq & Hagen, Terje P. (2012). Hospital costs fell as numbers of LVADs were increasing: experiences from Oslo University Hospital. Journal of Cardiothoracic Surgery.  ISSN 1749-8090.  Aug(27) . doi: 10.1186/1749-8090-7-76
• Grundtvig, Morten; Hagen, Terje P.; Amrud, Elin S & Reikvam, Åsmund (2011). Mortality after myocardial infarction: impact of gender and smoking status. European Journal of Epidemiology.  ISSN 0393-2990.  26, s 385- 393 . doi: 10.1007/s10654-011-9557-6
• Grytten, Jostein Ivar; Monkerud, Lars Christian; Hagen, Terje P.; Sørensen, Rune Jørgen; Eskild, Anne & Skau, Irene (2011). The impact of hospital revenue on the increase in Caesarean sections in Norway. A panel data analysis of hospitals 1976-2005. BMC Health Services Research.  ISSN 1472-6963.  11 . doi: 10.1186/1472-6963-11-267
• Hagen, Terje P. (2011). Organization and financing of healthcare services, In Olav Molven & Julia Ferkis (ed.),  Healthcare, Welfare and Law. Health legislation as a mirror of the Norwegian welfare state.  Gyldendal Akademisk.  ISBN 978-82-05-40081-8.  Kapittel 3.  s 38 - 46
• Moe, Joakim Oliu & Hagen, Terje P. (2011). Trends and variation in mild disability and functional limitations among older adults in Norway, 1986-2008. European Journal of Ageing.  ISSN 1613-9372.  8(1), s 49- 61 . doi: 10.1007/s10433-011-0179-3 Fulltekst i vitenarkiv. Vis sammendrag

  An increase in the number of older adults may raise the demand for health and care services, whereas decreasing prevalence of disability and functional limitations among them might counteract this demographic effect. However, the trends in health are inconsistent between studies and countries. In this article, we estimated the trends in mild disability and functional limitations among older Norwegians and analyzed whether they differ between socio-demographic groups. Data were obtained from repeated cross-sectional surveys conducted in 1987, 1991, 1995, 2002, 2005, and 2008, in total 4,036 noninstitutionalized persons aged 67 years or older. We analyzed trends using multivariate logistic regression. On average, the age-adjusted trend in functional limitations was -3.3% per year, and in disability 3.4% per year. The risk for functional limitations or disability was elevated for women compared to men, for married compared to nonmarried, and was inversely associated with educational level The trends were significantly weaker with increasing age for disabilities, whereas none of the trends differed significantly between subgroups of sexes, educational level or marital status. Both functional limitations free and disability-free life expectancy appeared to have increased more than total life expectancy at age 67 during this period. The analysis suggests downward trends in the prevalence of mild disability and functional limitations among older Norwegians between 1987 and 2008 and a compression of lifetime in such health states. The reduced numbers of older people with disability and functional limitations may have restrained the demand for health and care services caused by the increase in the number of older adults.

• Reikvam, Åsmund & Hagen, Terje P. (2011). Endringer i dødelighet av hjerteinfarkt. Tidsskrift for Den norske legeforening.  ISSN 0029-2001.  131(5), s 468- 470 . doi: 10.4045/tidsskr.10.0592
• Ringard, Ånen & Hagen, Terje P. (2011). Are waiting times for hospital admissions affected by patients' choices and mobility?. BMC Health Services Research.  ISSN 1472-6963.  11(170) . doi: 10.1186/1472-6963-11-170
• Biørn, Erik; Hagen, TP; Iversen, Tor & Magnussen, Jon (2010). How different are hospitals' responses to a financial reform? The impact on efficiency of activity-based financing. Health Care Management Science.  ISSN 1386-9620.  13(1), s 1- 16 . doi: 10.1007/s10729-009-9106-y
• Hagen, Terje P.; Anthun, Kjartan Sarheim & Reikvam, Åsmund (2010). Hjerteinfarkt i Norge 1991-2007. Tidsskrift for Den norske legeforening.  ISSN 0029-2001.  130(8), s 820- 824
• Mishra, Vinod Kumar; Geiran, Odd; Fiane, Arnt E; Sørensen, Gro; Andresen, Sølvi; Olsen, Ellen Kristin; Kushi, Ishtiaq & Hagen, Terje P. (2010). Costs and reimbursement gaps following implementation of 3rd generation Left Ventricular Assist Devices. The Journal of Heart and Lung Transplantation.  ISSN 1053-2498.  29(1), s 72- 78 . doi: 10.1016/j.healun.2009.06.029 Vis sammendrag

  BACKGROUND: The purpose of this study was to compare and contrast total hospital costs and subsequent reimbursement of implementing a new program using a third-generation left ventricular assist device (LVAD) in Norway. METHODS: Between July 2005 and March 2008, the total costs of treatment for 9 patients were examined. Costs were calculated for three periods—the pre-implantation LVAD phase, the LVAD implantation phase and the post-implantation LVAD phase—as well as for total hospital care. Patientspecific costs were obtained prospectively from patient records and included personnel resources, medication, blood products, blood chemistry and microbiology, imaging, and procedure costs including operating room costs. Overhead costs were registered retrospectively and allocated to the specific patient by pre-defined allocation keys. Finally, patient-specific costs and overhead costs were aggregated into total patient costs. RESULTS: The average total patient cost in 2007 U.S. dollars was $735,342 and the median was $613,087 (range $342,581 to $1,256,026). The mean length of stay was 77 days (range 40 to 127 days). For the LVAD implantation phase, the mean cost was $457,795 and median cost was $458,611 (range $246,239 to $677,680). The mean length of stay for the LVAD implantation phase was 55 days (range 25 to 125 days). The diagnosis-related group (DRG) reimbursement (2007) was $143,192. CONCLUSIONS: There is significant discrepancy between actual hospital costs and the current Norwegian DRG reimbursement for the LVAD procedure. This discrepancy can be partly explained by excessive costs related to the introduction of a new program with new technology. Costly innovations should be considered in price setting of reimbursement for novel technology.

• Mishra, Vinod Kumar; Svennevig, Jan Ludvig; Bugge, Jan Frederik; Andresen, Sølvi; Mathisen, Agnete; Karlsen, Harald; Kushi, Ishtiaq & Hagen, Terje P. (2010). Cost of extracorporeal membrane oxygenation: evidence from Rikshospitalet University Hospital, Oslo, Norway. European Journal of Cardio-Thoracic Surgery.  ISSN 1010-7940.  37(2), s 339- 342 . doi: 10.1016/j.ejcts.2009.06.059
• Grundtvig, Morten; Hagen, Terje P.; German, Mikal & Reikvam, Åsmund (2009). Sex-based differences in premature first myocardial infarction caused by smoking: twice as many years lost by women as by men. European Journal of Cardiovascular Prevention & Rehabilitation.  ISSN 1741-8267.  16(2), s 174- 179 . doi: 10.1097/HJR.0b013e328325d7f0 Vis sammendrag

  BACKGROUND: It has been debated whether smoking increases the risk of heart disease relatively more in women than in men. It is not known whether there are sex differences with regard to how many years prematurely smoking causes acute myocardial infarction (AMI) to occur. We aimed to determine how smoking affects the age of onset of first myocardial infarction in both the sexes. DESIGN: Clinical data were consecutively entered into a database and were analysed with a multivariate regression technique. METHODS: In the years 1998-2005, data on 1784 consecutive patients (38.3% women) who were discharged from or died in a district general hospital with a diagnosis of first myocardial infarction were included in the study. Age at first AMI was analysed. RESULTS: Unadjusted mean ages were 76.2 years for women and 69.8 years for men, a difference of 6.4 years (P<0.001). Mean age within the various groups was: women nonsmokers 80.7 years, women smokers 66.2 years, difference 14.4 years (P<0.001); men nonsmokers 72.2 years, men smokers 63.9 years, difference 8.3 years (P<0.001). After adjustment for risk factors (hypertension, cholesterol levels, diabetes) and patient characteristics (history of angina, history of stroke) 13.7 years of the age difference in women were attributed to smoking; the corresponding figure in men was 6.2 years (P<0.001). CONCLUSION: First AMI occurred significantly more prematurely in women than in men smokers, implying that twice as many years were lost by women as by men smokers.

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• Botten, Grete Synøve; Frich, Jan C; Hagen, Terje P.; Iversen, Tor & Nordby, Halvor (red.) (2014). Helsetjenestens nye logikk. Akademika forlag.  ISBN 978-82-321-0348-5.  343 s.
• Fiva, Jon H.; Hagen, Terje P. & Sørensen, Rune Jørgen (2014). Kommunal Organisering. Universitetsforlaget.  ISBN 9788215022789.  232 s.
• Hagen, Terje P. (2009). Finansieringsordninger som styringsredskap i helsetjenestene, i B. Wilmar, P. Bruusgaard, J. C. Frich og P. Fugelli (red): Penger og verdier i helsetjenesten. Gyldendal Akademisk.  ISBN 978-82-05-39332-5.  16 s.

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• Ambugo, Eliva Atieno; Hagen, Terje P. & Melberg, Hans Olav (2018). Effects of introducing a fee for “inpatient overstays” on adverse events among patients hospitalized for chronic obstructive pulmonary disease, heart failure, hip fracture and stroke. Vis sammendrag

  Introduction: The Norwegian healthcare coordination reform (Samhandlingsreformen) was implemented from January 1, 2012. In addition to providing municipalities with funding to strengthen their health infrastructure, it required municipalities to pay hospitals a daily fee for patients who, having been declared ready for discharge and in need of municipal health services, were not received by the municipalities on time. This study examines the effects of the reform on adverse events, defined as deaths or readmissions occurring within 60 days of hospitalization. Methods: We use Norwegian register data for patients (age 18+) hospitalized between 2009 and 2014 for COPD/asthma (N=25,936), heart failure (N=27,708), hip fracture (N=44,981) and stroke (N=43,313). Our logit models test for conditional effects of the reform, whereby associations between the reform and adverse events vary by whether or not patients were classified as ready for discharge and in need of follow-up care in the municipality. The models include fixed effects for districts and a year trend. They also adjust for sociodemographic and health characteristics. Results: We found significant (p<0.042) conditional effects of the reform among patients with heart failure but not among patients with COPD/asthma, hip fracture, or stroke. Specifically, during the post-reform period (2012-2014), heart failure patients who needed follow-up had a slightly higher and significant probability of adverse events (Pr=0.36, p=0.029) compared to their counterparts not in need of follow-up (Pr=0.34). We did not find a similar effect among heart failure patients in the pre-reform period (2009-2011; p=0.946). Conclusion: Overall, there is no strong evidence to suggest that the Norwegian healthcare coordination reform is functioning in a manner that exacerbates risk for readmissions or death among the patients considered in this study. Even so, patients with heart failure appear somewhat vulnerable to the reform and its incentive scheme.

• Hagen, Terje P. (2018). Ekspertutvalget: Nye oppgaver til fylkeskommunene. PLAN.  (1), s 6- 11
• Hagen, Terje P. (2018). Privatisering av helsetjenester i Norden - hovedkonklusjoner.
• Lehto, Juhani S. & Hagen, Terje P. (2018). HEALTH AND SOCIAL CARE SYSTEM REFORM IN FINLAND perspectives on private insurance and private hospitals.
• Hagen, Terje P. (2017). Privatisering på norsk. Anbudskonkurranser, seleksjon og kvalitet i en skattefinansiert helsetjeneste..
• Häkkinen, Unto; Hagen, Terje P. & Moger, Tron Anders (2017). Performance comparison of hip fracture pathways in two metropolitan areas - does the level of integration matter?.
• 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.
• Moger, Tron Anders; Häkkinen, Unto & Hagen, Terje P. (2017). Higher mortality among ACS patients in Finland than in Norway: Do differences in acute preparedness and scale effects in hospital treatment explain the variation?. Vis sammendrag

  Background: Mortality differences following hospital treatment in Finland and Norway are similar for major diseases with acute coronary syndrome (ACS) as an important exception. For ACS, mortality in Finland is significantly higher than in Norway. Objective: To study whether the differences in the organization of the PCI facilities, a decentralized structure with reduced emergency preparedness and small scale production in Finland vs. a centralized structure with large PCI departments performing acute services 24/7 in Norway, add to the explanations of country differences in 30 and 365 day all-cause mortality for patients hospitalized with ACS (acute myocardial infarction or unstable angina pectoris). Data and methods: Data for patients discharged with acute myocardial infarction (ICD 10 I21 and I22) and unstable angina pectoris (ICD 10 I 20.0) from the hospital discharge registers in 2009-2014 was linked with socio-demographic variables, variables describing distances to hospitals and causes of death registers in Norway and Finland. The variables of main interest, emergency preparedness of PCI and the volume of ACS patients at hospital level were included as independent variables in logistic regression analyses. Preliminary results: Across all years combined, Norway had lower 30 and 365 days mortality (7% vs 11%, p<0.001 and 14% vs 20%, p<0.001). However, differences for STEMI patients were smaller (30 days: 10% vs 12%, p<0.001, 365 days: 17% vs 18%, p=0.01) than for non-STEMI, undefined and unstable angina patients (30 days: 6% vs 10%, p<0.001, 365 days: 13% vs 20%, p<0.001). The average Finnish patient was first admitted to a hospital treating 540 ACS patients per year (average travel time by car: 40 min), increasing to 590 patients (travel time: 43 min) during the first episode including transfers to higher level hospitals. Corresponding numbers for Norway were 630 ACS patients per year for the first admission (travel time: 60 min) and 1240 patients (!) for the first episode (travel time: 96 min). In Finland, 48% of STEMI and 39% of non-STEMI, undefined and unstable angina patients were admitted to hospitals with an emergency PCI service during the episode. The corresponding numbers for Norway were 77% and 66%. However, more patients received PCI within 2 days in Finland than Norway (38% vs. 33%, p<0.001), and the distribution of PCIs performed during weekends was similar (23% vs. 23%, p=0.55). Both in Norway and Finland non-STEMI patients who not receive PCI have a significantly lower mortality if they are treated at hospital with PCI facility than at other hospitals (OR 0.65 in Norway and 0.73 in Finland for 365 days mortality, p<0.001). This may indicate better quality at high volume centers. Further work: Multilevel logistic models with individual level risk adjustment and hospital level variables and random effects are going to be used to study if the reduced preparedness for PCI at some of the Finnish hospitals and differences in organization of care for ACS patients add to our understanding of mortality differences between Finland and Norway.

• Moger, Tron Anders; Häkkinen, Unto & Hagen, Terje P. (2017). Higher mortality among ACS patients in Finland than in Norway: Do differences in acute services and scale effects in hospital treatment explain the variation?.
• Swanson, Jayson O. J; Vogt, Verena; Sundmacher, Leonie; Hagen, Terje P. & Moger, Tron Anders (2017). Continuity of care and its effect on readmissions for COPD patients: A comparative study of Norway and Germany.
• Tjerbo, Trond; Hagen, Terje P. & Monkerud, Lars Chr. (2017). Is there a health political budget cycle? An analysis of growth in health expenditure in election years for OECD countries.
• Alexandersen, Nina; Hagen, Terje P. & Kaarbøe, Oddvar Martin (2016). Hvilke bedrifter kjøper private helseforsikringer i Norge?.
• Ambugo, Eliva Atieno; Hagen, Terje P. & Vaage, Silje Kathrine Hofgaard (2016). || Chapter in a report. "Integrated care for older people living at home: Current situation and ambition of sites participating in the SUSTAIN project - Norway"..
• Ambugo, Eliva Atieno; Vaage, Silje Kathrine Hofgaard & Hagen, Terje P. (2016). || Poster presentation. “Integrated care for older people living at home: Current situation and ambition of sites participating in the SUSTAIN project - Norway”.
• Hagen, Terje P. & Iversen, Tor (2016). EuroHOPE – sammenligning av helseutfall og behandlingskostnader mellom sju europeiske land. BestPractice.  (Juni), s 17- 19
• Hagen, Terje P.; Iversen, Tor & Moger, Tron Anders (2016). T.P. Hagen og medarbeidere svarer:. Tidsskrift for Den norske legeforening.  ISSN 0029-2001.  136(8), s 690- 690 . doi: 10.4045/tidsskr.16.0331
• Kaarbøe, Oddvar Martin; Hagen, Terje P. & Aleksandersen, Nina (2016). Hvilke bedrifter kjøper private helseforsikringer i Norge?.
• Lappegard, Øystein; Hagen, Terje P. & Hjortdal, Per (2016). Acute admissions to a community hospital: a descriptive cost study.. HERO skriftserie / Working paper. 9.
• Swanson, Jayson O. J; Hagen, Terje P. & Alexandersen, Nina (red.) (2016). Førte opprettelsen av kommunale akutte døgnenheter til færre innleggelser ved somatiske sykehus? HERO working paper 1/2016..
• Ambugo, Eliva Atieno & Hagen, Terje P. (2015). Conference presentation. "A multilevel analysis of mortality following acute myocardial infarction in Norway: Do municipal health services make a difference.".
• Hagen, Terje P. (2015). Kommunale akutte døgnenheter (KAD). Resultater fra følgeforskning.
• Hagen, Terje P. (2015). Makt, media og mortalitet: Noen erfaringer fra evalueringen av Samhandlingsreformen.
• Hagen, Terje P. (2015). Prossessevalueringen av Samhandlingsreformen: Statlige virkemidler, kommunale innovasjoner.
• Hagen, Terje P. (2015). Samhandlingsreformen etter fire år. Hva kan vi lære og hvem kan vi lære av.
• Hagen, Terje P.; McArthur, David & Tjerbo, Trond (2015). Resultatevaluering av Omsorgsplan 2015: Kommunenes drifts- og investeringsbeslutninger. HERO skriftserie / Working paper. 4.
• Holom, Geir Hiller & Hagen, Terje P. (2015). Kostnader, pasientseleksjon og kvalitet - en sammenligning mellom offentlige og private sykehus.
• Holom, Geir Hiller & Hagen, Terje P. (2015). Patient selection and quality in total hip arthroplasty among patients treated at private for-profit, private non-profit and public hospitals.
• Olsen, Camilla Beck & Hagen, Terje P. (2015). Kommunenes respons på Samhandlingsreformen. HELEDs Skriftserie. 1. Fulltekst i vitenarkiv.
• Saltman, Richard B.; Hagen, Terje P. & Vrangbæk, Karsten (2015). New Strategies for Elderly Care in Denmark and Norway. Eurohealth.  ISSN 1356-1030.  21(2), s 23- 25
• Swanson, Jayson O. J & Hagen, Terje P. (2015). Reinventing the Community Hospital.
• Swanson, Jayson O. J & Hagen, Terje P. (2015). Reinventing the Community Hospital.
• Botten, Grete; Frich, Jan C; Hagen, Terje P.; Iversen, Tor & Nordby, Halvor (2014). Helsetjenestens nye logikk: fortsatt målrettet mangfold, I: Grete Synøve Botten; Jan C Frich; Terje P. Hagen; Tor Iversen & Halvor Nordby (red.),  Helsetjenestens nye logikk.  Akademika forlag.  ISBN 978-82-321-0348-5.  Kapittel 1.  s 13 - 22
• Hagen, Terje P. (2014). Foreløpige erfaringer med Samhandlingsreformen.
• Hagen, Terje P. (2014). Hva har vi lært og hvordan gå videre?.
• Hagen, Terje P. (2014). Hva kan vi si om effektene av kommunale akutte døgnenheter?.
• Hagen, Terje P. (2014). Reduserer kommunale akutte døgnenheter (KAD) antall innleggelsen av eldre pasienter ved somatiske sykehus?.
• Hagen, Terje P. (2014). Reinventing the “cottage hospital”: Did implementation of municipal acute bed units reduce the demand for hospital admissions?.
• Hagen, Terje P. (2014). The Norwegian strategy for developing better integrated and less expensive long term care services.
• Hagen, Terje P. (2013). Samhandlingsreformen - foreløpige erfaringer.
• Hagen, Terje P. (2013). Samhandlingsreformen: Effekter for kommunene etter første året.
• Hagen, Terje P. (2013). Samhandlingsreformen: Kva skjedde første året?.
• Hagen, Terje P.; McArthur, David Philip & Tjerbo, Trond (2013). Midtveisevaluering av Omsorgsplan 2015: Effekter for pleieårsverk og plasser i boliger og institusjoner. HERO skriftserie / Working paper. 7.
• Grundtvig, Morten; Hagen, Terje P. & Reikvam, Åsmund (2011). Reduced life expectancy after myocardial infarction in women and men: smoking is most harmful in women. European Heart Journal, Supplement.  ISSN 1520-765X.  32, s 320
• Hagen, Terje P.; Amayu, Kebebew Negera; Godager, Geir; Iversen, Tor & Øien, Henning (2011). Utviklingen i kommunenes helse- og omsorgstjenester 1986-2010. HERO skriftserie / Working paper. 5.
• Iversen, Tor; Hagen, Terje P. & Godager, Geir (2011). Omfang og sammensetning av omsorgstjenester i tre nordiske land. HERO skriftserie / Working paper. 2. Vis sammendrag

  Sammendrag Formålet med denne rapporten er å beskrive de nordiske lands tjenesteprofiler innenfor de kommunale omsorgstjenestene. Med tjenesteprofil menes blant annet antall brukere og type brukergrupper, tjenestens organisering og tjenestens driftskostnader, samt fordelingen mellom hjemmebasert versus institusjonsbasert omsorg. Datagrunnlag og definisjoner varierer mellom de nordiske landene. Dette gjør det vanskelig å sammenlikne nivået på tjenestetilbudet. Dette gjelder særlig for Finland der det ikke er mulig å skille pleie og omsorgstjenestene fra deler av spesialisthelsetjenestene. Finland inngår derfor ikke i den tallmessige beskrivelsen. Når det gjelder hjemmetjenester, er det bare for praktisk bistand at data er sammenlignbare for de tre landene Danmark, Norge og Sverige. Andelen mottakere av praktisk bistand i Danmark og Norge er omtrent på samme nivå, mens tilsvarende andel i Sverige er mindre. Noe av forskjellen kan skyldes at svenske tall bare omfatter hjemmetjenester til hjemmeboende og ikke for eksempel i omsorgsboliger som i Norge. Når hjemmetjenester inkluderer både praktisk bistand og hjemmesykepleie, er gjennomsnittlig andel mottakere noe større i Danmark enn i Norge. Andelen av befolkningen som bor i institusjon eller tilrettelagte boformer er redusert noe i alle tre land etter 2001. Reduksjonen synes å ha vært størst i Sverige og minst i Norge. For den eldste aldersgruppen (80 år og over) har Norge den største andelen av befolkningen i institusjon eller tilrettelagte boformer, mens andel beboere i aldersgruppen 67-79 år er større i Danmark enn i Norge. En oppsplitting i institusjon og tilrettelagt boform er bare mulig i Danmark og Norge. Andelen på institusjon i den eldste aldersgruppen er noe større i Norge enn i Danmark. Mens andelen har blitt redusert i Danmark siden 2006, har den vært konstant i Norge. Norge viser gjennomgående en større kommunal variasjon i omfang og sammensetning av omsorgstjenester enn Sverige og Danmark. Analysene av de skandinaviske landene samlet viser at kommunenes inntektsnivå har en positiv effekt på andel innbyggere i institusjoner og omsorgsboliger, dvs. at andelen beboere i disse boformene øker med kommunenes inntekter. Vi finner ikke tilsvarende effekter av inntekter på andel innbyggere som mottar praktisk bistand. At inntekter har ulike effekter på de to formene for omsorg, kan skyldes ulikhet i kostnader mellom omsorgsformene. Det kan også være at større inntekter vil medføre at antallet timer med praktisk bistand til de som allerede er mottakerne, vil øke. Tilgjengelige data har ikke gitt mulighet til å undersøke dette nærmere. Vi finner videre en positiv effekt av andel av befolkningen i aldergruppen 67 og over for begge de to omsorgsformene. Dødelighet har en positiv effekt på institusjonsdekning og en negativ effekt på andel innbyggere som mottar praktisk bistand. Vi tolker dette som at det i kommuner som har mange innbyggere i livets siste fase, skjer en dreining av omsorgstilbudet over fra lettere til tyngre omsorgsformer. Tidligere analyser har vist at Danmark har lagt stor vekt på utvikling av hjemmetjenester som kom til erstatning for institusjonstjenestene. Utviklingen i Sverige har derimot vært preget av reduksjon både i hjemmetjenester og institusjonsplasser/omsorgsboliger. Norge har vært et sted i mellom de to andre landene. I dag kan vi konkludere med at Danmark fortsatt har noe større dekning når det gjelder mottakere av hjemmehjelp/hjemmesykepleie, mens Sverige har lavere dekning enn Norge. Norge ligger svakt over Danmark i dekningsgrader for institusjoner/omsorgsboliger. Også her ligger Sverige lavere. De lange linjer viser med andre ord at Norge fortsatt har lavere nivå enn Danmark på hjemmetjenester. De viser også at avinstitusjonaliseringen fortsetter i våre to naboland, mens institusjonsdekningen i Norge trolig er nokså stabil og høyere enn i de to andre landene.

• Hagen, Terje P. (2010). Endring av finansieringsansvaret for TNF-alfa-hemmere. BestPractice.  2(3), s 12- 13
• Melberg, Hans Olav & Hagen, Terje P. (2010). Bruker Norge mye eller lite penger på helse?. Overlegen.  ISSN 1503-2663.  (2), s 8- 9
• Danielsen, Åge; Hagen, Terje P. & Sørensen, Rune J. (2009). Hvordan kan sykehusene få bedre resultater?. Tidsskrift for Den norske legeforening.  ISSN 0029-2001.  129(10), s 1004- 1006
• Hagen, Terje P. (2009, 29. juli). - Sykehus bløffer seg effektive.  Vårt land.
• Hagen, Terje P. (2009, 15. mai). Fattig eldrebølge i USA.  Dagsavisen.
• Hagen, Terje P. (2009, 23. januar). Helse til folket.  Dag og tid.
• Hagen, Terje P. (2009, 18. mai). Helsereform kan ramme pasientene.  Bergens tidende.
• Hagen, Terje P. (2009). Kan pengestrømmen snus? Hvordan skal samspillet mellom primær- og spesialisthelsetjenesten bedres?.
• Hagen, Terje P. (2009). Kommunal medfinansiering av sykehusene: Er det en god ide?.
• Hagen, Terje P. (2009, 26. mai). Kritisk blikk på helsereform. [Internett].  Nyheter fra Norges Forskningsråd.
• Hagen, Terje P. (2009). Modeller for kommunal medfinansiering. HERO skriftserie / Working paper. 6.

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