Trond Tjerbo

• Rostad, Hanne Marie; Skinner, Marianne Sundlisæter; Burrell, Lisa Victoria; Yang, Fan; Tjerbo, Trond & Vatnøy, Torunn Kitty (2026). Explaining Variation in the Percentage of Admissions for Patients Aged 80 and Over in Municipal InPatient Acute Care Services: A Cross-Sectional Analysis From Norway. Health Services Insights (HSI Journal). 19. doi: 10.1177/11786329261490712. Fulltekst i vitenarkiv Vis sammendrag

  Background Municipal Inpatient Acute Care (MIPAC) units in Norway provide short-term inpatient services, but structural and contextual disparities, spanning resources, competence, and accessibility, may affect utilization patterns. Objectives To examine to what extent variation in the percentage of admissions involving patients aged ≥80 years across MIPAC units is associated with structural and contextual conditions. Design Cross-sectional study using aggregated register and survey data. Methods The analytical sample included 147 MIPAC units, corresponding to 68% of the 215 units in the administrative dataset. Descriptive statistics describe sample characteristics and admissions by age group. Pearson correlations assessed interrelationships and multicollinearity before regression analysis. Results The model explained 38% of the variance. Unit location, registered nurse coverage, and driving distance to the nearest emergency department were associated with the percentage of admissions involving patients aged ≥80 years. Units located in GP out-of-hours clinics had a lower percentage compared to nursing home–based units (B = -17.12, 95% CI [-23.51 to -10.73], β =-0.41, p < 0.001). Greater registered nurse coverage (B = -0.12, 95% CI [-0.22 to -0.02], β = -0.18, p = 0.021) and longer driving distance to the nearest emergency department (B = -0.07, 95% CI [-0.11 to -0.04], β = -0.31, p < 0.001) were also associated with lower percentages. The estimate for the proportion of adults ≥80 years in the MIPAC catchment area was positive, but uncertain, as the confidence interval included zero (B = 1.76, 95% CI [-0.06 to 3.57], β = 0.20, p = 0.057). Conclusion MIPAC admission patterns for the oldest patients were associated with both service configuration and local context. These findings highlight variation in the use of MIPAC services across different units. Future research should examine how structural and contextual factors are related to patterns of MIPAC utilization and explore the mechanisms underlying these associations.

• Tjerbo, Trond; Hagen, Terje P. & Holte, Jon Helgheim (2026). When Policy Meets Reality: Municipal Leaders’ Views Amid Rising LTC Expenditure. Health Services Insights (HSI Journal). 19. doi: 10.1177/11786329251410041. Fulltekst i vitenarkiv
• Holte, Jon Helgheim; Moger, Tron Anders; Edvardsen, Anne; Tjerbo, Trond; Vøllestad, Nina Køpke & Hellesø, Ragnhild [Vis alle 7 forfattere av denne artikkelen] (2026). Long-term patterns of health services utilization after hospitalization for COPD. A nationwide registry-based study from Norway. Respiratory Medicine. ISSN 0954-6111. 260. doi: 10.1016/j.rmed.2026.108958. Fulltekst i vitenarkiv Vis sammendrag

  Chronic obstructive pulmonary disease (COPD) is commonly regarded as an ambulatory care-sensitive condition (ACSC), for which targeted outpatient and primary care can improve patients' outcomes and reduce their risk of hospitalization. Yet little is known about how COPD patients' use of such services evolves in real-life settings. Using national health registry data from Norway (2008–2020), linked to demographic and socioeconomic registers, we explore how COPD patients' combined use of primary and specialist services evolves in the first four years after an acute respiratory hospital episode, and assess whether these patterns align with clinical guidelines and vary by sociodemographic characteristics. A two-stage clustering approach was employed to identify individuals with similar care trajectories. The 13 057 patients were first grouped by the number of respiratory hospital episodes after the index episode (0, 1–2, or 3+), then K-medoid clustering was performed within each group to identify similar patterns of respiratory-related outpatient and primary health service utilization. Four distinct care trajectories emerged within each group, with similar combination patterns: (1) predominantly GP services (most common), (2) GP and outpatient services, (3) GP, out-of-hours primary care and infrequent outpatient services, and (4) frequent physiotherapist, GP and outpatient services (rarest). Notably, groups 2 and 4 had higher income and education than groups 1 and 3, and many patients do not follow care trajectories according to current guidelines for COPD treatment. Understanding the mechanisms that explain these variations in health services use, and their implications for care quality and equity, is essential for improving COPD management in universal healthcare systems.

• Amundsen, Olav; Moger, Tron Anders; Holte, Jon Helgheim; Haavaag, Silje Bjørnsen; Bragstad, Line Kildal & Hellesø, Ragnhild [Vis alle 8 forfattere av denne artikkelen] (2026). Use of primary care physiotherapy and its associations with clinical and socioeconomic outcomes in musculoskeletal disorders: a cohort study. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 44(1). doi: 10.1080/02813432.2026.2660328. Fulltekst i vitenarkiv Vis sammendrag

  Isolating the effects of outpatient care on hospitalisation in observational data is challenging. We estimate the effects of factors believed to influence hospital admissions in patients with COPD. The factors were related to outpatient care and social factors, motivated by recommendations in COPD guidelines and the literature. We applied linked national and municipal registry data on 25,369 COPD patients in Oslo and Trondheim 2008–2019. Yearly frequency and type of healthcare contacts (respiratory and non-respiratory, across providers), together with comorbidities, were used as proxies for patients’ health status. We constructed samples matched on the full set of proxy variables to estimate the effect of each factor on future COPD hospital admissions. Overall, 9.8% of follow up years had at least one COPD hospital admission. Findings indicated beneficial effects of several of the factors. Care interaction between general practitioner (GP) and other health providers, follow-up by GP within 30 days after COPD hospital discharge and counselling/psychotherapy by GP showed significant reductions of 2.9, 4.9 and 1.4% points in the rate of next-year COPD hospital admissions, respectively. The effects are noteworthy when extrapolated to the entire Norwegian COPD population. A reduction of 1% point could result in up to 1,500 fewer patients experiencing one or more COPD hospital admissions during a year. In the absence of detailed clinical information, creating samples that are multidimensionally matched on health service use and comorbidities as pragmatic proxies for health status could be a viable approach for estimating the effects of other factors.

• Moger, Tron Anders; Holte, Jon Helgheim; Amundsen, Olav; Haavaag, Silje Bjørnsen; Edvardsen, Anne & Bragstad, Line Kildal [Vis alle 9 forfattere av denne artikkelen] (2026). Matching on health status to estimate the effects of outpatient care and social factors in patients with COPD: a Norwegian registry‑based study. BMC Health Services Research. 26(1). doi: 10.1186/s12913-026-14285-9. Fulltekst i vitenarkiv Vis sammendrag

  Isolating the effects of outpatient care on hospitalisation in observational data is challenging. We estimate the effects of factors believed to influence hospital admissions in patients with COPD. The factors were related to outpatient care and social factors, motivated by recommendations in COPD guidelines and the literature. We applied linked national and municipal registry data on 25,369 COPD patients in Oslo and Trondheim 2008–2019. Yearly frequency and type of healthcare contacts (respiratory and non-respiratory, across providers), together with comorbidities, were used as proxies for patients’ health status. We constructed samples matched on the full set of proxy variables to estimate the effect of each factor on future COPD hospital admissions. Overall, 9.8% of follow up years had at least one COPD hospital admission. Findings indicated beneficial effects of several of the factors. Care interaction between general practitioner (GP) and other health providers, follow-up by GP within 30 days after COPD hospital discharge and counselling/psychotherapy by GP showed significant reductions of 2.9, 4.9 and 1.4% points in the rate of next-year COPD hospital admissions, respectively. The effects are noteworthy when extrapolated to the entire Norwegian COPD population. A reduction of 1% point could result in up to 1,500 fewer patients experiencing one or more COPD hospital admissions during a year. In the absence of detailed clinical information, creating samples that are multidimensionally matched on health service use and comorbidities as pragmatic proxies for health status could be a viable approach for estimating the effects of other factors.

• Haavaag, Silje Bjørnsen; Obstfelder, Aud Uhlen; Hellesø, Ragnhild; Moger, Tron Anders; Amundsen, Olav & Tjerbo, Trond [Vis alle 9 forfattere av denne artikkelen] (2026). Patient Work in Long-Term Conditions. Qualitative Health Research. ISSN 1049-7323. doi: 10.1177/10497323261430632. Fulltekst i vitenarkiv Vis sammendrag

  Long-term conditions are one of the major causes to morbidity and death worldwide. Management of such conditions in healthcare settings has been framed as a challenge for healthcare systems, and people living with long-term conditions often experience fragmented care. Integrated care approaches have been advocated as the solution, but few studies include the work done by patients and its significance for care processes. The present study aimed to explore the work of people with long-term conditions in the unfolding of their care trajectories. The study is based on semi-structured interviews of people living with chronic obstructive pulmonary disease and musculoskeletal disorders. The participants were all home-dwelling and living in Norway. Reflexive thematic analysis was used to guide the analysis. Theory about work as theorized by Strauss et al. was central to the analysis. The persons highlight that they feel that it is up to them to ask questions and initiate care, that they monitor their bodies to be equipped to act adequately when changes occur, and that they engage in deliberative interaction with healthcare personnel. The findings add depth to current knowledge and highlight that people living with long-term conditions participate in the unfolding of their care trajectories by doing comprehensive work. Framing what people with long-term conditions do when participating in their care trajectories as work brings forth aspects of healthcare use that may be less visible for healthcare personnel and enables addressing individual care trajectories as intertwined with patient work.

• Moger, Tron Anders; Holte, Jon Helgheim; Amundsen, Olav; Haavaag, Silje Bjørnsen; Døhl, Øystein & Bragstad, Line Kildal [Vis alle 9 forfattere av denne artikkelen] (2025). Predictors, Healthcare Utilization and Costs Related to Short-Term Stays in Patients with COPD: A Registry-Based Analysis in Norway. Clinical Epidemiology. Volume 17, s. 707–719. doi: 10.2147/clep.s521958. Fulltekst i vitenarkiv Vis sammendrag

  Background: Chronic obstructive pulmonary disease (COPD) incurs significant healthcare costs, often accompanied by multimorbidity. Advanced patients may need short-term stays for rehabilitation, treatment, or respite to maintain home living. Aim: To identify predictors for a first short-term stay and study the healthcare utilization and costs compared with similar patients without a short-term stay. Patients and Methods: Data on COPD patients in the cities Oslo and Trondheim 2010–2019 and including information on specialist, primary and long-term care, diagnoses, sociodemographics and -economics were collected from national and municipal registries, resulting in a sample of 24,613 patients. Using discrete time survival models, we identified predictors for a short-term stay. We described the costs before and after admission, and the duration of living at home, compared to non-recipients matched on age, comorbidities and healthcare use. Results: Depression, anxiety, mental disorders, alcoholism, prior hospitalization and reception of home care were associated with higher odds of short-term stays. One to two GP visits for respiratory diseases, being in the top quartile for GP visits for non-respiratory diseases, visits to specialists, and physiotherapist visits for non-respiratory issues were significantly associated with lower odds of short-term institutional stay. Patients admitted to short-term stays incurred markedly higher costs both in the year before admission and during subsequent years compared to matched non-recipients, primarily due to increased use of inpatient and home care services. Conclusion: Prior receipt of home care, unlike standard outpatient services, was linked to a higher likelihood of short-term stays. This suggests that some outpatient services may delay the need for such stays, or that patients already in municipal services are more readily admitted. Additionally, patients with psychosocial issues may have greater care needs, indicating that resource allocation aligns with these needs. The findings suggest that by the time short-term stays are required, health deterioration has already become considerable.

• Moger, Tron Anders; Holte, Jon Helgheim; Amundsen, Olav; Haavaag, Silje Bjørnsen; Døhl, Øystein & Bragstad, Line Kildal [Vis alle 9 forfattere av denne artikkelen] (2024). The in- and outpatient health care use of patients with COPD before and after initiation of home care: a registry study from Norway. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 43(1). doi: 10.1080/02813432.2024.2404056. Fulltekst i vitenarkiv Vis sammendrag

  Objective: Chronic obstructive pulmonary disease (COPD) is a common condition associated with age, multimorbidity and frequently involves the use of health care across levels. Understanding the factors associated with the initiation of long-term care is important when planning the future need for services. We describe healthcare use before and after the reception of any home care. We further studied the associations between healthcare use and first registered home care service and from first registered home care service to nursing home admission or death. Design and subjects: Patients residing in Oslo or Trondheim at the time of first contact with a COPD primary diagnosis, 2009–2018. Patient data were linked across national and municipal registries, covering healthcare and sociodemographics. The sample consisted of 16,738 individuals. Results: There was a marked increase in inpatient and outpatient hospital contacts in the years prior to and after the reception of any home care. Adjusted for comorbidities and sociodemographics, high numbers of GP consultations, and inpatient and outpatient hospital contacts for respiratory diagnoses were associated with a significantly higher likelihood of receiving home care the next year (hazard odds ratios > 1.3). Following the reception of home care, the type of home care service received (e.g. home nursing or short-term rehabilitation/treatment) was more important than outpatient services in predicting next-year nursing home admission or death. Conclusion: Including data on prior outpatient care when predicting future need for home care is beneficial. A high frequency (top 10%) of yearly GP, in- or outpatient hospital contacts can imply that the patient may be in need of home care in the near future.

• Amundsen, Olav; Moger, Tron Anders; Holte, Jon Helgheim; Haavaag, Silje Bjørnsen; Bragstad, Line Kildal & Hellesø, Ragnhild [Vis alle 8 forfattere av denne artikkelen] (2024). Patient characteristics and healthcare use for high-cost patients with musculoskeletal disorders in Norway: a cohort study. BMC Health Services Research. 24(1). doi: 10.1186/s12913-024-12051-3. Fulltekst i vitenarkiv Vis sammendrag

  Background: A high proportion of healthcare costs can be attributed to musculoskeletal disorders (MSDs). A small proportion of patients account for most of the costs, and there is increasing focus on addressing service overuse and high costs. We aimed to estimate healthcare use contributing to high costs over a five-year period at the individual level and to examine if healthcare use for high-cost patients is in accordance with guidelines and recommendations. These findings contribute to the understanding of healthcare use for high-cost patients and help in planning future MSD-care. Methods: This study combined Norwegian registries on healthcare use, diagnoses, demographic, and socioeconomic factors. Patients (≥ 18 years) were included by their first MSD-contact in 2013–2015. We analysed healthcare use during the subsequent five years. Descriptive statistics were used to compare high-cost (≥ 95th percentile) and non-high-cost patients. Total healthcare contacts and costs for high-cost patients were examined stratified by number of hospitalisations and surgical treatments. Healthcare use of General Practitioners (GPs), physiotherapy, chiropractor and Physical Medicine and Rehabilitation physicians prior to the first hospitalisation or surgical treatment for a non-traumatic MSD was registered. Results: High-cost patients were responsible for 61% of all costs. Ninety-four percent of their costs were related to hospital treatment. Ninety-nine percent of high-cost patients had at least one hospitalisation or surgical procedure. Out of the high-cost patients, 44% had one registered hospitalisation or surgical procedure, 52% had two to four and 4% had five or more. Approximately 30–50% of patients had seen any healthcare personnel delivering conservative treatment other than GPs the year prior to their first hospitalisation/surgical treatment for a non-traumatic MSD. Conclusion: Most healthcare costs were concentrated among a small proportion of patients. In contrast to guidelines and recommendations, less than half had been to a healthcare service focused on conservative management prior to their first hospitalisation or surgical treatment for a non-traumatic MSD. This could indicate that there is room for improvement in management of patients before hospitalisation and surgical treatment, and that ensuring sufficient capacity for conservative care and rehabilitation can be beneficial for reducing overall costs.

• Moger, Tron Anders; Holte, Jon Helgheim; Amundsen, Olav; Haavaag, Silje Bjørnsen; Edvardsen, Anne & Bragstad, Line Kildal [Vis alle 9 forfattere av denne artikkelen] (2024). Associations between outpatient care and later hospital admissions for patients with chronic obstructive pulmonary disease - a registry study from Norway. BMC Health Services Research. 24(1). doi: 10.1186/s12913-024-10975-4. Fulltekst i vitenarkiv Vis sammendrag

  Background Although chronic obstructive pulmonary disease (COPD) admissions put a substantial burden on hospitals, most of the patients’ contacts with health services are in outpatient care. Traditionally, outpatient care has been difficult to capture in population-based samples. In this study we describe outpatient service use in COPD patients and assess associations between outpatient care (contact frequency and specific factors) and next-year COPD hospital admissions or 90-day readmissions. Methods Patients over 40 years of age residing in Oslo or Trondheim at the time of contact in the period 2009–2018 were identified from the Norwegian Patient Registry (in- and outpatient hospital contacts, rehabilitation) and the KUHR registry (contacts with GPs, contract specialists and physiotherapists). These were linked to the Regular General Practitioner registry (characteristics of the GP practice), long-term care data (home and institutional care, need for assistance), socioeconomic and–demographic data from Statistics Norway and the Cause of Death registry. Negative binomial models were applied to study associations between combinations of outpatient care, specific care factors and next-year COPD hospital admissions and 90-day readmissions. The sample consisted of 24,074 individuals. Results A large variation in the frequency and combination of outpatient service use for respiratory diagnoses (GP, emergency room, physiotherapy, contract specialist and outpatient hospital contacts) was apparent. GP and outpatient hospital contact frequency were strongly associated to an increased number of next-year hospital admissions (1.2–3.2 times higher by increasing GP frequency when no outpatient hospital contacts, 2.4-5 times higher in combination with outpatient hospital contacts). Adjusted for healthcare use, comorbidities and sociodemographics, outpatient care factors associated with lower numbers of next-year hospitalisations were fees indicating interaction between providers (7% reduction), spirometry with GP or specialist (7%), continuity of care with GP (15%), and GP follow-up (8%) or rehabilitation (18%) within 30 days vs. later following any current year hospitalisations. For 90-day readmissions results were less evident, and most variables were non-significant. Conclusion As increased use of outpatient care was strongly associated with future hospitalisations, this further stresses the need for good communication between providers when coordinating care for COPD patients. The results indicated possible benefits of care continuity within and interaction between providers.

• Hagen, Terje P.; Tjerbo, Trond & Aarflot, Morten (2024). Pasienter nyinnlagt i sykehjem – alder, tilstand og funksjonsnivå. Michael. ISSN 1893-9651. 21(1), s. 23–38. doi: 10.5617/michael.10949. Fulltekst i vitenarkiv Vis sammendrag

  Sykehjemmene er en hjørnestein i kommunehelsetjenesten. De siste årene er antall sykehjemsplasser blitt redusert. Har det skjedd endringer i populasjonen av pasienter som er i langtidsopphold i sykehjemmene? Hensikten med denne artikkelen er å gi en nærmere beskrivelse av pasientpopulasjonen i kommunale helseinstitusjoner der sykehjemsplasser utgjør mer enn 95 % av plassene. Våre hovedfunn, basert på individdata fra Kommunalt pasient- og brukerregister fra perioden 2017–2021, er at det skjer en foryngelse av sykehjemsbeboerne, men at 70 % av dem fortsatt er 80 år eller eldre. I de eldre aldersgruppene som legges inn i langtidsopphold, finner vi overvekt av pasienter med hjerte- og karlidelser, nevrologiske lidelser og demens, mens psykiske og nevrologiske lidelser er de største sykdomsgruppene i de lavere aldersgruppene. Funksjonsevnen til eldre som er nyinnlagt, er noe redusert over tid. Det kan indikere at terskelen for å få langtidsplass er hevet for denne gruppen. Nyinnlagte pasienter i de lavere aldergruppene har imidlertid dårligere funksjonsevne enn de eldre. Våre resultater indikerer at inntakene til sykehjemmene reflekterer prioriteringskriteriene når vi betrakter landet samlet. Kommunenes utgifter til institusjonene ser ikke ut til å øke som følge av at andelen yngre pasienter som får langtidsplass, øker.

• Bikova, Mariya Stoyanova; Ambugo, Eliva Atieno; Tjerbo, Trond; Jalovcic, Djenana & Førland, Oddvar (2024). Does assistive technology contribute to safety among home-dwelling older adults? BMC Health Services Research. 24(1). doi: 10.1186/s12913-024-11185-8. Fulltekst i vitenarkiv Vis sammendrag

  Background Assistive technology carries the promise of alleviating public expenditure on long-term care, while at the same time enabling older adults to live more safely at home for as long as possible. Home-dwelling older people receiving reablement and dementia care at their homes are two important target groups for assistive technology. However, the need for help, the type of help and the progression of their needs differ. These two groups are seldom compared even though they are two large groups of service users in Norway and their care needs constitute considerable costs to Norwegian municipalities. The study explores how assistive technology impacts the feeling of safety among these two groups and their family caregivers. Methods Face-to-face, semi-structured interviews lasting between 17 and 61 min were conducted between November 2018 and August 2019 with home-dwelling older adults receiving reablement (N = 15) and dementia care (N = 10) and the family caregivers (N = 9) of these users in seven municipalities in Norway. All interviews were audio-recorded, fully transcribed, thematically coded and inductively analyzed following Clarke and Braun’s principles for thematic analysis. Results Service users in both groups felt safe when knowing how to use assistive technology. However, the knowledge of how to use assistive technology was not enough to create a feeling of safety. In fact, for some users, this knowledge was a source of anxiety or frustration, especially when the user had experienced the limitations of the technology. For the service users with dementia, assistive technology was experienced as disturbing when they were unable to understand how to handle it, but at the same time, it also enabled some of them to continue living at home. For reablement users, overreliance on technology could undermine the progress of their functional improvement and thus their independence. Conclusion For users in both service groups, assistive technology may promote a sense of safety but has also disadvantages. However, technology alone does not seem to create a sense of safety. Rather, it is the appropriate use of assistive technology within the context of interactions between service users, their family caregivers and the healthcare staff that contributes to the feeling of safety.

• Amundsen, Olav; Moger, Tron Anders; Holte, Jon Helgheim; Haavaag, Silje Bjørnsen; Bragstad, Line Kildal & Hellesø, Ragnhild [Vis alle 8 forfattere av denne artikkelen] (2023). Combination of health care service use and the relation to demographic and socioeconomic factors for patients with musculoskeletal disorders: a descriptive cohort study. BMC Health Services Research. 23(1). doi: 10.1186/s12913-023-09852-3. Fulltekst i vitenarkiv Vis sammendrag

  Background Patients with musculoskeletal disorders (MSDs) access health care in different ways. Despite the high prevalence and significant costs, we know little about the different ways patients use health care. We aim to fill this gap by identifying which combinations of health care services patients use for new MSDs, and its relation to clinical characteristics, demographic and socioeconomic factors, long-term use and costs, and discuss what the implications of this variation are. Methods The study combines Norwegian registers on health care use, diagnoses, comorbidities, demographic and socioeconomic factors. Patients (≥ 18 years) are included by their first health consultation for MSD in 2013–2015. Latent class analysis (LCA) with count data of first year consultations for General Practitioners (GPs), hospital consultants, physiotherapists and chiropractors are used to identify combinations of health care use. Long-term high-cost patients are defined as total cost year 1–5 above 95th percentile (≥ 3 744€). Results We identified seven latent classes: 1: GP, low use; 2: GP, high use; 3: GP and hospital; 4: GP and physiotherapy, low use; 5: GP, hospital and physiotherapy, high use; 6: Chiropractor, low use; 7: GP and chiropractor, high use. Median first year health care contacts varied between classes from 1–30 and costs from 20€-838€. Eighty-seven percent belonged to class 1, 4 or 6, characterised by few consultations and treatment in primary care. Classes with high first year use were characterised by higher age, lower education and more comorbidities and were overrepresented among the long-term high-cost users. Conclusion There was a large variation in first year health care service use, and we identified seven latent classes based on frequency of consultations. A small proportion of patients accounted for a high proportion of total resource use. This can indicate the potential for more efficient resource use. However, the effect of demographic and socioeconomic variables for determining combinations of service use can be interpreted as the health care system transforming unobserved patient needs into variations in use. These findings contribute to the understanding of clinical pathways and can help in the planning of future care, reduction in disparities and improvement in health outcomes for patients with MSDs.

• Moger, Tron Anders; Amundsen, Olav; Tjerbo, Trond; Hellesø, Ragnhild; Holte, Jon Helgheim & Vøllestad, Nina Køpke (2023). Innovations in use of registry data (INOREG) - Design of a registry-based study analyzing care pathways and outcomes for chronic patients. Nordic Journal of Health Economics. ISSN 1892-9729. 6(1), s. 129–146. doi: 10.5617/njhe.10097. Fulltekst i vitenarkiv Vis sammendrag

  In recent years there have been several political initiatives in Norway, requiring more research into how multimorbidity and health care pathways in the municipality affect outcomes such as work participation, hospital admissions, disability and quality of life for patients with chronic diseases. Most of the care is provided outside hospitals and has been difficult to capture in large, registry-based studies. Focusing on two important groups, patients with chronic obstructive pulmonary disease (COPD) and musculoskeletal disorders (MSD), the INOREG project aims to reduce these knowledge gaps. In the paper we present 1) the data that are used in the project, 2) the construction of samples, variables and possible methods for analysis and 3) an example on how the data and methods will be applied. The project database is constructed from a novel linkage of national health and welfare registries. The data cover social, primary and specialized care for all COPD and MSD patients in Norway, long-term care data from Oslo and Trondheim municipalities and functioning and quality of life for ca. 2,700 patients treated at physiotherapy clinics in the FYSIOPRIM project. This enables construction of care pathways and outcomes at the individual level from 2008 through 2019. The project will fill knowledge gaps regarding the patterns of care at different levels in the health care system, and the association to outcomes for chronic patient groups. If the project is successful, it will provide improved insight on how to further develop provision and coordination of services to the decision makers, and ideally reduce inequalities in health.

• Holte, Jon Helgheim; Hagen, Terje P. & Tjerbo, Trond (2023). Brukere med særlig høye kostnader i pleie- og omsorgstjenestene – hvem er de, og hva betyr de for kommunale utgifter? Magma forskning og viten. ISSN 1500-0788. 26(5), s. 93–102. doi: 10.23865/magma.v26.1423. Fulltekst i vitenarkiv Vis sammendrag

  Bakgrunn: Det er kjent fra internasjonal litteratur at en liten gruppe tjenestemottakere står for en stor andel av de totale kostnadene i helsetjenestene. Om det finnes en tilsvarende gruppe med høykostnadsbrukere innenfor pleie- og omsorgstjenestene, og hva som eventuelt kjennetegner disse brukerne, er ikke undersøkt i Norge eller andre vestlige land. Mål: Målet for studien er å etablere oversikt over høykostnadsbrukere innenfor de kommunale pleie- og omsorgstjenestene i Norge. Finnes det en liten gruppe av tjenestemottakere som står for en stor del av kostnadene i de kommunale pleie- og omsorgstjenestene? Hvilke grupper representerer de, og hva betyr de for kommunale utgifter? Metode: Analysen gjøres på individdata fra Kommunalt pasientregister (KPR) for 2019. Pasientene med 5 prosent høyest kostnader defineres som brukere med særlig høye kostnader – høykostnadsbrukere. Oddsen for å være i gruppen av høykostnadsbrukere estimeres deretter ved en flernivåanalyse. Resultater: Høykostnadsbrukerne står for 39 prosent av de samlede kostnadene for kommunale pleie- og omsorgstjenester. Gjennomsnittskostnaden for høykostnadsbrukerne er knapt 2,2 millioner kroner. For de øvrige brukerne er gjennom-snittskostnaden vel 186 000 kroner. Det er betydelige forskjeller mellom høykostnadsbrukerne og de øvrige brukerne særlig når det gjelder tjenestebruk, alder og diagnoser. For høykostnadsbrukerne genereres nesten 90 prosent av kostnadene gjennom bruk av hjemmetjenester. Den største kostnaden er forbundet med Praktisk bistand – opplæring (36,2 prosent). Høykostnadsbrukerne er i gjennomsnitt yngre enn de øvrige brukerne (46 år vs. 66 år) og har ofte funksjonshemminger. Konklusjon: En liten gruppe tjenestemottakere står for en stor andel av de samlede kostnadene for pleie- og omsorgstjenester i Norge. Disse brukerne er yngre, hjemmeboende og funksjonshemmede

• Hagen, Terje P. & Tjerbo, Trond (2023). The Causal Effect of Community Hospitals on General Hospital Admissions. Evaluation of a Natural Experiment Using Register Data. International Journal of Integrated Care (IJIC). 23(2). doi: 10.5334/ijic.6515. Fulltekst i vitenarkiv Vis sammendrag

  Background: To reduce overall healthcare costs, several countries have attempted to shift services from specialist to primary care. This was also the main strategy of the Coordination Reform introduced in Norway in 2012. An important part of the reform was the introduction of Municipal Acute Wards (MAWs), a type of community hospital aimed at reducing admissions to general hospitals. The main objective of this paper is to investigate whether the implementation of MAWs had a causal effect on hospital admissions. Methods: Monthly admission rates in total and by age groups for patients admitted with acute or elective conditions at internal medicine or surgical departments were analyzed using panel data regression techniques. We identified causal effects by exploiting the sequential roll out of the MAWs within fixed effect analyses. Our data covered all municipalities from start of 2010 until the end of 2017. Results: The sequential implementation of the MAWs started during the summer of 2012. By the beginning of 2016 close to all municipalities had an operative MAW. The introduction of MAWs significantly reduced acute hospital admissions. The effect was strongest for patients ≥80 years admitted acutely to internal medicine departments. The effects were even stronger if the MAW had a physician on site 24/7 or was located close to a local emergency center. Conclusion: Our findings suggest that this type of intermediate care unit is a viable option to alleviate the burden on hospitals by reducing acute secondary care admission volumes.

• Hagen, Terje P. & Tjerbo, Trond (2023). Vi forbereder oss på «eldrebølgen», men i kommunehelsetjenesten er det en «yngrebølge». Tidsskrift for omsorgsforskning. ISSN 2387-5976. 9(2), s. 92–104. doi: 10.18261/tfo.9.2.8. Fulltekst i vitenarkiv Vis sammendrag

  Bakgrunn: Det er ventet at økningen i andelen eldre vil skape utfordringer for omsorgstjenestene. Kommunalt pasient- og brukerregister (KPR) gir gode muligheter til å analysere bruk av omsorgstjenester og se på variasjoner etteralder. Så langt er denne muligheten ikke fullt utnyttet. I denne artikkelen gjennomfører vi en detaljert analyse av endringer i etterspørselen av kommunale pleie- og omsorgstjenester i perioden fra starten av 2017 til og med 2020 basert på data fra KPR. Metode: Vi benytter enkle beskrivende analyser. Hovedresultater: Nedgangen i pasienter på langtidsopphold i institusjoner har stoppet opp. I analyseperioden observerte vi et stabilt antall pasienter, om lag 33000 per uke. Andelen pasienter over 80 år utgjør om lag 75 prosent av totalen, men er svakt fallende over tid. Det er en økning i antall pasienter i alle aldersgrupper under 80 år. Antall pasienter som har vært i institusjoner på tidsbegrensede opphold og i avlastningsopphold, har økt. Veksten er sterkest i aldersgruppene under 80

• Ambugo, Eliva Atieno; Dar, Imran; Bikova, Mariya Stoyanova; Førland, Oddvar & Tjerbo, Trond (2022). A qualitative study on promoting reablement among older people living at home in Norway: opportunities and constraints. BMC Health Services Research. 22(1), s. 1–13. doi: 10.1186/s12913-022-07543-z. Fulltekst i vitenarkiv Vis sammendrag

  Background: Healthcare services that traditionally have been provided in long-term care institutions in Norway are increasingly being delivered at home to a growing population of older people with chronic conditions and functional limitations. Fostering reablement among older people is therefore important if they are to live safety at home for as long as possible. This study examines how healthcare professionals and managers (staff ) in Norwegian municipalities promote reablement among community-dwelling older people. Methods: Face-to-face, semi-structured interviews lasting between 21 and 89 min were conducted between November 2018 and March 2019 with healthcare managers (N = 8) and professionals (N = 8 focus groups with 2–5 participants) in six municipalities in Norway. All interviews were audio-recorded, transcribed, and thematically coded inductively and analyzed with the aid of NVivo 12 software. Results: Overall, healthcare staff in this study used several strategies to promote reablement, including: carrying out assessments to evaluate older people’s functional status and needs (including for safe home environments), and to identify older people’s wishes and priorities with regard to reablement training. Staff designed care plans informed by the needs assessments, and worked with older people on reablement training at a suitable pace. They promoted among older people and staff (within and across care-units) the principle of ‘showing/doing with’ versus ‘doing for’ the older person so as to not enable disablement. Additionally, they supported older people in the safe and responsible use of welfare technology and equipment. Even so, staff also reported constraints to their efforts to foster reable- ment, such as: heavy workload, high turnover, insufficient training in reablement care, and poor collaboration across care-units. Conclusion: Older people may be supported to live safely at home by meeting them as individuals with agency, identifying and tailoring services to their needs and wishes, and encouraging their functional abilities by ‘showing/ doing with’ versus ‘doing for them’ when possible. The healthcare professionals and managers in this study were posi- tive towards reablement care. However, meeting the resource demands of reablement care is a key challenge.

• Fosse, Rina Moe; Ambugo, Eliva Atieno; Moger, Tron Anders; Hagen, Terje P. & Tjerbo, Trond (2021). Does rehabilitation setting influence risk of institutionalization? A register-based study of hip fracture patients in Oslo, Norway. BMC Health Services Research. 21(1), s. 1–14. doi: 10.1186/s12913-021-06703-x. Fulltekst i vitenarkiv Vis sammendrag

  Background: Reducing the economic impact of hip fractures (HF) is a global issue. Some efforts aimed at curtailing costs associated with HF include rehabilitating patients within primary care. Little, however, is known about how different rehabilitation settings within primary care influence patients’ subsequent risk of institutionalization for long-term care (LTC). This study examines the association between rehabilitation setting (outside an institution versus short-term rehabilitation stay in an institution, both during 30 days post-discharge for HF) and risk of institutionalization in a nursing home (at 6–12 months from the index admission). Methods: Data were for 612 HF incidents across 611 patients aged 50 years and older, who were hospitalized between 2008 and 2013 in Oslo, Norway, and who lived at home prior to the incidence. We used logistic regression to examine the effect of rehabilitation setting on risk of institutionalization, and adjusted for patients’ age, gender, health characteristics, functional level, use of healthcare services, and socioeconomic characteristics. The models also included fixed-effects for Oslo’s boroughs to control for supply-side and unobserved effects. Results: The sample of HF patients had a mean age of 82.4 years, and 78.9 % were women. Within 30 days after hospital discharge, 49.0 % of patients received rehabilitation outside an institution, while the remaining 51.0 % received a short-term rehabilitation stay in an institution. Receiving rehabilitation outside an institution was associated with a 58 % lower odds (OR = 0.42, 95 % CI = 0.23–0.76) of living in a nursing home at 6–12 months after the index admission. The patients who were admitted to a nursing home for LTC were older, more dependent on help with their memory, and had a substantially greater increase in the use of municipal healthcare services after the HF. Conclusions: The setting in which HF patients receive rehabilitation is associated with their likelihood of institutionalization. In the current study, patients who received rehabilitation outside of an institution were less likely to be admitted to a nursing home for LTC, compared to those who received a short-term rehabilitation stay in an institution. These results suggest that providing rehabilitation at home may be favorable in terms of reducing risk of institutionalization for HF patients.

• Indset, Marthe; Tjerbo, Trond & Hansen, Tore (2021). The Role of the Norwegian County Governor: Agent with a Wide Scope or Servant of the State Authorities? I Tanguy, Gildas & Eymeri-Douzans, Jean-Michel (Red.), Prefects, Governors and Commissioners. Territorial representatives of the State in Europe. Palgrave Macmillan. ISSN 9783030593957. s. 275–302. doi: 10.1007/978-3-030-59396-4. Fulltekst i vitenarkiv Vis sammendrag

  This chapter explores the role of the Norwegian County Governor in light of the current political and administrative context. In Norway, the state-municipality relationship is of a rather integrated character. In this relationship, the County Governor is located as a node between the local and central levels of government, advising municipalities in their implementation of national policies and conducts legal supervision of the same tasks. Applying principal-agent conceptualization, in which the County Governor is the agent operating on behalf of its principal, the state, we depart from the observation that the County Governor increasingly has to relate to multiple principals. The chapter argues that increased fragmentation at the central level has put the role of the County Governor under pressure, making it appear more of a servant of competing state objectives and to a lesser extent as a coordinator of the state’s policies at the local level.

• Grønstad, Anniken; Kjekshus, Lars Erik; Tjerbo, Trond & Bernstrøm, Vilde Hoff (2020). Work-related moderators of the relationship between organizational change and sickness absence: a longitudinal multilevel study. BMC Public Health. 20:1218, s. 1–14. doi: 10.1186/s12889-020-09325-w. Fulltekst i vitenarkiv Vis sammendrag

  A sizeable body of research has demonstrated a relationship between organizational change and increased sickness absence. However, fewer studies have investigated what factors might mitigate this relationship. The aim of this study was to examine if and how the relationship between unit-level downsizing and sickness absence is moderated by three salient work factors: temporary contracts at the individual-level, and control and organizational commitment at the work-unit level. We investigated the association between unit-level downsizing, each moderator and both short- and long-term sickness absence in a large Norwegian hospital (n = 21,085) from 2011 to 2016. Data pertaining to unit-level downsizing and employee sickness absence were retrieved from objective hospital registers, and moderator variables were drawn from hospital registers (temporary contracts) and the annual work environment survey (control and organizational commitment). We conducted a longitudinal multilevel random effects regression analysis to estimate the odds of entering short- (< = 8 days) and long-term (> = 9 days) sickness absence for each individual employee. The results showed a decreased risk of short-term sickness absence in the quarter before and an increased risk of short-term sickness absence in the quarter after unit-level downsizing. Temporary contracts and organizational commitment significantly moderated the relationship between unit-level downsizing in the next quarter and short-term sickness absence, demonstrating a steeper decline in short-term sickness absence for employees on temporary contracts and employees in high-commitment units. Additionally, control and organizational commitment moderated the relationship between unit-level downsizing and long-term sickness absence. Whereas employees in high-control work-units had a greater increase in long-term sickness absence in the change quarter, employees in low-commitment work-units had a higher risk of long-term sickness absence in the quarter after unit-level downsizing. The results from this study suggest that the relationship between unit-level downsizing and sickness absence varies according to the stage of change, and that work-related factors moderate this relationship, albeit in different directions. The identification of specific work-factors that moderate the adverse effects of change represents a hands-on foundation for managers and policy-makers to pursue healthy organizational change.

• Buttigeg, Sandra; Tomaselli, Gianpaolo; Byers, Vivienne; Cassar, Maria; Tjerbo, Trond & Rosano, Aldo (2019). Corporate social responsibility and person-centered care: a scoping review. Journal of Global Responsibility. ISSN 2041-2568. 10(4), s. 289–306. doi: 10.1108/JGR-01-2019-0006. Fulltekst i vitenarkiv
• Grønstad, Anniken; Kjekshus, Lars Erik; Tjerbo, Trond & Bernstrøm, Vilde Hoff (2019). Organizational change and the risk of sickness absence: a longitudinal multilevel analysis of organizational unit-level change in hospitals. BMC Health Services Research. 19(895). doi: 10.1186/s12913-019-4745-2. Fulltekst i vitenarkiv Vis sammendrag

  Background: Organizational change is often associated with reduced employee health and increased sickness absence. However, most studies in the field accentuate major organizational change and often do not distinguish between and compare types of change. The aim of this study was to examine the different relationships between six unit-level changes (upsizing, downsizing, merger, spin-off, outsourcing and insourcing) and sickness absence among hospital employees. Methods: The study population included employees working in a large Norwegian hospital (n=26,252). Data on unit-level changes and employee sickness absence were retrieved from objective hospital registers for the period January 2011 to December 2016. The odds of entering short- (<=8days) and long-term (>=9days) sickness absence for each individual employee were estimated in a longitudinal multilevel random effects logistic regression model. Results: Unit-level organizational change was associated with both increasing and decreasing odds of short-term sickness absence compared to stability, but the direction depended on the type and stages of change. The odds of long-term sickness absence significantly decreased in relation to unit-level upsizing and unit-level outsourcing. Conclusions: The results from this study suggested that certain types of change, such as unit-level downsizing, may produce greater strain and concerns among employees, possibly contributing to an increased risk of sickness absence at certain stages of the change. By contrast, changes such as unit-level insourcing and unit-level upsizing were related to decreased odds of sickness absence, possibly due to positive change characteristics.

• Vassbotn, Ane Drougge; Sjøvik, Hege; Tjerbo, Trond; Frich, Jan C & Spehar, Ivan (2018). General practitioners' perspectives on care coordination in primary health care: A qualitative study. International Journal of Care Coordination. ISSN 2053-4345. 21(4), s. 153–159. doi: 10.1177/2053434518816792. Fulltekst i vitenarkiv Vis sammendrag

  Introduction To explore Norwegian general practitioners’ experiences with care coordination in primary health care. Methods Qualitative study using data from five focus groups with 32 general practitioners in Norway. We analysed the data using systematic text condensation, a descriptive and explorative method for thematic cross-case analysis of qualitative data. Results The general practitioners had different notions of care pathways. They expressed a wish and an obligation to be involved in planning and coordination of primary health-care services, but they experienced organisational and financial barriers that limited their involvement and contribution. General practitioners reported lack of information about and few opportunities for involvement in formal coordination initiatives, and they missed informal arenas for dialogue with other primary health-care professionals. They argued that the general practitioner’s role as coordinator should be recognised by other parties and that they needed financial compensation for contributions and attendance in meetings with the municipality. Discussion General practitioners need informal arenas for dialogue with other primary health-care professionals and access to relevant information to promote coordinated care. There might be an untapped potential for improving patient care involving general practitioners more in planning and coordinating services at the system level. Financial compensation of general practitioners contribution may promote increased involvement by general practitioners.

• Tjerbo, Trond & Hagen, Terje P. (2018). The health policy pendulum: Cost control vs activity growth. International Journal of Health Planning and Management. ISSN 0749-6753. 33(1), s. e67–e75. doi: 10.1002/hpm.2407. Fulltekst i vitenarkiv Vis sammendrag

  Background: Cost containment is a major policy challenge and one of the key drivers of health care reform. In this article, we focus on the role cost control has played as a reform driver in the Norwegian hospital sector between 1980 and 2014. Methods: We use data on aggregate expenditure as well as on activity changes from year to year. We also use qualitative data for illustrative purposes. Results: We identify 4 phases in the period 1980 to 2014: two where activity increases have dominated the agenda and 2 where cost control has been emphasized. The desire to either increase activity or improve cost control has been important reform drivers. Conclusion: Cost control has been a major reform motivator in the period, and some of the policies aimed towards achieving cost control have been successful. But as cost control is achieved, waiting lists and popular dissatisfaction increase and new policies are implemented to increase activity. The final version of this research has been published in International Journal of Health Planning and Management. © 2017 Wiley

• Monkerud, Lars Chr. & Tjerbo, Trond (2017). Budsjettprosesser og budsjettdisiplin - en studie av norske kommuner i perioden 2002-2007. Michael. ISSN 1893-9651. 14, s. 29–42. Fulltekst i vitenarkiv Vis sammendrag

  I denne artikkelen tar vi utgangspunkt i en artikkel publisert av Terje Hagen og Signy Vabo i 2005, hvor de analyserte effekten av bestemte politiske og administrative trekk ved den enkelte kommune og den samme kommunens fiskale prestasjon. En av variablene de benyttet seg av var organiseringen av den kommunale budsjettprosessen. Siden Hagen og Vabo publiserte sin artikkel har andelen kommuner som har valgt en administrativ sentralisering av budsjettprosessen – det vil si en modell der administrasjonssjefen spiller en mer sentral rolle enn hva hun/han gjør i en politisk sentralisert eller fragmentert modell- økt betydelig. Vi spør om den den modellen en kommune har valgt for organiseringen av budsjettprosessen påvirker budsjettdisiplinen.

• Tjerbo, Trond & Skinner, Marianne Sundlisæter (2016). Interkommunalt samarbeid om døgnåpne kommunale akuttenheter og legevakt: Tar helsekommunen form? Tidsskrift for omsorgsforskning. ISSN 2387-5976. 2(2), s. 117–124. doi: 10.18261/issn.2387-5984-2016-02-06. Fulltekst i vitenarkiv Vis sammendrag

  Fra og med 2016 skal alle norske kommuner ha opprettet kommunale akutte døgnenheter (KAD). I denne artikkelen ser vi på omfanget av samarbeid om KAD og legevakt, samt grad av overlapping innen disse samarbeidene. Studien er basert på et datasett som dekker alle landets 428 kommuner. Analysene viser at interkommunalt samarbeid er utbredt, og at overlapping er vanlig. Vi finner at nærhet til sykehus er forbundet både med interkommunalt samarbeid og hvorvidt en kommune er en del av overlappende samarbeid. Avslutningsvis diskuterer vi mulige implikasjoner av våre funn for spørsmål knyttet til kommunestruktur og lokal styring.

• Monkerud, Lars Chr. & Tjerbo, Trond (2016). The effects of the Norwegian Coordination reform on the use of rehabilitation services: panel data analyses of service use, 2010 to 2013. BMC Health Services Research. 16(353). doi: 10.1186/s12913-016-1564-6. Fulltekst i vitenarkiv Vis sammendrag

  Background In 2012 the Norwegian Coordination Reform was implemented. The main motivation was to encourage municipalities to expand local, primary health care services. From 2012 to 2014, under the Municipal Co-Financing regime, municipalities were obliged to cover 20 % of the costs of health services provided at the specialist (hospital) level. Importantly, use of rehabilitation services in private institutions was not part of the cost-sharing mechanism of Municipal Co-Financing. Rehabilitation services may be seen as quite similar in nature whether they be provided by municipalities, hospitals or private institutions. Thus, with rehabilitation patients readily “transferrable” between levels, the question is whether the reform brought with it a sought after shift towards more municipal rehabilitation and less specialist rehabilitation. Methods Data from the Norwegian Patient Register and from Statistics Norway/KOSTRA were utilized to gauge annual expenditures and inputs in specialist, municipal and private institution rehabilitation services respectively. Fixed effects and first difference regression analyses for the period 2010–2013 were carried out to account for certain time-invariant traits of municipalities and/or hospital regions, and results were adjusted for contemporaneous trends in local needs. Results Expenditures in specialist rehabilitation services declined sharply (typically by 8–10 %) from 2011 (pre-reform) to 2012 (post-reform), while expenditures in private rehabilitation services rose markedly in the same period (typically by 42–44 %). The results do not suggest any general expansion of municipal rehabilitation services. Conclusions The results of the analyses suggest that municipalities shift away from the use of specialist rehabilitation services and towards the use of rehabilitation services in private institutions since the latter becomes relatively cheaper (free-of charge) than both municipal and specialist services in post-reform periods (as specialist services come at a cost to municipalities post-reform). While the main goal of the reform has not materialized the results nevertheless suggest that incentives (of cost-shifting) do play a significant role in rehabilitation service use.

• Hagen, Terje P. & Tjerbo, Trond (2014). Helsetjenesteaksjonen av 2013: Hva er alternativene og hva blir effekten av forslagene? I Botten, Grete Synøve; Frich, Jan C; Hagen, Terje P.; Iversen, Tor & Nordby, Halvor (Red.), Helsetjenestens nye logikk. Akademika forlag. ISSN 9788232103485. s. 107–116. Fulltekst i vitenarkiv
• 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. Fulltekst i vitenarkiv
• Tjerbo, Trond & Hagen, Terje P. (2013). Historien om da Kostnadskontroll spiste New Public Management til middag. I Veggeland, Noralv (red.) (Red.), Reformer i norsk helsevesen : veier videre. Akademika forlag. ISSN 9788232102914. s. 65–77. Fulltekst i vitenarkiv
• Tjerbo, Trond (2012). Strukturendringer i sykehussektoren - nåværende og fremtidige dilemmaer, konflikter og politikk, Det regionale Norge 1950 til 2050. Abstrakt forlag. ISSN 9788279353294. s. 237–255. Fulltekst i vitenarkiv
• Tjerbo, Trond; Indset, Marthe & Hansen, Tore (2011). Fylkesmannens rolle i det norske styringssystemet. Nordisk Administrativt Tidsskrift. ISSN 0029-1285. 88(2), s. 93–109. Fulltekst i vitenarkiv
• Tjerbo, Trond (2010). Does competition among general practitioners increase or decrease the consumption of specialist health care? Health Economics, Policy and Law. ISSN 1744-1331. 5(1), s. 53–70. doi: 10.1017/S1744133109990156. Fulltekst i vitenarkiv
• Tjerbo, Trond (2009). The politics of local hospital reform: a case study of hospital reorganization following the 2002 Norwegian hospital reform. BMC Health Services Research. 9. doi: 10.1186/1472-6963-9-212. Fulltekst i vitenarkiv
• Tjerbo, Trond & Hagen, Terje P. (2009). Deficits, soft budget constraints and bailouts: Budgeting after the Norwegian hospital reform. Scandinavian Political Studies. ISSN 0080-6757. 32(3), s. 337–358. doi: 10.1111/j.1467-9477.2008.00230.x. Fulltekst i vitenarkiv Vis sammendrag

  In the 1990s, the Norwegian hospital sector was characterized by soft budgetary constraints and increasing budget deficits. This was one of the main antecedents of the 2002 hospital reform, where the central state took over ownership of the hospitals from the counties. Arguably, the centralization of ownership, financing and production would harden the budget constraints and increase the budgetary discipline. This analysis shows that this has not been accomplished. Instead, the production has been far above what was planned, and the deficits higher than ever. Two stages of the post-reform budget processes are analyzed: first, the stage where the central state set the budgets and sends signals of budgetary rules (whether the state sends signals of soft or hard budget constraints), and second, how the central state handled deficits in the hospital sector as they emerged (whether the hospitals was bailed out or not). The conclusion is that the central state neither set a hard budget constraint nor managed to stay firm as deficits turned up. It is argued that three mechanisms explain the prevailing problems of managing the hospital sector: uncertainty of the hospitals’ financial situation during the transition phase; minority governments; and specific features related to the organization of the budgetary process in parliament.

• Hagen, Terje P. & Tjerbo, Trond (2008). La reforma del sector hospitalario y los elusivos compromisos de disciplina presupuestaria. Panorama Social. ISSN 1699-6852. 7(1), s. 21–35. Fulltekst i vitenarkiv
• Tjerbo, Trond & Hagen, Terje P. (2005). Harde og Myke budsjettskranker og de regionale helseforetakenes aktivitets - og effektivitetsutvikling. I Opedal, Ståle & Stigen, Inger Marie (Red.), Helse-Norge i støpeskjeen. Søkelys på sykehusreformen. Fagbokforlaget. ISSN 9788245002553. Fulltekst i vitenarkiv
• Tjerbo, Trond & Hansen, Tore (2005). Individualisme, sosial kapital og politisk deltakelse. Norsk statsvitenskapelig tidsskrift. ISSN 0801-1745. s. 29–51. Fulltekst i vitenarkiv
• Kværner, Kari Jorunn; Tjerbo, Trond; Botten, Grete Synøve & Aasland, Olaf Gjerløw (2005). Epikrisen som samhandlingsverktøy. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. Fulltekst i vitenarkiv
• Tjerbo, Trond & Kjekshus, Lars Erik (2005). Coordinating health care: Lessons from Norway. International Journal of Integrated Care (IJIC). 5. Fulltekst i vitenarkiv
• Tjerbo, Trond; Botten, Grete Synøve; Aasland, Olaf Gjerløw & Kværner, Kari Jorunn (2005). Bruk av incentiver for å øke svarandelen i spørreskjemaundersøkelser. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. Fulltekst i vitenarkiv

Se alle arbeider i NVA

• Berg, Ole Trond; Hagen, Terje P.; Gjefsen, Hege Marie; Godager, Geir; Hart, Rannveig Kaldager & Kinge, Jonas Minet [Vis alle 13 forfattere av denne artikkelen] (2026). Organisering og finansering av helsetjenester. Fagbokforlaget. ISBN 9788245061505. 414 s. doi: 10.55669/oa1809. Fulltekst i vitenarkiv Vis sammendrag

  Boken gir en bred innføring i organisering og finansiering av helsetjenester, med vekt på norske forhold. Den innledende bolken omfatter kapitler om helsetjenestesystemer og forsikringsordninger, betalingssystemer og demografiske endringer. I de følgende bolkene brukes de grunnleggende begrepene til å beskrive og analysere kommunehelsetjenesten og spesialisthelsetjenesten, samt samhandlingen mellom de to nivåene. Enkelte policy-orienterte temaer, som effektivitet og likhet i tilbudet, analyseres i egne kapitler. Den avsluttende bolken er viet komparativ helsepolitikk, med beskrivelser av land med sosialforsikringsordninger og private helseforsikringer. Utviklingen av EUs helsepolitikk beskrives i et eget kapittel. Bokens underliggende perspektiv er at organisering og finansiering er virkemidler i offentlig helsepolitikk. Dette er instrumenter som kan brukes til å redusere ulikhet i tjenestetilbudet, øke effektiviteten og heve kvaliteten. Boken inneholder oppdatert kunnskap om reformer og piloter fra de siste tiårene, også reformer i andre land som har relevans for norske forhold.

• Frich, Jan C; Iversen, Tor & Tjerbo, Trond (2017). Helsepolitikkens faglige premisser. Det norske medicinske Selskab. ISBN 9788292871874. 243 s. Fulltekst i vitenarkiv

Se alle arbeider i NVA

• Moger, Tron Anders; Vøllestad, Nina Køpke; Tjerbo, Trond; Amundsen, Olav; Holte, Jon Helgheim & Haavaag, Silje Bjørnsen [Vis alle 8 forfattere av denne artikkelen] (2025). Bruk av registerdata i analyse av tjenesteforløp for muskelskjelett- og KOLS-pasienter – et sammendrag av INOREG prosjektet. Fulltekst i vitenarkiv Vis sammendrag

  Bakgrunn: Muskel-/skjelettlidelser (MSK) og kronisk obstruktiv lungesykdom (KOLS) representerer to betydelige typer av kroniske sykdommer. I et tverrfaglig forskningsprosjekt ved Institutt for Helse og Samfunn, UiO, som ble introdusert på Helsetjenestekonferansen 2022, har vi analysert tjenesteforløpene for disse pasientgruppene ved hjelp av koblede registerdata. Formål: Beskrive pasientforløpene for de to pasientgruppene, finne faktorer i forløpene assosiert med utfall som sykehusinnleggelser, hjemmetjenester, høy fremtidig tjenestebruk og uførhet. Metode: Kvantitative og kvalitative analyser av pasientforløp. Kvantitative analyser baseres på data fra nasjonale registre, fra registre i pleie- og omsorgstjenestene i Oslo og Trondheim, samt internt fysioterapiregister. Resultater: Flere viktige avvik fra anbefalt oppfølging for pasientgruppene ble oppdaget i analysene. Noen eksempler er at mer enn 50 % av MSK-pasienter fikk kirurgi, uten å ha forsøkt konservativ behandling først, og at mer enn 10 % av KOLS-pasienter ikke mottar oppfølging for luftveisdiagnoser i året før en sykehusinnleggelse med KOLS. Samtidig hadde mange av pasientene med gjentatte KOLS-innleggelser begrenset oppfølging i primærhelsetjenesten i årene etter indeksinnleggelsen. For KOLS-pasienter observerer man videre en sterk økning i fastlegekontakter i året før man mottar hjemmetjenester, som har betydning for å predikere fremtidig tjenestebruk. På den positive siden fant vi at MSK-pasienter med dårlig prognose hadde fire ganger høyere sjanse for å rapportere et godt klinisk utfall dersom de hadde høy bruk av fysioterapi, som videre var assosiert med lavere sjanse for fremtidig uførhet. For pasienter med god/middels prognose var det ingen sammenheng mellom klinisk utfall og høy frekvens av fysioterapi. For KOLS-pasienter fant vi at bruk av samhandlingstakster, kontinuitet i fastlegeoppfølging, og psykososial støtte for særlig sårbare grupper var assosiert med lavere sannsynlighet for fremtidige akutte sykehusinnleggelser for KOLS. Konklusjon: Prosjektet illustrerer mulighetene ved bruk av administrative helseregisterdata. Samtidig finnes det flere begrensninger dersom man ikke har data på tvers av tjenestene, mer detaljerte kliniske data, samt pasientrapporterte utfallsmål

• Moger, Tron Anders; Hellesø, Ragnhild; Tjerbo, Trond; Holte, Jon Helgheim; Haavaag, Silje Bjørnsen & Bragstad, Line Kildal [Vis alle 8 forfattere av denne artikkelen] (2025). INOREG workshop, perspective paper. Fulltekst i vitenarkiv
• Moger, Tron Anders; Haavaag, Silje Bjørnsen; Vøllestad, Nina Køpke; Tjerbo, Trond; Holte, Jon Helgheim & Hellesø, Ragnhild [Vis alle 8 forfattere av denne artikkelen] (2025). INOREG workshop 2025. Fulltekst i vitenarkiv
• Moger, Tron Anders; Vøllestad, Nina Køpke; Tjerbo, Trond; Hellesø, Ragnhild; Bragstad, Line Kildal & Holte, Jon Helgheim [Vis alle 8 forfattere av denne artikkelen] (2024). INOREG workshop 2024. Fulltekst i vitenarkiv
• Hagen, Terje P.; Aarflot, Morten & Tjerbo, Trond (2024). Analyzing the Impact of Reduced Hospital Stays on Mortality in Primary Care Settings with Variation in Nursing Home Capacity: An Observational Study of Hip Fracture Patients from 2010-2019. Fulltekst i vitenarkiv
• Amundsen, Olav; Moger, Tron Anders; Vøllestad, Nina Køpke; Tjerbo, Trond; Hellesø, Ragnhild & Bragstad, Line Kildal [Vis alle 8 forfattere av denne artikkelen] (2023). INOREG workshop 2023. Fulltekst i vitenarkiv
• Amundsen, Olav; Vøllestad, Nina Køpke; Moger, Tron Anders; Tjerbo, Trond & Holte, Jon Helgheim (2022). Is future disability benefit associated with specific combinations of health care use for musculoskeletal disorders? Fulltekst i vitenarkiv Vis sammendrag

  Background Musculoskeletal disorders (MSD) are one of the highest contributors to disability benefit in Norway and other OECD-countries. This is an increasing problem in most OECD countries and is a major challenge for welfare states. To be able to prevent people from falling out of the work force it is important to identify combinations of care associated with poorer outcomes and increased risk of future disability pension. Objective Examine how combinations of health care use relate to future disability benefit, controlling for demographic, socioeconomic and clinical factors. Methods The study combines Norwegian data registers with information on health care use, diagnosis, comorbidities, demographic, education, socioeconomic factors and disability benefits. Patients are included at the time of their first health care visit for MSD in 2013-2015 and are followed until end of 2020. Patients between 18-62 years and registered in the work force at index are included. The outcome is being registered with disability benefit minimum 12 months after index. Multivariable regression analysis is used with combinations of health care use for the first 12 months as the main explanatory variables. Combinations of health care use are identified by variables for having used GP, physiotherapy and specialist health care for MSD and creating combinations of these dichotomous variables. Other variables were included as covariates. Results/conclusion Using specialist health care for MSD in combination with GP (OR 1.91, 95%CI 1.36-2.68) or in combination with both GP and physiotherapy services (OR 2.38, 95%CI 1.53-3.71) was associated with increased risk of future disability pension compared to seeing GP alone. Seeing physiotherapist only or in combination with GP was not associated with increased risk of future disability pension. Reasons for these associations remain to be explored.

• Moger, Tron Anders; Vøllestad, Nina Køpke; Hellesø, Ragnhild; Tjerbo, Trond; Holte, Jon Helgheim & Amundsen, Olav (2022). INOREG workshop 2022. Fulltekst i vitenarkiv
• Moger, Tron Anders; Tjerbo, Trond; Hellesø, Ragnhild & Vøllestad, Nina Køpke (2021). INOREG opening seminar. Fulltekst i vitenarkiv
• 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. Fulltekst i vitenarkiv
• Frich, Jan C; Iversen, Tor & Tjerbo, Trond (2017). Helsepolitikkens faglige premisser. Michael. ISSN 1893-9651. 14, s. 9–16. Fulltekst i vitenarkiv
• Vassbotn, Ane Drougge; Sivertsen, Christina; Sjøvik, Hege; Frich, Jan C & Tjerbo, Trond (2016). Care pathways across the primary care and hospital interface in Norway: a qualitative study. Fulltekst i vitenarkiv
• Hovik, Sissel & Tjerbo, Trond (2011). Organizing local service delivery - a question of ideology or instrumentsl considerations? Fulltekst i vitenarkiv
• Kjekshus, Lars Erik & Tjerbo, Trond (2011). Interaction between General Practitioners and Hospitals: The Effect of Cooperation Initiatives on GPs Satisfaction. Fulltekst i vitenarkiv
• Tjerbo, Trond & Hagen, Terje P. (2005). Deficits, Soft Budget Constraints and Bailuts: Budgeting after the Norwegian Hospital Reform. Fulltekst i vitenarkiv
• Tjerbo, Trond (2005). Coordinating health care: lessons from Norway. Fulltekst i vitenarkiv
• Tjerbo, Trond (2004). Politics after the Norwegian Hospital Reform. The case of "Sykehuset Innlandet". Fulltekst i vitenarkiv
• Hagen, Terje P.; Tjerbo, Trond & Aarflot, Morten (2024). Brukerne blir yngre, psykiske lidelser øker: Dypdykk i pleie- og omsorgstjenestene 2017-2021. Helseøkonomisk forskningsprogram ved Universitetet i Oslo. Fulltekst i vitenarkiv Vis sammendrag

  Det var en kraftig vekst i utgiftene i kommunenes pleie- og omsorgstjenester i perioden 2015-2020. Veksten flatet ut i 2020, men har i årene 2021 og 2022 igjen vært kraftig – nesten 9 prosent per år. Det er spesielt i tjenester til hjemmeboende veksten har vært sterk. I tillegg har veksten vært sterk i aldersgruppene under 80 år.Hovedmålsettingene med denne rapporten har vært å gå dypere i tre temaer: - Langtidsopphold i institusjoner: I en tidligere analyse (Andrews et al., 2021; Hagen & Tjerbo, 2023) fant vi at veksten i langtidsoppholdene kom i aldersgruppene under 80 år. Her stiller vi spørsmål om årsakene til denne endringen. Har de ‘yngre’ brukergruppene større behov enn de eldre? - Høykostnadsbrukere: I de tidligere analysene fant vi også indikasjoner på at en del yngre hjemmeboende brukere var kostnadskrevende. Her definerer vi høykostnadsbrukerne som de mottakere av pleie- og omsorgstjenester som har de 5% høyeste kostnadene og stiller følgende spørsmål: Hvor stor andel av de samlede pleie- og omsorgstjenestene kan knyttes til de 5 prosentene med høyest kostnader? Hva kjennetegner brukergruppen med høyest kostnader? - Samhandling mellom sykehus og kommuner: Hoftebruddspasientene er en særlig sårbar gruppe. Pasientene er gamle, skrøpelige og har mange tilleggssykdommer (komorbiditeter). Dødeligheten i gruppen er høy. Spørsmålene vi stiller er hvilke effekter reduksjon i sykehusenes liggetider, hardere konkurranse om sykehjemsplassene og bedre helse blant de eldre, til sammen har for pasientenes overlevelse. Klarer kommunene å kompensere for den reduserte liggetiden i sykehus?

• Tjerbo, Trond; Førland, Oddvar; Sørvoll, Jardar; Hagen, Terje P.; Fosse, Rina Moe & Ambugo, Eliva Atieno [Vis alle 8 forfattere av denne artikkelen] (2022). Resultatevaluering av Omsorg 2020 – regjeringens plan for omsorgsfeltet 2015–2020. Universitetet i Oslo. ISSN 9788277562735. Fulltekst i vitenarkiv
• Andrews, Therese Marie; Tjerbo, Trond; Ambugo, Eliva Atieno; Bliksvær, Trond; Fabritius, Merete Kvamme & Aguinaldo, Sean Jayven [Vis alle 7 forfattere av denne artikkelen] (2021). Årsaker til kostnadsvekst i kommunale pleie- og omsorgstjenester. Nordlandsforskning. ISSN 9788273217615. Fulltekst i vitenarkiv Vis sammendrag

  Studien som ligger til grunn for rapporten, belyser årsaker til kostnadsvekst i kommunale pleie- og omsorgstjenester basert på data fra KOSTRA (2015- 2019), Kommunalt pasientregister (2017-2020), og intervjuer med ledere i 15 kommuner. Rapporten viser hvilke tjenesteområder som har hatt størst vekst, og til hvilke typer brukere og hvilke aldersgrupper som veksten i tjenester har vært størst. Kvalitative data utdyper og nyanserer resultater fra det statistiske datamaterialet. I rapporten diskuteres også noen bakenforliggende forhold som har bidratt til å forklare veksten i utgifter til denne sektoren.

• Zeiner, Hilde Hatleskog & Tjerbo, Trond (2015). Helsekommunen? Interkommunalt samarbeid og samhandlingsreformen. Norsk institutt for by- og regionforskning. ISSN 9788283090604. Fulltekst i vitenarkiv
• Hagen, Terje P.; McArthur, David & Tjerbo, Trond (2015). Resultatevaluering av Omsorgsplan 2015: Kommunenes drifts- og investeringsbeslutninger. Institutt for helse og samfunn, Universitetet i Oslo. ISSN 9788277562483. Fulltekst i vitenarkiv
• Tjerbo, Trond & Zeiner, Hilde Hatleskog (2014). Interkommunale samarbeid på helseområdet. OsloMet - storbyuniversitetet. ISSN 9788283090420. Fulltekst i vitenarkiv Vis sammendrag

  Last ned gratis I dette notatet ser vi nærmere på interkommunale samarbeid innenfor helseområdet. Spørsmålene som stilles er: Hvor omfattende er det interkommunale samarbeidet, og hvordan begrunner kommunene slikt samarbeid? Vi finner at interkommunalt samarbeid innenfor helse er utbredt, men det er klare regionale variasjoner. En gjennomgang av et utvalg prosjektrapporter viser at det særlig er økonomiske og faglige hensyn som blir vektlagt av kommunene forut for etableringen av interkommunale samarbeid. Tilknyttet prosjekt Prosessevaluering av samhandlingsreformen: Statlige virkemidler, kommunale innovasjoner

• Hagen, Terje P.; McArthur, David Philip & Tjerbo, Trond (2013). Midtveisevaluering av Omsorgsplan 2015: Effekter for pleieårsverk og plasser i boliger og institusjoner. Universitetet i Oslo, Helseøkonomisk forskningsprogram (HERO). ISSN 9788277562377. Fulltekst i vitenarkiv
• Tjerbo, Trond; Aamodt, Per Olaf; Stigen, Inger Marie; Helgesen, Marit Kristine; Næss, Terje & Arnesen, Clara Åse [Vis alle 8 forfattere av denne artikkelen] (2012). Bemanning av pleie- og omsorgssektoren: handlingsplan og iverksetting. OsloMet - storbyuniversitetet. ISSN 9788270719150. Fulltekst i vitenarkiv Vis sammendrag

  I 2007 fikk NIBR og NIFU i oppdrag å evaluere Kompetanseløftet 2015. I denne rapporten sees det nærmere på hvordan Kompetanseløftet er blitt iverksatt, og da særlig i kommunene. I tillegg innholder rapporten oppdaterte data fra NIFUs tidligere underveisrapporter om oppnåelse av måltallene. Forskergruppen har også utarbeidet en kortere rapport der erfaringene fra evalueringen er oppsummert. Tilknyttet prosjekt Kompetanseløftet 2015

• Tjerbo, Trond; Zeiner, Hilde Hatleskog & Helgesen, Marit (2012). Kommunalt psykisk helsearbeid 2012. OsloMet - storbyuniversitetet. ISSN 9788270719204. Fulltekst i vitenarkiv Vis sammendrag

  Rapporten tar for seg utviklingen i kommunenes organisering av psykisk helsearbeid. Hovedinntrykket er at kommunenes arbeid ikke har endret seg vesentlig siden Opptrappingsplanen for psykisk helse ble avsluttet i 2008. Rapporten ser på organiseringen av det psykiske helsearbeidet blant voksne og blant barn/unge.

• Aamodt, Per Olaf & Tjerbo, Trond (2012). Får vi nok personell til omsorgstjenestene? Sammendrag av Evalueringen av Kompetanseløftet 2015. NIFU Nordisk institutt for studier av innovasjon, forskning og utdanning. ISSN 9788272188428. Fulltekst i vitenarkiv Vis sammendrag

  I 2007 lyste Helsedirektoratet ut et oppdrag med å evaluere iverksettingen av Kompetanseløftet 2015 i den første delen av planens virkningstid fram til 2010. Oppdraget gikk til NIFU og NIBR i fellesskap. Underveis i prosjektet er det publisert en rekke delrapporter. Denne siste rapporten fra prosjektet tar sikte på å gi et kortfattet sammendrag og en samlet analyse av de viktigste resultatene fra evalueringen.

• Helgesen, Marit; Stigen, Inger Marie & Tjerbo, Trond (2011). Fylkesmennenes og kommunenes arbeid med Kompetanseløftet 2015. Om muligheter og begrensninger i et flernivåsystem. Norsk institutt for by- og regionforskning. ISSN 9788270718849. Fulltekst i vitenarkiv Vis sammendrag

  Våre respondenter i fylkesmannsembetene var i 2009 gjennomgående godt fornøyd med den løpende kontakten med kontaktpersonene i Helsedirektoratet. Det ser altså ut til at styringen og samordningen fungerer godt på dette nivået.Samarbeidet mellom fylkesmannsembetene og kommunene ser også ut til å fungere godt. Det største problemet til kommunene er av økonomisk art. Tilskuddenes beskjedne størrelse og problemer med å få dekket vikarutgifter fremstår som Kompetanseløftets akkileshæl.

• Helgesen, Marit; Stigen, Inger Marie & Tjerbo, Trond (2009). Kompetanseløftet 2015 - kommunenes deltakelse –Erfaringer høsten 2008. Norsk institutt for by- og regionforskning. ISSN 9788270717781. Fulltekst i vitenarkiv Vis sammendrag

  Basert på resultatene fra surveyen til kommunene er kommunene svært positive til Kompetanseløftet 2015.Formålet med satsingen synes å være godt tilpasset behovet ute i kommunene og kommunene oppgir jevnt over å ha gode erfaringer med prosessen rundt iverksettingen av Kompetanseløftet. De er også gjennomgående porsitive til kontakten med Fylkesmennene, og mener også at ansvarsforholdene i planene er klare og enkle å forstå.

• Hansen, Tore; Indset, Marthe; Sletnes, Ingun & Tjerbo, Trond (2009). Fylkesmannen mellom lokalt folkestyre og statlig styring. OsloMet - storbyuniversitetet. ISSN 9788270717965. Fulltekst i vitenarkiv Vis sammendrag

  Rapporten foretar en analyse av fylkesmannsrollen i det norske styringssystem. Analysen omfatter både en historisk redegjørelse for fylkesmannsrollen, en juridisk vurdering av fylkesmannens oppgaver og en empirisk kartlegging av fylkesmennenes egen rolleforståelse

• Knudtzon, Lillin Cathrine & Tjerbo, Trond (2009). De unge stemmene. Innflytelsesorgan for barn og unge i kommuner og fylker. Norsk institutt for by- og regionforskning. ISSN 9788270718269. Fulltekst i vitenarkiv
• Tjerbo, Trond (2007). Målkonflikter og styringsdilemmaer : Utviklingen i Sykehuset Innlandet etter etableringen. Universitetet i Oslo. Fulltekst i vitenarkiv Vis sammendrag

  Høsten 2003 inngikk Sykehuset Innlandet en avtale med Institutt for helseledelse og helseøkonomi om delvis finansiering av et doktorgradsprosjekt. Dette doktorgradsprosjektet er nå i ferd med å bli ferdigstilt, og har ledet til flere publikasjoner. Denne rapporten viser hvordan Sykehuset Innlandet plasserer seg i forhold til øvrige sykehus i landet på en rekke forskjellige kriterier. Rapporten er ikke en evaluering av Sykehuset Innlandet og det arbeidet ledelsen ved sykehuset har lagt ned. I rapporten vises utviklingen i Innlandet på flere viktige variabler, men det er viktig å understreke at det har gått altfor kort tid til at det er mulig å si hva som ligger bak tallene. Det er derfor ikke forsvarlig å benytte resultatene som presenteres her som en indikator på hvorvidt den nye organisasjonen har oppnådd sine mål eller ikke. De vil imidlertid kunne utgjøre et utgangspunkt for en diskusjon om disse forholdene.

• Hansen, Tore & Tjerbo, Trond (2003). Politisk engasjement, borgerroller og sosial kapital. Unipub forlag. Fulltekst i vitenarkiv Vis sammendrag

  Rapportens hovedproblemstilling er hvordan befolkningens politiske engasjement betinges av deres borgerforståelse og tilgang til sosial kapital. Analysene er basert på Makt- og demokratiutredningens medborgerundersøkelse. Analysene avdekker en stor bredde i befolkningens politiske engasjement, og der direkte deltakelsesformer inntar en stadig mer sentral plass. Analysene indikerer en økt individualistisk orientering i folks politiske engasjement, noe som antas primært å henge sammen med den rettighetsorienteringen som utviklingen av de offentlige velferdsoppaver innebærer. Bildet av hvilken borgerforståelse folk legger til grunn er imidlertid blandet; man er både individualist og kollektivist - og slutter opp om både en liberal og en kommunitgær borgerrolle.

• Tjerbo, Trond (2003). Et demokrati i krise? : en studie av den politiske deltakelsens vilkår, omfang og karakter. Universitetet i Oslo. Fulltekst i vitenarkiv Vis sammendrag

  Sammendrag Funnene i denne oppgaven kan kort oppsummeres i følgende punkter: 1. Både det politiske og det sosiale deltakelsesnivået i Norge er høyt sammenlignet med andre land det er naturlig å sammenligne seg med. De analysene som er foretatt her gir heller ikke grunn til å konkludere med at deltakelsen er av en kumulativ karakter. Det ser snarere ut til å være slik at den politiske deltakelsen er forholdsvis bredt fordelt. Andelen som er tilfredse med demokratiets virkemåte er imidlertid på et historisk lavt nivå. Det viser seg likevel at de som er mindre tilfredse er mer tilbøyelige til å delta, men ikke ved å stemme. 2. Sammenhengen mellom sosial kapital ( operasjonalisert som medlemskap og deltakelse i frivillge organisasjoner samt sosial tillit)og politisk deltakelse er ikke så sterk som forventet. I tillegg viser det seg at disse variablene i noen tilfeller har effekter med motsatt fortegn. Medlemskap i frivillige organisasjoner ser ut til å ha gjennomgående positive effekter på flere former for politisk deltakelse, men noen tilsvarende effekt av sosial tillit er ikke til stede. 3. Befolkningens oppfatninger om borgerrollen lar seg gruppere langs to dimensjoner, som i denne oppgaven har blitt karakterisert som en kommunitær og en liberal borgeroppfatning. Det viser seg også at konsekvensen av disse for den politiske deltakelsen er klare og sterke. Mens oppslutning om det kommunitære borgeridealet har positive effekter på samtlige av de aktivitetsformene som er inkludert her, har det liberale idealet kun en positiv effekt på stemmegivning. 4. Andelen som er identifiserer seg med et bestemt politisk parti er fortsatt synkende, hvilket er en tendens vi deler med de fleste andre vestlige demokratier. Jeg argumenterer for at de politiske konsekvensene av sosial kapital ikke lever opp til de forventningene som kan stilles mot det, eksempelvis med utgangspunkt i Robert D Putnams Making Democracy Work (1992). Det er først og fremst medlemskap og deltakelse som er av betydning for den faktiske deltakelsen. Dette sammen med det faktum at korrelasjonen mellom sosial tillit og medlemskap samt deltakelse er beskjeden, bidrar også til å så tvil om det er slik at disse fenomenene er spesielt sterkt knyttet sammen.

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