Hostname: page-component-8448b6f56d-cfpbc Total loading time: 0 Render date: 2024-04-18T03:57:15.363Z Has data issue: false hasContentIssue false
  • English
  • Français

Patient choice and access to primary physician services in Norway

Published online by Cambridge University Press:  22 December 2008

JOSTEIN GRYTTEN  and
RUNE J. SØRENSEN
JOSTEIN GRYTTEN*
Affiliation:
Institute of Community Dentistry, University of Oslo, Norway
RUNE J. SØRENSEN
Affiliation:
Norwegian School of Management (BI), Oslo,Norway
*
*Correspondence to: Professor Jostein Grytten, Institute of Community Dentistry, Box 1052, Blindern, University of Oslo, 0316 Oslo, Norway. Email: josteing@odont.uio.no
Get access Rights & Permissions [Opens in a new window]

Abstract

Quasi-markets have become fashionable within health care. This is also the case in Norway where primary physician services are organized as a quasi-market. Physicians compete for patients, and patients can choose another physician if they are not satisfied with the physician they have. This is meant to provide incentives for physicians to provide services that are both efficient and of high quality. One condition that is necessary in order for such a market to function is that there is excess supply to ensure that patients have a real opportunity for choice. In this study we investigated the influence of excess supply on patient access and the mobility of patients between primary physicians in Norway. The analyses were performed on data from two comprehensive national surveys. Access to physicians is better for physicians who have spare capacity than for physicians who have a lack of capacity. Patients take advantage of their possibilities for choice. They move from physicians who have too little capacity to physicians who have spare capacity. Patient choice means that patients are not ‘stuck’ with physicians who have too little capacity to provide adequate services for their patients. The results show that quasi-markets can ensure good access to primary physician services, but this presupposes that there is enough spare capacity to provide patients with a real choice of physician.

Type
Articles
Information
Health Economics, Policy and Law , Volume 4 , Issue 1 , January 2009 , pp. 11 - 27
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Allison, P.D. (1999), Logistic regression using SAS: Theory and Application, Cary, NC: SAS Institute Inc.Google Scholar
Bakke, H.K. (2003), ‘Fastlegeordningen to år etter’, Tidsskrift for Den norske lægeforening, 123: 1745.Google Scholar
Besley, T. and Ghatak, M. (2003), Incentives, Choice and Accountability in the Provision of Public Services, WP03/08, London: The Institute for Fiscal Studies.Google Scholar
Carlsen, B. (2003), ‘Fastlegenes erfaringer med fastlegeordningen’, Tidsskrift for Den norske lægeforening, 123: 1322–1324.Google Scholar
Chalkley, M. and Malcomson, J.M. (1998), ‘Contracting for health services with unmonitored quality’, The Economic Journal, 108: 1093–1110.Google Scholar
Culyer, A.J., Maynard, A.K., and Posnett, J.W. (1990), Competition in Health Care: Reforming the NHS, London: Macmillan Press.Google Scholar
Enthoven, A.C. (1999), In Pursuit of an Improving National Health Service, London: The Nuffield Trust.Google Scholar
Fenn, P., Rickman, N., and McGuire, A. (1994), ‘Contracts and supply assurance in the UK health market’, Journal of Health Economics, 13: 124–144.Google Scholar
Finnvold, J.E., Svalund, J., and Paulsen, B. (2005), Etter innføring av fastlegeordningen – brukervurdering av allmennlegetjenesten, Rapport 2005/1, Oslo: Statistics Norway.Google Scholar
Goddard, M. and Mannion, R. (1998), ‘From competition to co-operation: new economic relationships in the National Health Service’, Health Economics, 7: 105–119.Google Scholar
Grytten, J. and Sørensen, R. (2007), ‘Primary physician services – list size and primary physicians’ service production’, Journal of Health Economics, 26: 721–741.Google Scholar
Grytten, J. and Sørensen, R. (2008), ‘Busy physicians’, Journal of Health Economics, 27: 510–518.Google Scholar
Grytten, J., Skau, I., Sørensen, R., and Aasland, O.G. (2004a), ‘Legenes arbeidssituasjon etter ett år med fastlegeordningen’, Tidsskrift for Den norske lægeforening, 124: 358–361.Google Scholar
Grytten, J., Skau, I., Sørensen, R., and Aasland, O.G. (2004b), ‘Endringer i tjenesteproduksjon og tilgjengelighet under fastlegeordningen’, Tidsskrift for Den norske lægeforening, 124: 362–364.Google Scholar
Hetlevik, Ø. and Hunskår, S.(2004), ‘Listelengde, arbeidstid, ventetid og jobbtilfredshet blant fastleger i Bergen’, Tidsskrift for Den norske lægeforening, 124: 813–815.Google Scholar
Hougen, H.C. and Gløboden, M.A. (2004), Samordnet levekårsundersøkelse 2002 – tverrsnittsundersøkelsen: Dokumentasjonsrapport, Notat 2004/22, Oslo: Statistics Norway.Google Scholar
Jones, P.R. and Cullis, J.G. (1996), ‘Decision making in quasi-markets: a pedagogic analysis’, Journal of Health Economics, 15: 187–208.CrossRefGoogle ScholarPubMed
LeGrand, J. (2007), The Other Invisible Hand, Princeton, NJ and Oxford: Princeton University Press.Google Scholar
LeGrand, J., Mays, N., and Mulligan, J.-A. (2001), Learning from the NHS Internal Market, London: Kings Fund.Google Scholar
Macinko, J., Starfield, B., and Shi, L. (2003), ‘The contribution of primary care systems to health outcomes within Organization for Economic Cooperation and Development (OECD) countries, 1970–1998’, Health Services Research, 38: 831–865.CrossRefGoogle ScholarPubMed
Macinko, J., Starfield, B., and Shi, L. (2007), ‘Quantifying the health benefits of primary care physician supply in the United States’, International Journal of Health Services, 37: 111–126.Google Scholar
Milne, R.G. and Torsney, B. (2003), ‘Financial incentives, competition and a two tier service: lessons from the UK National Health Service internal market’, Health Policy, 64: 1–12.Google Scholar
Ministry of Health (2001), Ot prp nr 66 (2000–2001), Om lov om helseforetak m.m (helseforetaksloven), Oslo: Statens forvaltningstjeneste.Google Scholar
Ministry of Health and Social Affairs (1998), Ot prp nr 10 (1998–1999): Om lov om spesialisthelsetjenesten m.m., Oslo: Statens forvaltningstjeneste.Google Scholar
Ministry of Health and Social Affairs (1999), Ot prp nr 99 (1998–1999): Om lov om endringer i lov 19. november 1982 nr 66 om helsetjenesten i kommunene og visse andre lover (fastlegeordningen), Oslo: Statens forvaltningstjeneste.Google Scholar
Normann, T.M. (2004), Samordnet levekårsundersøkelse 2002 – Panelundersøkelsen: Dokumentasjonsrapport, Notat 2004/55, Oslo: Statistics Norway.Google Scholar
Norwegian Association of Local and Regional Authorities (1999), ‘Allmennlegetjenesten i kommunen – trygghet og ansvar – høringsnotat om fastlegeordningen’, Høringsnotat om fastlegeordningen, 1 February1999.Google Scholar
OECD (1995), Internal Markets in the Making: Health systems in Canada, Iceland and the United Kingdom, Health Policy Studies No. 6, Paris: OECD.Google Scholar
Propper, C., Burgess, S., and Green, K. (2004), ‘Does competition between hospitals improve the quality of care? Hospital death rates and the NHS internal market’, Journal of Public Economics, 88: 1247–1272.Google Scholar
Propper, C., Burgess, S., and Gossage, D. (2008), ‘Competition and quality: Evidence from the NHS internal market 1991–9’, The Economic Journal, 118: 138–170.Google Scholar
Skau, I. (1998), Folketrygdens refusjoner til allmennlegehjelp: En beskrivelse av kontaktmønster, takstbruk og trygderefusjoner, Report 1/1998, Sandvika: Norwegian School of Management.Google Scholar
Starfield, B. and Shi, L. (2002), ‘Policy relevant determinants of health: an international perspective’, Health Policy, 60: 201–218.Google Scholar
Statistics Norway (2007), ‘Årsverk av legar med ulike avtaleformer i kommunehelsetenesta. Sentralitet. 1994–2006’,www.ssb.no/emner/03/02/helsetjko/tab-2007-06-19-03.html (24 October 2007).Google Scholar