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The purpose of this study was to investigate whether increased uptake of private health insurance (PHI) in a traditionally NHS type system is likely to affect support for the public healthcare system. Using the Norwegian healthcare system as our case, and building on a survey among 7500 citizens, with 2688 respondents, we employed multivariate analysis to uncover whether the preferences for public health services are associated with having PHI, controlling for key predictors such as socio-economic background, self-rated health and perceived health service quality, as well as age and gender. The basis for our analysis was the following two propositions related to the role of public healthcare, which the respondents were asked to score on a 5-point Likert scale (1 = "totally disagree", 5 = "totally agree"): 1) "the responsibility of providing health services should mainly be public", and 2) "the activity of private commercial actors should be limited". The regression analyses showed that the willingness to increase the role of commercial private actors is positively associated with having a PHI. However, we found no relationship between holding a PHI and support for public provision of health services when other factors were controlled for.

Research on chronic obstructive pulmonary disease (COPD) that includes geographic information is important in order to improve care and appropriate allocation of resources to patients suffering from COPD. The purpose of this study is to investigate the geography of COPD and factors associated with the spatial patterns of COPD prevalence. Particular emphasis is put on the role of the local socioeconomic environment. Utilising information from the Norwegian Prescription Database on all lung medication prescribed in 2009 we identified 62,882 persons with COPD in the Norwegian population. Patterns of spatial clustering in the prevalence of COPD are clearly evident, even when age and gender are controlled for. Gender and age are strongly related to COPD risk. Socio-economic characteristics of the community such as education and unemployment are also significantly correlated with COPD risk. People living in rural parts of the country are generally associated with less risk than people in urban settings, and in particular people living in communities with high levels of farm and fisheries employment.

Objectives: Prescribed medication consumption for chronic, non-malignant pain may not be beneficial. This study investigated how self-reported treatment outcomes among individuals in a musculoskeletal pain rehabilitation program are related to the prevalence and trends in the dispensing of prescribed medications.Methods: Patients with musculoskeletal pain were recruited as they began a rehabilitation program. Each participant completed a self-administrated questionnaire on pain, health status and socioeconomic factors in the beginning and at the end of the rehabilitation period. Each individual’s baseline data from the rehabilitation sample was linked to the national Norwegian Prescription Database [2004–2010]. Dispensing prescribed medications in the groups of centrally acting analgesics [opioids], anxiolytics and hypnotics were studied.Results: A total of 1562 individuals participated, and there was no loss to follow-up. Controlled medications [Schedule 2] were prescribed in 36.4% [n = 569] of t...

Aims: It has been shown that referral letters from GPs often are of poor quality, but research in this field is scarce, and few efforts have been made to investigate the factors that may help explain the variation in referral quality. Methods: Combining a survey among 1298 Norwegian hospital physicians (response rate: 52%) with information on the hospitals and the communities they are serving, this study investigates how they view the general quality of patient referrals received from GPs, and the extent to which insufficient information in referrals and inappropriate referrals is considered a problem for cooperation with GPs. Results: Only 15.6% of the hospital physicians perceived the quality of the referrals to be “usually good”, and both lack of information in referrals and inappropriate referrals are seen as important barriers to cooperation with GPs. Of the individual factors, former GP practice is associated with a positive view on referral quality, while regular meetings between hospital physicians and GPs seem to reduce the problems of inappropriate and incomplete referrals. Furthermore, both average number of patients on GPs’ lists and lack of free capacity in nursing and care institutions in the hospital catchment area was found to be negatively associated with perceived referral quality. Conclusions: There is a need to increase the knowledge on how contextual, institutional and professional factors affect coordination of care. The main contribution of this study lies in the attempt to address the macro and micro barriers of obtaining good referral care.

The way in which hospital physicians and general practitioners (GPs) interact has important implications for any health care system, particularly in systems relying on gatekeeping through the GPs for moderating access to hospital and specialist services. Several individual, organisational and contextual factors may serve as potential barriers or facilitators of the interaction between specialists and GPs. Using a survey among 1229 Norwegian hospital physicians the paper tests the role of physician and community factors for hospital physicians’ satisfaction with their interaction with GPs, while also controlling for relevant hospital characteristics. The results indicate that the hospital physicians are only moderately satisfied with their interaction with GPs, and that there is certainly room for improvement. The multivariate analysis shows that the more satisfied the GPs are with their interaction with the hospital, the more satisfied are also the hospital physicians with their corresponding interaction with the GPs. Furthermore, a high GP coverage in the municipalities in the hospital catchment area is associated with a higher satisfaction among the hospital physicians. The results also suggest that meeting GPs face-to-face in meetings is associated with a more positive evaluation of the interaction with GPs.

A striking common characteristic in many Western countries at the turn of the millennium is the debate on the role of private actors in public health care systems. Following the long line of Norwegian political scientists paying attention to attitudes towards privatization, this article uses data from 2005 on medical specialists to investigate their preferences for private welfare services, and to uncover the relative role of political ideology and self-interest in affecting their attitudes. So far, few attempts have been made to test in depth the impact of ideology and self-interest as alternative explanations of the attitudes of a professional group toward a policy issue that is important to its interests. The analysis documents the fact that both public and private specialists display scepticism towards leaving welfare services in the hands of private actors. The empirical model for the multivariate analysis builds on the large body of literature on political attitudes, and incorporates variables that are derived from economic and psychological theories in order to test the impact of ideology and subjective self-interest (emphasis on high salary for job satisfaction) and objective self-interest (private economy). In addition, the model also controls for a vector of individual characteristics and professional background. For the group of full-time public specialists, both subjective and objective self-interest, together with ideology, turns out to be the major determinants of view on private welfare services. The attitudes of the private specialists are, on the other hand, not at all affected by self-interest – only by ideology.

Norwegian local government has traditionally been strongly rooted in the consensus ideal. When the new Local Government Act of 1992 allowed the municipalities to introduce parliamentary models and abolished the statutory requirement of qualified majority decisions in the councils, this therefore implied a significant change in the local government ideal. Even though the municipalities have been reluctant to formally adopt a parliamentary model, this paper argues that in practice a majority system is replacing the traditional consensual model, with functional roles for a governing majority and an opposition. The empirical analysis employs data on local politicians from 1994 and 1998 to test the proposition that representatives of the governing parties exert more influence on local policies than members of the opposition. Two different indicators of political influence are used: (1) the councillors' budgetary influence measured as the distance between the councillors' ideal point and the actual decision out...

Day surgery has gained increasing significance in Norwegian health care during the 1990s, and now constitutes more than 50% of all elective surgery. Although the underlying general assumption is that this mode of delivering surgery will increase the efficiency of hospitals, most former studies have focused only on the cost-efficiency for specific types of surgical operations. The present study therefore uses data from Norwegian hospitals to test whether the proposition that day surgery spells efficiency also holds true at the hospital level. Hospital efficiency is measured as the technical efficiency of hospitals. This indicator captures how efficient hospitals are in utilising their total resources, and builds on a variety of hospital inputs (inpatient care, outpatient care) and hospital outputs (physician full-time equivalents (FTEs), other labour equivalents, medical expenses). Our empirical analysis is based on a simple decision model where the hospitals maximise utility functions of income, patients and effort under the constraint of the budget and various structural characteristics. The empirical model thus controls for several other important determinants of efficiency, such as hospital budget, the outpatient revenue share, irregularly long length of stay, hospital type and the share of emergency admissions. After accounting for these variables, our results document significant effects of day surgery on technical efficiency. The results furthermore show that the positive effect of day surgery is contingent upon hospital budget, as hospitals with large budgets experience stronger efficiency effects of day surgery.