Ageing, mortality and health care expenditures. The case of Norwegian hospitals and ambulances

In order to predict future health care expenditures and to understand the current financial situation, key variables that drive the expenditures have to be estimated. The aim of this thesis is to identify and estimate the impact of variables driving the health care expenditures within secondary care—in particular, the impact of age and mortality. Both the hospital expenditures and the emergency services are examined. In order to quantify the impact of mortality and age on the expenditures, data covering all inpatient hospital admissions in Norway from 1998 to 2010 and all ambulance transports for the South-Eastern Regional Health Authority (Helse Sør-Øst) for 2009 and 2010 were applied. For hospitals, both age and mortality are suggested to drive current hospital expenditures. For ambulances, distance to hospitals and age are central in explaining the variation in costs. For hospitals and ambulances, health care expenditures are found to be higher for newborns and the elderly as compared to the rest of the population. We estimate that approximately 10% of total hospital expenditures are allocated to decedents within a calendar year. With data from 2010, the share is estimated to be 10.6% (for inpatient and outpatient care), while with data from 1998–2009, the estimated share is 9.0% (for inpatient care). Furthermore, our analysis suggests that mortality-related hospital expenditures are a decreasing function of age. The connection between the concepts of steepening and the red herring hypothesis are also discussed. The red herring hypothesis states that it is time to death and not age per se that drives health care expenditures, while steepening states that health care expenditures grow faster for the elderly population than the rest of the population over time. The two concepts are found to be independent. The empirical analyses also suggest that steepening is present for the Norwegian hospital sector for the time period 1998–2009 if newborns are excluded. Furthermore, I put forth the hypothesis that steepening will be present for countries with high per capita health care expenditures in periods of increased per capita expenditures

The association between age and mortality related hospital expenditures: Evidence from a complete national registry

The aim of this paper is to contribute to the debate on population aging and growth in health expenditures, by providing precise estimates on how mortality related expenditures are influenced by age. Using a complete register of inpatient hospital admissions to create gender-cohort specific panels for each of the 430 Norwegian municipalities, we are able to identify mortality related hospital expenditures by separating the impact of mortality on current hospital expenditures from the impact of patients’ age and gender. We apply model estimates to quantify the mortality-related hospital expenditures for twenty age groups. The results suggest that mortality-related hospital expenditures are a decreasing function of age. Furthermore, the results clearly suggest that, both age and mortalities should be included when predicting future health care expenditures. The estimation results suggest that 9.2 % of all hospital expenditures is associated with treating individuals in their last year of life. Our results also suggest that the reduction in mortality rates in the period from 1998 to 2009 have, cet. par. contributed to an estimated reduction in total hospital expenditures of 0.6 billion NOK, a difference corresponding to 2 % of the expenditures in 2009. (The appendix can be found under "Supplementary Files" in the menu to the right

Experiences with capacity reductions on urban main roads – rethinking allocation of urban road capacity?

This paper presents results from a study concerning effects and consequences of a temporary (one year) capacity reduction on an urban main road tunnel in Oslo, Norway. The main findings are that reduction of the road capacity from in total four to two lanes in the Smestad tunnel, carrying about 50 000 vehicles per workday, caused few or no effects or consequences. Three months after the capacity reduction was implemented, traffic volumes were about the same as before, there are only small increases in delays, and the road users (commuters and freight traffic) have not made significant adaptions.publishedVersio

Experiences with capacity reductions on urban main roads – rethinking allocation of urban road capacity?

This paper presents results from a study concerning effects and consequences of a temporary (one year) capacity reduction on an urban main road tunnel in Oslo, Norway. The main findings are that reduction of the road capacity from in total four to two lanes in the Smestad tunnel, carrying about 50 000 vehicles per workday, caused few or no effects or consequences. Three months after the capacity reduction was implemented, traffic volumes were about the same as before, there are only small increases in delays, and the road users (commuters and freight traffic) have not made significant adaptions

20 years of competitive tendering in the Norwegian bus industry – An analysis of bidders and winning bids

Our paper investigates the developments in the Norwegian bus industry following the ramp-up of competitive tendering since the early 2000s. We analyse a complete dataset of all 232 local bus contracts awarded through competitive tendering in Norway since 1995. We also utilize the Central Register of Establishments and Enterprises (CRE) for structural developments in the bus industry. We first present some overall tendencies, including developments in number of bids per tender, contract size and cost developments. We use the cost implied by the winning bid as our cost indicator. The average cost per kilometre in the winning bid has increased substantially more than the general rate of inflation. At the same time, the average number of bidders per contract has fallen. Second, we build regression models to identify key drivers of cost developments in the bids. Contract sizes, in terms of vehicle-kilometres are found on average to be on the low side and an increase would reduce unit prices. We find as expected a significant effect of the number of bidders on unit prices. This leads us to a further investigation of factors explaining the number of bids per tender. We find that larger contracts tend to attract more bids, as do repeated tenders in the same area

Food Scares: Reflections and Reactions

The aim of this study is to investigate consumers’ reflections and reactions to a food scare news story. Previous studies indicate that risk communication not always is able to influence people’s behavior and that pre-existing attitudes may influence people’s reactions and reflections. In this study, we investigate how consumers critically reflect and emotionally react to a food scare, here defined as risk communication that spirals public anxiety over food safety incidents, and leads to an unwanted escalation in media attention. Fall 2014, a researcher from the Norwegian Institute of Public Health said in a newspaper interview that she never touched chicken with her bare hands. This interview was the beginning of a media storm, which resulted in a dramatic drop in sales of chicken. In this study, we explore a small group of consumers’ reflections and reactions to this news article. Data from five focus group interviews with Norwegian consumers of chicken were transcribed, content analyzed, and coded, before we conducted a multiple correspondence analysis and a hierarchical cluster analysis in JMP Pro 12. The findings indicate that consumers do reflect when confronted with a food scare story. Some question the research behind the news, others compare the food scare’s danger to other risks. Even though consumers do reflect around the facts in the food scare article, their emotions seem to affect their behavior more systematic than their reflections.Food Scares: Reflections and ReactionspublishedVersio

Development of an algorithm to predict serum vitamin D levels using a simple questionnaire based on sunlight exposure

Sun exposure is the main determinant of vitamin D production. The aim of this study was to develop an algorithm to assess individual vitamin D status, independently of serum 25(OHD) measurement, using a simple questionnaire, mostly relying upon sunlight exposure, which might help select subjects requiring serum 25(OHD) measurement. Six hundred and twenty adult subjects living in a mountain village in Southern Italy, located at 954 m above the sea level and at a latitude of 40°50′11″76N, were asked to fill the questionnaire in two different periods of the year: August 2010 and March 2011. Seven predictors were considered: month of investigation, age, sex, BMI, average daily sunlight exposure, beach holidays in the past 12 months, and frequency of going outdoors. The statistical model assumes four classes of serum 25(OHD) concentrations: ≤10, 10–19.9, 20–29.9, and ≥30 ng/ml. The algorithm was developed using a two-step procedure. In Step 1, the linear regression equation was defined in 385 randomly selected subjects. In Step 2, the predictive ability of the regression model was tested in the remaining 235 subjects. Seasonality, daily sunlight exposure and beach holidays in the past 12 months accounted for 27.9, 13.5, and 6.4 % of the explained variance in predicting vitamin D status, respectively. The algorithm performed extremely well: 212 of 235 (90.2 %) subjects were assigned to the correct vitamin D status. In conclusion, our pilot study demonstrates that an algorithm to estimate the vitamin D status can be developed using a simple questionnaire based on sunlight exposure

Longitudinal minimal residual disease assessment in multiple myeloma patients in complete remission – results from the NMSG flow-MRD substudy within the EMN02/HO95 MM trial

Background Multiple myeloma remains an incurable disease with multiple relapses due to residual myeloma cells in the bone marrow of patients after therapy. Presence of small number of cancer cells in the body after cancer treatment, called minimal residual disease, has been shown to be prognostic for progression-free and overall survival. However, for multiple myeloma, it is unclear whether patients attaining minimal residual disease negativity may be candidates for treatment discontinuation. We investigated, if longitudinal flow cytometry-based monitoring of minimal residual disease (flow-MRD) may predict disease progression earlier and with higher sensitivity compared to biochemical assessments. Methods Patients from the Nordic countries with newly diagnosed multiple myeloma enrolled in the European-Myeloma-Network-02/Hovon-95 (EMN02/HO95) trial and undergoing bone marrow aspiration confirmation of complete response, were eligible for this Nordic Myeloma Study Group (NMSG) substudy. Longitdudinal flow-MRD assessment of bone marrow samples was performed to identify and enumerate residual malignant plasma cells until observed clinical progression. Results Minimal residual disease dynamics were compared to biochemically assessed changes in serum free light chain and M-component. Among 20 patients, reaching complete response or stringent complete response during the observation period, and with ≥3 sequential flow-MRD assessments analysed over time, increasing levels of minimal residual disease in the bone marrow were observed in six cases, preceding biochemically assessed disease and clinical progression by 5.5 months and 12.6 months (mean values), respectively. Mean malignant plasma cells doubling time for the six patients was 1.8 months (95% CI, 1.4–2.3 months). Minimal malignant plasma cells detection limit was 4 × 10–5. Conclusions Flow-MRD is a sensitive method for longitudinal monitoring of minimal residual disease dynamics in multiple myeloma patients in complete response. Increasing minimal residual disease levels precedes biochemically assessed changes and is an early indicator of subsequent clinical progression. Trial registration NCT0120876