Evaluering av utprøving av digital hjemmeoppfølging: Delrapport II

Med støtte fra Helsedirektoratet prøver seks lokale prosjekter i kommunal regi ut digital hjemmeoppfølging av personer med kronisk sykdom. Utprøvingen gjennomføres i perioden 2018-2021 som en del av Nasjonalt velferdsteknologiprogram. Formålet med utprøvingen er å få tilstrekkelig kunnskap om digital hjemmeoppfølging til å gi nasjonale anbefalinger om implementering av tiltaket. Utprøvingen evalueres av forskere fra Universitetet i Oslo, Oslo Economics og Nasjonal senter for distriksmedisin. I denne delrapporten beskriver vi erfaringer med og effekter av digital hjemmeoppfølging til og med høsten 2020

Does an activity based remuneration system attract young doctors to general practice?

<p>Abstract</p> <p>Background</p> <p>The use of increasingly complex payment schemes in primary care may represent a barrier to recruiting general practitioners (GP). The existing Norwegian remuneration system is fully activity based - 2/3 fee-for-service and 1/3 capitation. Given that the system has been designed and revised in close collaborations with the medical association, it is likely to correspond - at least to some degree - with the preferences of <it>current </it>GPs (men in majority). The objective of this paper was to study which preferences that young doctors (women in majority), who are the <it>potential entrants </it>to general practice have for activity based vs. salary based payment systems.</p> <p>Methods</p> <p>In November-December 2010 all last year medical students and all interns in Norway (n = 1.562) were invited to participate in an online survey. The respondents were asked their opinion on systems of remuneration for GPs; inclination to work as a GP; risk attitude; income preferences; work pace tolerance. The data was analysed using one-way ANOVA and multinomial logistic regression analysis.</p> <p>Results</p> <p>A total of 831 (53%) responded. Nearly half the sample (47%) did not consider the remuneration system to be important for their inclination to work as GP; 36% considered the current system to make general practice <it>more </it>attractive, while 17% considered it to make general practice <it>less </it>attractive. Those who are attracted by the existing system were men and those who think high income is important, while those who are deterred by the system are risk averse and less happy with a high work pace. On the question of preferred remuneration system, half the sample preferred a mix of salary and activity based remuneration (the median respondent would prefer a 50/50 mix). Only 20% preferred a fully activity based system like the existing one. A salary system was preferred by women, and those less concerned with high income, while a fully activity based system was preferred by men, and those happy with a high work pace.</p> <p>Conclusions</p> <p>Given a concern about low recruitment to general practice in Norway, and the fact that an increasing share of medical students is women, we were interested in the extent to which the current Norwegian remuneration system correspond with the preferences of potential GPs. This study suggests that an existing remuneration mechanism has a selection effect on who would like to become a GP. Those most attracted are income motivated men. Those deterred are risk averse, and less happy with a high work pace. More research is needed on the extent to which experienced GPs differ along the questions we asked potential GPs, as well as studying the relative importance of other attributes than payment schemes.</p

Altruism Heterogeneity and Quality Competition Among Healthcare Providers

New empirical evidence shows substantial heterogeneity in the altruism of healthcare providers. Spurred by this evidence, we build a spatial quality competition model with altruism heterogeneity. We find that more altruistic healthcare providers supply relatively higher quality levels and position themselves closer to the center. Whether the social planner prefers more or less horizontal differentiation is in general ambiguous and depends on the level of altruism. The more altruistic healthcare providers are, the more likely it is that the social planner prefers greater horizontal differentiation to offset costly quality competition.Neue empirische Evidenz für Leistungsanbieter im Gesundheitswesen zeigt, dass es erhebliche Heterogenität im Grad des Altruismus gibt. Auf Basis dieser neuen Evidenz entwickeln wir ein räumliches Wettbewerbsmodell, in dem Leistungsanbieter mittels Qualität konkurrieren und das für Heterogenität im Grad des Altruismus erlaubt. Wir finden, dass Leistungsanbieter, die durch einen relativ höheren Grad an Altruismus gekennzeichnet sind, auch höhere Qualitäten anbieten und sich zentraler allokieren (niedrigere horizontale Differenzierung). Ob aus der sozialen Perspektive mehr oder weniger horizontale Differenzierung bevorzugt wird, hängt von dem Grad des Altruismus ab. Je höher der Grad des Altruismus, desto wahrscheinlicher ist es, dass der Sozialplaner mehr horizontale Differenzierung bevorzugt, um den Qualitätswettbewerb einzuschränken

A comprehensive theoretical framework for the implementation and evaluation of opt-out HIV testing

Opt-out HIV testing (in which patients are offered HIV testing as a default) is a potentially powerful strategy for increasing the number of people who know their HIV status and thus limiting viral transmission. Like any change in clinical practice, implementation of opt-out HIV testing in a health service requires a change management strategy, which should have theoretical support. This paper considers the application of three theories to the implementation and evaluation of an opt-out HIV testing programme: Behavioural Economics, the Health Belief Model and Normalisation Process Theory. An awareness, understanding and integration of these theories may motivate health care providers to order HIV tests that they may not routinely order, influence their beliefs about who should be tested for HIV and inform the operational aspects of opt-out HIV testing. Ongoing process evaluation of opt-out HIV testing programmes (based on these theories) will help to achieve individual health care provider self-efficacy and group collective action, thereby improving testing rates and health outcomes. © 2016 John Wiley & Sons, Ltd

Incentives in primary care and their impact on potentially avoidable hospital admissions

Primary care, Preventable hospitalisation, Financial incentive, Organizational appropriateness, Multilevel modelling, I11, I18, C31,