Inequity in the use of physician services in Norway. Changing patterns over time

We analyze and compare inequity in use of physician visits (GP and specialists) in Norway based on data from the Surveys of Living Conditions for the years 2000, 2002 and 2005. Within this period the Norwegian public health care system underwent two major reforms, both aimed at ensuring equitable access to health care services for the entire population. A list patient system was introduced in the primary health care sector in 2001, and in 2002 the ownership of hospitals was moved from the regional to the state level. At both care levels a real increase in public expenditures followed in the wake of the reforms. We apply the indirect standardization approach and estimate the relationship between health care use, need and other control variables by linear and nonlinear regression. We measure horizontal inequity in physician visits by concentration indices and investigate changes in inequity over time when decomposing the concentration indices into the contribution of its determinants. For specialist services we find pro-rich inequity in the probability of seeing an outpatient specialist in all three years. Estimated concentration indices are reduced in magnitude over time and no longer statistically significant in 2005. Inclusion of more information about need for medical care in 2002 and 2005, results in larger and statistical significant concentration indices. In sum, in a period with important changes in the health care system aimed at obtaining equity, inequity in medical specialist utilization has been reduced but not removed in Norway. §Analysis of Health Care Markets; Government Policy; Regulation; Public Health

Regulation and Pricing of Pharmaceuticals: Reference Pricing or Price Cap Regulation?

We study the relationship between regulatory regimes and pharmaceutical firms’ pricing strategies using a unique policy experiment from Norway, which in 2003 introduced a reference price (RP) system called “index pricing” for a sub-sample of off-patent pharmaceuticals, replacing the existing price cap (PC) regulation. We estimate the effect of the reform using a product level panel dataset, covering the drugs exposed to RP and a large number of drugs still under PC regulation in the time before and after the policy change. Our results show that RP significantly reduced both brand-name and generic prices within the reference group, with the effect being stronger for brand-names. We also identify a negative cross-price effect on therapeutic substitutes not included in the RP-system. In terms of policy implications, the results suggest that RP is more effective than PC regulation in lowering drug prices, while the cross-price effect raises a concern about patent protection.Pharmaceuticals; Price Regulation; Branded-Generic competition.

Inequity in the use of physician services in Norway before and after introducing patient lists in primary care

<p>Abstract</p> <p>Background</p> <p>Inequity in use of physician services has been detected even within health care systems with universal coverage of the population through public insurance schemes. In this study we analyse and compare inequity in use of physician visits (GP and specialists) in Norway based on data from the Surveys of Living Conditions for the years 2000, 2002 and 2005. A patient list system was introduced for GPs in 2001 to improve GP accessibility, strengthen the stability of the patient-doctor relationship and ensure equity in the use of health care services for the entire population.</p> <p>Method</p> <p>We measure horizontal inequity by concentration indices and investigate changes in inequity over time when decomposing the concentration indices into the contribution of its determinants.</p> <p>Results</p> <p>We find that pro-rich inequity in the probability of seeing a private outpatient specialist has declined, but still existed in 2005.</p> <p>Conclusion</p> <p>Improved patient-doctor stability as well as better GP accessibility facilitated by the introduction of patient lists improved access to private specialist services. In particular the less well off benefited from this reform.</p

Regulation and Pricing of Pharmaceuticals: Reference Pricing or Price Cap Regulation?

We study the relationship between regulatory regimes and pharmaceutical firms’ pricing strategies using a unique policy experiment from Norway, which in 2003 introduced a reference price (RP) system called “index pricing” for a sub-sample of off-patent pharmaceuticals, replacing the existing price cap (PC) regulation. We estimate the effect of the reform using a product level panel dataset, covering the drugs exposed to RP and a large number of drugs still under PC regulation in the time before and after the policy change. Our results show that RP significantly reduces both brand-name and generic prices within the reference group, with the effect being stronger for brand-names. We also identify a negative cross-price effect on therapeutic substitutes not included in the RP-system. In terms of policy implications, the results suggest that RP is more effective than PC regulation in lowering drug prices, while the cross-price effect raises a concern about patent protection.pharmaceuticals, price regulation, branded-generic competition

Childlessness among men in Norway - who are they, and where do they live?

In Norway, like in many other western countries, we see a steady increase over time in the proportion of men who become childless. Now nearly 20 percent of Norwegian men passing the age of 50 do not have children of their own. In this study we take advantage of comprehensive Norwegian register data and logistic regression analysis in order to map out background characteristics of childless men and explore if changes over time in individual background characteristics correlate with increasing childlessness. We focus in particular on education and place of living as it is often argued that women avoid to have children with low educated men, and that men become childless because they stay behind on the country side when women move to the cities. We find that childlessness indeed is more common among men with low rather than higher education. Still, poor health and weak income ability are more pronounced markers of childlessness, and the probability of being childless is larger among men living in Oslo than elsewhere in Norway.Andelen barnløse menn øker i Norge. I nær framtid kan vi vente at omtrent hver femte mann som passerer 50 år, ikke har fått egne barn. Utviklingen er noenlunde den samme i mange andre vestlige land. Vi har ved hjelp av omfattende registerdata og logistisk regresjonsanalyse kartlagt bakgrunnskjennetegn ved barnløse menn og undersøkt hvordan endringer over tid i disse kjennetegnene henger sammen med veksten i barnløshet. Spesielt har vi studert sammenhenger mellom barnløshet på den ene siden og utdanning og bosted på den andre, da det ofte blir påstått at kvinner velger vekk å få barn med menn med lite utdanning, og at menn forblir barnløse fordi de blir igjen i utkantstrøk når kvinnene flytter til byen. Selv om barnløshet er mer vanlig blant menn med lav heller enn høy utdanning, er det likevel primært dårlig helse og svak inntektsevne som fremstår som sterkest korrelert med barnløshet. Over tid har befolkningen i Norge fått både høyere utdanning og langt større inntekt, men innvirkningen av å ligge bak i inntektsfordelingen på sannsynligheten for mannlig barnløshet har økt – og dette fremstår som en viktig driver for den økende barnløsheten over tid. Når det gjelder geografi, finner vi ikke tydelige forskjeller i barnløshet etter størrelsen på bostedskommunen eller grad av sentralitet. Sannsynligheten for å være barnløs mann er større for bosatte i Oslo enn i resten av landet.publishedVersio

Return to work in patients with chronic musculoskeletal pain: multidisciplinary intervention versus brief intervention: a randomized clinical trial

Objective: This randomized clinical trial was performed to compare the effect of a new multidisciplinary intervention (MI) programme to a brief intervention (BI) programme on return to work (RTW), fully and partly, at a 12-month and 24-month follow-up in patients on long-term sick leave due to musculoskeletal pain. Methods: Patients (n = 284, mean age 41.3 years, 53.9 % women) who were sick-listed with musculoskeletal pain and referred to a specialist clinic in physical rehabilitation were randomized to MI (n = 141) or BI (n = 143). The MI included the use of a visual educational tool, which facilitated patienttherapist communication and self-management. The MI also applied one more profession, more therapist time and a comprehensive focus on the psychosocial factors, particularly the working conditions, compared to a BI. The main features of the latter are a thorough medical, educational examination, a brief cognitive assessment based on the non-injury model, and a recommendation to return to normal activity as soon as possible. Results: The number of patients with full-time RTW developed similarly in the two groups. The patients receiving MI had a higher probability to partly RTW during the first 7 months of the follow-up compared to the BI-group. Conclusions: There were no differences between the groups on full-time RTW during the 24 months. However, the results indicate that MI hastens the return to work process in long-term sick leave through the increased use of partial sick leave. Trial Registration: http://www.clinicaltrials.gov with the registration number NCT01346423.publishedVersio

Protocol for the SEED-Trial: Supported Employment and Preventing Early Disability

Early withdrawal or exclusion from the labor market leads to significant personal and societal costs. In Norway, the increasing numbers of young adults receiving disability pension is a growing problem. While a large body of research demonstrates positive effects of Supported Employment (SE) in patients with severe mental illness, no studies have yet investigated the effectiveness of SE in young adults with a range of social and health conditions who are receiving benefits

Protocol for the SEED-trial: Supported Employment and preventing Early Disability

Background: Early withdrawal or exclusion from the labor market leads to significant personal and societal costs. In Norway, the increasing numbers of young adults receiving disability pension is a growing problem. While a large body of research demonstrates positive effects of Supported Employment (SE) in patients with severe mental illness, no studies have yet investigated the effectiveness of SE in young adults with a range of social and health conditions who are receiving benefits. Methods/design: The SEED-trial is a randomized controlled trial (RCT) comparing traditional vocational rehabilitation (TVR) to SE in 124 unemployed individuals between the ages of 18-29 who are receiving benefits due to various social- or health-related problems. The primary outcome is labor market participation during the first year after enrollment. Secondary outcomes include physical and mental health, health behaviors, and well-being, collected at baseline, 6, and 12 months. A cost-benefit analysis will also be conducted. Discussion: The SEED-trial is the first RCT to compare SE to TVR in this important and vulnerable group, at risk of being excluded from working life at an early age

The performance of sample selection estimators to control for attrition bias

Sample attrition is a potential source of selection bias in experimental, as well as non-experimental programme evaluation. For labour market outcomes, such as employment status and earnings, missing data problems caused by attrition can be circumvented by the collection of follow-up data from administrative registers. For most non-labour market outcomes, however, investigators must rely on participants' willingness to co-operate in keeping detailed follow-up records and statistical correction procedures to identify and adjust for attrition bias. This paper combines survey and register data from a Norwegian randomized field trial to evaluate the performance of parametric and semi-parametric sample selection estimators commonly used to correct for attrition bias. The considered estimators work well in terms of producing point estimates of treatment effects close to the experimental benchmark estimates. Results are sensitive to exclusion restrictions. The analysis also demonstrates an inherent paradox in the 'common support' approach, which prescribes exclusion from the analysis of observations outside of common support for the selection probability. The more important treatment status is as a determinant of attrition, the larger is the proportion of treated with support for the selection probability outside the range, for which comparison with untreated counterparts is possible. Copyright © 2001 John Wiley & Sons, Ltd.

De helserelaterte trygdeytelsene - Betydningen av økonomiske insentiver og samspill mellom trygdeordninger

Empiriske studier fra Norge og andre land viser at både arbeidstakere og arbeidsgivere lar seg påvirke av økonomiske insentiver i offentlige trygdeordninger. Generøse ytelser og lav medfinansiering gir begge parter svake insentiver til å unngå sykefravær, og medvirker til at helserelaterte trygdeordninger brukes som substitutt for arbeidsløshetstrygd. Forskningsresultater fra land som har innført reformer for å redusere sykefravær og dempe tilstrømmingen til uføretrygd viser at økonomiske innstramminger og strengere kontroll virker, men at dette også fører marginale arbeidstakere med mangelfull kompetanse og mindre helseplager over på andre, midlertidige trygdeordninger og ut av arbeidsstyrken. økonomiske insentiv, sykeforsikring, uføretrygd, arbeidsløshetstrygd, gradert tryg