Will increased wages increase nurses' working hours in the health care sector?

Many registered nurses (RNs) in Norway work part-time, or in non-health jobs. The nurses’ trade organizations claim that a wage increase will increase the short-term labor supply in health care. This paper is an attempt to identify the effects of job-type specific wage increases through policy simulations on micro data. The individual’s labor supply decision can be considered as a choice from a set of discrete alternatives (job packages). These job packages are characterized by attributes such as hours of work, sector specific wages and other sector specific aspects of the jobs. The unique data set covers all RNs registered in Norway and their families. The spouses’ incomes and age of the children are vital when estimating the labor supply of this profession. For married females the results indicate job type specific wage elasticities for hours of work of 0.17 in hospitals and 0.39 in primary care. The total hours worked in health and non-health jobs are actually predicted to be slightly reduced, but the change is not significantly different from zero. Single females are somewhat more responsive to wage changes than married ones.Registered nurses; discrete choice; non-convex budget sets; labor supply; sector-specific wages

A Discrete Choice Analysis of Norwegian Physicians’ Labor Supply and Sector Choice

What is the effect of increased wages on physician’s working hours and sector choice? This study applies an econometric framework that allows for non-convex budget sets, nonlinear labor supply curves and imperfect markets with institutional constraints. The physicians are assumed to make choices from a finite set of job possibilities, characterized by practice form, hours and wage rates. The individuals may combine their main position with an extra job, opening for a variety of combinations of hours in the respective jobs. I take into account the complicated payment schemes for physicians, taxes and household characteristics when estimating labor supply on Norwegian micro data. The results show a modest response in total hours to a wage increase, but a reallocation of hours in favor of the sector with increased wages.Physicians; discrete choice; labor supply

Compensating differentials for nurses

When entering the job market registered nurses (RNs) face job alternatives with differences in wages and other job attributes. Previous studies of the nursing labor market have shown large earnings differences between similar hospital and non-hospital RNs. Corresponding differences are found in some of the analyses of shift and regular daytime workers. In the first part of this paper I analyze the wage differentials in the Norwegian public health sector, applying a switching regression model. I find no hospital premium for the shift RNs and a slightly negative hospital premium for the daytime RNs, but it is not significant for the hospital job choice. I find a positive shift premium. The wage rate is 19% higher for the shift working hospital RNs and 18% for the sample of primary care workers. The shift premium is only weakly significant for the shift work choice for the sample of hospital RNs, and not for the primary care RNs. I identify some selection effects. In the second part of the paper I focus on the shift compensation only, and present a structural labor supply model with a random utility function. This is done to identify the expected compensating variation necessary for the nurses to remain on the same utility level when they are “forced” from a day job to a shift job. The expected compensating variations are derived by Monte Carlo simulations and presented for different categories of hours. I find that on average the offered combination of higher wages, shorter working hours and increased flexibility overcompensates for the health and social strains related to shift work.Registered nurses; compensating variations; switching regression; random utility models; discrete choice; shift work; labor supply

Private health care as a supplement to a public health system with waiting time for treatment

In this article the authors Michael Hoel and Erik Magnus Sæther consider an economy where most of the health care is publicly provided, and where there is waiting time for several types of treatments. Private health care without waiting time is an option for the patients in the public health queue. This article shows the effects of a tax (positive or negative) on private health care, and derives the socially optimal tax/subsidy. Finally, a discussion of how the size of the tax might affect the political support for a high quality public health system is provided.Private health care; public health care; health queues

Public Health Care with Waiting Time: The Role of Supplementary Private Health Care

We consider an economy where most of the health care is publicly provided,and where there is waiting time for several types of treatments. Privatehealth care without waiting time is an option for the patients in the publichealth queue. We show that although patients with low waiting costs willchoose public treatment, they may be better off with waiting time thanwithout. The reason is that waiting time induces patients with high waitingcosts to choose private treatment, thus reducing the cost of public healthcare that everyone pays for. Even if higher quality (i.e. zero waiting time) canbe achieved at no cost, the self-selection induced redistribution may implythat it is socially optimal to provide health care publicly and at an inferiorquality level. We give a detailed discussion of the circumstances in which it isoptimal to have waiting time for public health treatment. Moreover, we studythe interaction between this quality decision and the optimal tax/subsidy onprivate health care.public health care, private health care, waiting time, healthqueues.

Wage Policies for Health Personnel - Essays on the Wage Impact on Hours of Work and Practice Choice

This thesis aims to explore the short-term impact of increased wages on the working hours of health personnel and their practice choice. An additional objective is to identify existing compensating differentials in the job market for health personnel.physicians; registered nurses; discrete choice; non-convex budget sets; labor supply; sector-specific wages

Comparative retention and effectiveness of migraine preventive treatments: A nationwide registry-based cohort study

Background and purpose Little is known about the comparative effects of migraine preventive drugs. We aimed to estimate treatment retention and effectiveness of migraine preventive drugs in a nationwide registry-based cohort study in Norway between 2010 and 2020. Methods We assessed retention, defined as the number of uninterrupted treatment days, and effectiveness, defined as the reduction in filled triptan prescriptions during four 90-day periods after the first preventive prescription, compared to a 90-day baseline period. We compared retention and efficacy for different drugs against beta blockers. Comparative retention was estimated with hazard ratios (HRs), adjusted for covariates, using Cox regression, and effectiveness as odds ratios (ORs) using logistic regression, with propensity-weighted adjustment for covariates. Results We identified 104,072 migraine patients, 81,890 of whom were female (78.69%) and whose mean (standard deviation) age was 44.60 (15.61) years. Compared to beta blockers, botulinum toxin (HR 0.43, 95% confidence interval [CI] 0.42–0.44) and calcitonin gene-related peptide pathway antibodies (CGRPabs; HR 0.63, 95% CI 0.59–0.66) were the least likely to be discontinued, while clonidine (HR 2.95, 95% CI 2.88–3.02) and topiramate (HR 1.34, 95% CI 1.31–1.37) were the most likely to be discontinued. Patients on simvastatin, CGRPabs, and amitriptyline were more likely to achieve a clinically significant reduction in triptan use during the first 90 days of treatment, with propensity score-adjusted ORs of 1.28 (95% CI 1.19–1.38), 1.23 (95% CI 0.79–1.90), and 1.13 (95% CI 1.08–1.17), respectively. Conclusions We found a favorable effect of CGRPabs, amitriptyline, and simvastatin compared with beta blockers, while topiramate and clonidine were associated with poorer outcomes.publishedVersio

Gir innføring av multidose riktigere legemiddelbruk?

Artikkelen beskriver funn fra en studie som har kartlagt hvordan uttaket av legemidler målt i definerte døgndoser påvirkes av innføring av multidose for pasienter tilknyttet hjemmesykepleien.Hensikt: Hensikten med studien er å kartlegge hvor dan uttaket av legemidler målt i definerte døgndoser (DDD) påvirkes av innføring av multidose for pasienter tilknyttet hjemmesykepleien. Både det totale uttaket og uttaket av vanedannende legemidler undersøkes. Materiale og metoder: Anonymiserte data over uttak av lege midler fra apotek i perioden 2006 til 2009 er studert for enkeltindivider til knyttet hjemmesykepleie som starter med multi dose (n = 1060). Videre sammenliknes grupper av pasienter tilknyttet henholdsvis hjemmesykepleie der multidose er utbredt (tiltaksgruppe, n = 4725), og hjemme sykepleie der multidose ikke er innført (kontrollgruppe, n = 2722). Tiltaksgruppen innfører multidose gradvis i løpet av studieperioden (endring fra ingen multi dosebrukere per 1.1.2006 til over 40 % av omsetningen til hjemmesykepleien i form av multidose tredje kvartal 2009). Resultater: Uttaket av vanedannende legemidler per bruker reduseres og blir mer enhetlig hos enkeltindividene som starter med multidose. Med enhetlig menes her hvorvidt de med unormalt høyt eller lavt uttak får uttaket henholdsvis redusert eller økt til et mer normalt nivå. For vanedannende legemidler er det også observert forskjell i utvikling mellom tiltaks- og kontrollgruppen. Uttaket i tiltaksgruppen reduseres over tid mens uttaket i kontrollgruppen øker. Det totale uttaket av legemidler øker over tid både hos enkeltindividene og for tiltaks- og kontrollgruppen, i likhet med utviklingen for samfunnet ellers. Det er ikke observert en signifikant forskjell i utvikling i det totale uttaket av legemidler mellom tiltaks- og kontrollgruppen. Også det totale uttaket hos enkeltindividene blir mer enhetlig etter innføring av multidose. Konklusjon: Funnene i denne studien indikerer at multidose påvirker uttaket av legemidler. Vi vurderer reduksjon i uttak av vanedannende legemidler og et mer enhetlig legemiddeluttak som bidrag til å oppnå riktigere legemiddelbruk

Evaluering av pilotprosjekt med primærhelseteam og alternative finansieringsordninger. Statusrapport I

Fra 1. april 2018 prøves primærhelseteam ut som en organisasjonsform med teamorganisering og to alternative finansieringsmodeller ved 13 fastlegekontor i ni kommuner. Forsøket administreres av Helsedirektoratet og skal pågå i tre år. Forsøket evalueres av en samarbeidskonstellasjon av forskere fra Universitetet i Oslo, Universitetet i Tromsø og Oslo Economics. I denne rapporten beskriver vi status ved starten av forsøket

Evaluering av forsøk med primærhelseteam og alternative finansieringsordninger. Statusrapport V

Source at https://osloeconomics.no/publikasjoner/.Primærhelseteam (PHT) er tverrfaglige team som inkluderer fastlege, sykepleier og helsesekretær. Sentrale målgrupper for PHT er brukere med kronisk sykdom, brukere med psykiske lidelser og rusavhengighet, brukere som omtales som «skrøpelige eldre» og brukere med utviklingshemming og funksjonsnedsettelser, samt «svake etterspørrere». For å finne ut om PHT, med mer systematisk oppfølging av målgruppen, gir et bedre tilbud til listeinnbyggerne enn den vanlige fastlegeordningen, ble forsøk med PHT startet 1. april 2018 på 13 legekontor, mens fire nye legekontor kom til fra 2020. Forsøket prøver ut to ulike finansieringsmodeller; 12 av legekontorene har valgt honorarmodellen og fem har valgt driftstilskuddsmodellen. Evalueringen bygger på analyser av data fra helseregistre og administrative registre, pasientjournaler, spørreundersøkelser, intervjuundersøkelser og dokumenter. I denne rapporten undersøker vi særlig: Pasienters erfaring med PHT Likheter og ulikheter mellom PHT-legekontor med ulike finansieringsmodeller Variasjon i teamarbeid og teameffektivitet ved et utvalg PHT-legekontor Samspill mellom PHT og øvrig helsetjeneste </uli