The impact of accessibility on the use of specialist health care in Norway
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Iversen, Tor & Gry Stine Kopperud
Number in series: 9
This paper presents a study of the factors that contribute to the utilization of specialist health care in Norway. The aim of the study is to explore to what extent the policy goal of allocating health care according to medical need is fulfilled. Hence, we are interested in studying the impact of a person’s health relative to the impact of access to specialist care. We distinguish between services provided by public hospitals and services provided by private specialists financed by the National Insurance Scheme. Our data allow us to consider individual patient characteristics since we merge Survey of Living Conditions data with data on capacity and access to general practice and specialist care. In accordance with our predictions, we find from the estimation of logit models and negative binomial models significant differences between the factors that influence contacts with private specialists and contacts with hospitals. While a person’s selfassessed health plays a major role in the utilization of hospitals, we find no significant effect of this variable on the utilization of private specialists. The supply-side variables measured by GP density and the accessibility indices for specialist care have significant effects on the utilization of private specialists, but not on hospital visits and inpatient stays. A preliminary conclusion is that the utilization of hospital services is rationed according to patients’ health status, and not influenced by patients’ access. Hence, the utilization of hospital services seems to be in accordance with officially stated health policy. On the other hand, private specialists seem to function as an alternative to general practice. Moreover, the significant effect of chronic conditions on the utilization of private specialists suggests that regular check-ups of chronic patients are an important part of the services provided by private specialists. The challenge to policy makers is to consider measures that bring the utilization of publicly funded private specialists in accordance with national health policy.
Project:Oppdragsgiver: Norges forskningsråd
Frisch prosjekt: 4101 - Economics of health
Norwegian Ministry of Health and Social Affairs and the Research Council of Norway to the Health Economics Research Programme at the University of Oslo