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Centralized or decentralized? A case study of Norwegian hospital reform

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  • Magnussen, Jon
  • Hagen, Terje P.
  • Kaarboe, Oddvar M.

Abstract

In recent years, decentralization of financial and political power has been perceived as a useful means to improve outcomes of the health care sector of many European countries. Such reforms could be the result of fashionable policy trends, rather than being based on knowledge of "what works". If decentralization is the favored strategy in health care, studies of countries that go against the current trend will be of interest and importance as they provide information about the potential drawbacks of decentralization. In Norway, specialized health care has recently been recentralized. In this paper, we review some of the evidence now available on the economic effects of recentralization. Although recentralization has been associated with improvements in both cost efficiency and technical efficiency this may have been caused by the increasing role of activity-based funding methods used in the allocation of health care resources. However, recentralization was also associated with an increase in the rate of growth of real resources and the proportion of total costs being met by supplementary funding. As a result, recentralization failed to address the issues of cost containment and reductions in budget deficits.

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Bibliographic Info

Article provided by Elsevier in its journal Social Science & Medicine.

Volume (Year): 64 (2007)
Issue (Month): 10 (May)
Pages: 2129-2137

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Handle: RePEc:eee:socmed:v:64:y:2007:i:10:p:2129-2137

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Keywords: Norway Health reform Decentralization Economic effects;

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References

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Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
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  1. J�nos Kornai & Eric Maskin & G�rard Roland, 2003. "Understanding the Soft Budget Constraint," Journal of Economic Literature, American Economic Association, vol. 41(4), pages 1095-1136, December.
  2. Gilbert, Guy & Picard, Pierre, 1996. "Incentives and optimal size of local jurisdictions," European Economic Review, Elsevier, vol. 40(1), pages 19-41, January.
  3. Picard Pierre & Gilbert G, 1991. "Incentives and the optimal size of local territories," CEPREMAP Working Papers (Couverture Orange) 9124, CEPREMAP.
  4. Hagen, Terje P. & Kaarboe, Oddvar M., 2006. "The Norwegian hospital reform of 2002: Central government takes over ownership of public hospitals," Health Policy, Elsevier, vol. 76(3), pages 320-333, May.
  5. Biørn, Erik & Hagen, Terje P. & Iversen, Tor & Magnussen, Jon, 2009. "The effect of activity-based financing on hospital efficiency: A panel data analysis of DEA efficiency scores 1992-2000," HERO On line Working Paper Series 2002:8, Oslo University, Health Economics Research Programme.
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Citations

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Cited by:
  1. Carlsen, Fredrik & Kaarbøe, Oddvar, 2009. "Norwegian priority guidelines: Estimating the distributional implications across age, gender and SES," Working Papers in Economics 08/09, University of Bergen, Department of Economics.
  2. Oddvar Kaarboe & Fredrik Carlsen, 2014. "Waiting Times And Socioeconomic Status. Evidence From Norway," Health Economics, John Wiley & Sons, Ltd., vol. 23(1), pages 93-107, 01.
  3. Oliver Reich & Cornelia Weins & Claudia Schusterschitz & Magdalena Thöni, 2012. "Exploring the disparities of regional health care expenditures in Switzerland: some empirical evidence," The European Journal of Health Economics, Springer, vol. 13(2), pages 193-202, April.
  4. János Kornai, 2009. "The soft budget constraint syndrome in the hospital sector," Society and Economy, Akadémiai Kiadó, Hungary, vol. 31(1), pages 5-31, June.
  5. Masayoshi Hayashi, 2011. "The Effects of Medical Factors on Transfer Deficits in Public Assistance in Japan: A Quantile Regression Analysis," CIRJE F-Series CIRJE-F-816, CIRJE, Faculty of Economics, University of Tokyo.
  6. Kornai, János, 2008. "A puha költségvetési korlát szindrómája a kórházi szektorban
    [The soft budget constraint syndrome in the hospital sector]
    ," Közgazdasági Szemle (Economic Review - monthly of the Hungarian Academy of Sciences), Közgazdasági Szemle Alapítvány (Economic Review Foundation), vol. 0(12), pages 1037-1056.
  7. Socha, Karolina, 2014. "Mixed reimbursement of hospitals: Securing high activity and global expenditures control?," COHERE Working Paper 2014:3, COHERE - Centre of Health Economics Research, University of Southern Denmark.
  8. Kristensen, Troels & Olsen, Kim Rose & Kilsmark, Jannie & Lauridsen, Jørgen T. & Pedersen, Kjeld Møller, 2012. "Economies of scale and scope in the Danish hospital sector prior to radical restructuring plans," Health Policy, Elsevier, vol. 106(2), pages 120-126.
  9. Park, Sungchul & Lee, Jason & Ikai, Hiroshi & Otsubo, Tetsuya & Imanaka, Yuichi, 2013. "Decentralization and centralization of healthcare resources: Investigating the associations of hospital competition and number of cardiologists per hospital with mortality and resource utilization in ," Health Policy, Elsevier, vol. 113(1), pages 100-109.
  10. Miika Linna & Unto Häkkinen & Mikko Peltola & Jon Magnussen & Kjartan Anthun & Sverre Kittelsen & Annette Roed & Kim Olsen & Emma Medin & Clas Rehnberg, 2010. "Measuring cost efficiency in the Nordic Hospitals—a cross-sectional comparison of public hospitals in 2002," Health Care Management Science, Springer, vol. 13(4), pages 346-357, December.
  11. Januleviciute, Jurgita & Askildsen, Jan Erik & Holmås, Tor Helge & Kaarbøe, Oddvar & Sutton, Matt, 2010. "The Impact of Different Prioritisation Policies on Waiting Times: A Comparative Analysis of Norway and Scotland," Working Papers in Economics 07/10, University of Bergen, Department of Economics.
  12. Izabela Karpowicz, 2012. "Narrowing Vertical Fiscal Imbalances in Four European Countries," IMF Working Papers 12/91, International Monetary Fund.
  13. Janueleviciute, Jurgita & Askildsen, Jan Erik & Kaarbøe, Oddvar & Siciliani, Luigi & Sutton, Matt, 2013. "How Do Hospitals Respond To Price Changes?Evidence From Norway," Working Papers in Economics 15/12, University of Bergen, Department of Economics.

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