Costs and Quality at the Hospital Level in the Nordic Countries

This article develops and analyzes patient register‐based measures of quality for the major Nordic countries. Previous studies show that Finnish hospitals have significantly higher average productivity than hospitals in Sweden, Denmark, and Norway and also a substantial variation within each country. This paper examines whether quality differences can form part of the explanation and attempts to uncover quality–cost trade‐offs. Data on costs and discharges in each diagnosis‐related group for 160 acute hospitals in 2008–2009 were collected. Patient register‐based measures of quality such as readmissions, mortality (in hospital or outside), and patient safety indices were developed and case‐mix adjusted. Productivity is estimated using bootstrapped data envelopment analysis. Results indicate that case‐mix adjustment is important, and there are significant differences in the case‐mix adjusted performance measures as well as in productivity both at the national and hospital levels. For most quality indicators, the performance measures reveal room for improvement. There is a weak but statistical significant trade‐off between productivity and inpatient readmissions within 30 days but a tendency that hospitals with high 30‐day mortality also have higher costs. Hence, no clear cost–quality trade‐off pattern was discovered. Patient registers can be used and developed to improve future quality and cost comparisons. Copyright © 2015 John Wiley & Sons, Ltd.