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

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    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. §

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    File URL: http://www.uib.no/filearchive/wp-0509.pdf
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    Paper provided by University of Bergen, Department of Economics in its series Working Papers in Economics with number 05/09.

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    Length: 28 pages
    Date of creation: 15 Aug 2009
    Date of revision:
    Handle: RePEc:hhs:bergec:2009_005
    Contact details of provider: Postal: Institutt for økonomi, Universitetet i Bergen, Postboks 7802, 5020 Bergen, Norway
    Phone: (+47)55589200
    Fax: (+47)55589210
    Web page: http://www.uib.no/econ/en
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    1. Iversen, Tor, 2009. "The effect of patient shortage on general practitioners’ future income and list of patients," HERO On line Working Paper Series 2003:1, Oslo University, Health Economics Research Programme.
    2. Bago d'Uva, Teresa & Jones, Andrew M. & van Doorslaer, Eddy, 2009. "Measurement of horizontal inequity in health care utilisation using European panel data," Journal of Health Economics, Elsevier, vol. 28(2), pages 280-289, March.
    3. Tom Van Ourti, 2004. "Measuring horizontal inequity in Belgian health care using a Gaussian random effects two part count data model," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 705-724.
    4. van Doorslaer, Eddy & Gerdtham, Ulf-G., 2003. "Does inequality in self-assessed health predict inequality in survival by income? Evidence from Swedish data," Social Science & Medicine, Elsevier, vol. 57(9), pages 1621-1629, November.
    5. Eddy van Doorslaer & Xander Koolman & Andrew M. Jones, 2004. "Explaining income-related inequalities in doctor utilisation in Europe," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 629-647.
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