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Regulation versus practice - The impact of accessibility on the use of specialist health care in Norway

Author

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  • Iversen, Tor

    () (Institute of Health Management and Health Economics)

  • Kopperud, Gry Stine

    (Institute of Health Management and Health Economics)

Abstract

In Norway specialized health services are provided both by public hospitals and by privately practicing specialists who have a contract with the public sector. Patients’ co-payment is the same irrespective of the type of provider they visit. The ambition of equity in the allocation of medical care is high among all political parties. The instruments for auditing whether these goals are fulfilled are not equally ambitious. The objective of the present study is to explore whether laws and regulations that govern the allocation of specialist health care resources in fact are fulfilled. Panel data from the Survey of Living Conditions are merged with data on capacity and spatial access to primary and specialist care. We find that accessibility and socio-economic variables play a considerable role in determining both the probability of at least one visit and the number of visits to a private specialist. A person with a higher university degree living in a municipality with the highest value of the geographical accessibility index has a 46%-points higher probability of at least one visit to a private specialist compared with a person with junior high living in a municipality with the lowest value of the accessibility index. With regard to visits to a hospital outpatient department these variables are not found to have significant effects. We conclude that public ambitions and regulations are fulfilled for specialist services provided by public hospitals. With regard to the provision of services provided by publicly financed private specialists we find a discrepancy between public goals and surveyed practice.

Suggested Citation

  • Iversen, Tor & Kopperud, Gry Stine, 2009. "Regulation versus practice - The impact of accessibility on the use of specialist health care in Norway," HERO On line Working Paper Series 2005:2, Oslo University, Health Economics Research Programme.
  • Handle: RePEc:hhs:oslohe:2005_002
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    File URL: http://www.hero.uio.no/publicat/2005/HERO2005_2.pdf
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    References listed on IDEAS

    as
    1. Iversen, Tor & Kopperud, Gry Stine, 2009. "The impact of accessibility on the use of specialist health care in Norway," HERO On line Working Paper Series 2002:9, Oslo University, Health Economics Research Programme.
    2. Mullahy, John, 1997. "Heterogeneity, Excess Zeros, and the Structure of Count Data Models," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 12(3), pages 337-350, May-June.
    3. Roy Carr-Hill & Geoffrey Hardman & Stephen Martin & Stuart Peacock & Trevor Sheldon & Peter Smith, 1994. "A formula for distributing NHS revenues based on small area use of hospital beds," Working Papers 022cheop, Centre for Health Economics, University of York.
    4. Manning, Willard G., 1998. "The logged dependent variable, heteroscedasticity, and the retransformation problem," Journal of Health Economics, Elsevier, vol. 17(3), pages 283-295, June.
    5. Goddard, Maria & Smith, Peter, 2001. "Equity of access to health care services: : Theory and evidence from the UK," Social Science & Medicine, Elsevier, vol. 53(9), pages 1149-1162, November.
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    Cited by:

    1. Kuhn, Michael & Ochsen, Carsten, 2009. "Demographic and geographic determinants of regional physician supply," Thuenen-Series of Applied Economic Theory 105, University of Rostock, Institute of Economics.
    2. Carlsen, Fredrik & Kaarboe, Oddvar Martin, 2015. "The relationship between educational attainment and waiting time among the elderly in Norway," Health Policy, Elsevier, vol. 119(11), pages 1450-1458.
    3. Carlsen, Fredrik & Kaarboe, Oddvar M., 2010. "Norwegian priority guidelines: Estimating the distributional implications across age, gender and SES," Health Policy, Elsevier, vol. 95(2-3), pages 264-270, May.
    4. Godager, Geir & Iversen, Tor & Ma, Ching-to Albert, 2015. "Competition, gatekeeping, and health care access," Journal of Health Economics, Elsevier, vol. 39(C), pages 159-170.

    More about this item

    Keywords

    specialist health services; utilization; equity; private/public provision; survey data;

    JEL classification:

    • H42 - Public Economics - - Publicly Provided Goods - - - Publicly Provided Private Goods
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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