Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2011

Open Access 01-12-2011 | Research

Inequity in the use of physician services in Norway before and after introducing patient lists in primary care

Authors: Astrid L Grasdal, Karin Monstad

Published in: International Journal for Equity in Health | Issue 1/2011

Login to get access

Abstract

Background

Inequity in use of physician services has been detected even within health care systems with universal coverage of the population through public insurance schemes. In this study we analyse 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. A patient list system was introduced for GPs in 2001 to improve GP accessibility, strengthen the stability of the patient-doctor relationship and ensure equity in the use of health care services for the entire population.

Method

We measure horizontal inequity by concentration indices and investigate changes in inequity over time when decomposing the concentration indices into the contribution of its determinants.

Results

We find that pro-rich inequity in the probability of seeing a private outpatient specialist has declined, but still existed in 2005.

Conclusion

Improved patient-doctor stability as well as better GP accessibility facilitated by the introduction of patient lists improved access to private specialist services. In particular the less well off benefited from this reform.
Literature
1.
van Doorslaer E, Masseria C, the OECD Health Equity Research Group: Income-Related Inequality in the use of Medical Care in 21 OECD-countries. Towards High-Performing Health Systems: Policy Studies. Edited by: OECD Health Project. 2004, Paris: OECD, 109-66.
2.
Bago d'Uva T, Jones A: Health care utilization in Europe: New evidence from the ECHP. Journal of Health Economics. 2009, 28: 265-279. 10.1016/j.jhealeco.2008.11.002.CrossRefPubMed
3.
Iversen T, Kopperud GS: Regulation versus practice - the impact of accessibility on the use of specialist health care in Norway. Health Economics. 2005, 14: 1231-1238. 10.1002/hec.1009.CrossRefPubMed
4.
Rodriguez M, Stoyonova A: The effect of private insurance access on the choice of GP/specialist and public/private provider in Spain. Health Economics. 2004, 13: 689-704. 10.1002/hec.832.CrossRefPubMed
5.
Buchmueller T, Couffinhal A, Grignon M, Perronnin M: Access to physicial services: does supplemental insurance matter ? Evidence from France. Health Economics. 2004, 13: 669-687. 10.1002/hec.879.CrossRefPubMed
6.
Jones A, Koolman X, van Doorslaer E: The impact of having supplementary health insurance on the use of specialists. Annales d'Economie et de Statistique. 2006, no. 83/84
7.
Stortingsmelding nr 23, 1996-97: Om legetjenesten i kommunene og fastlegeordningen. [Report to the Norwegian Parliament no. 23, 1996-1997. On general practitioner services in the municipalities and the Regular General Practitioner Scheme". In Norwegian]
8.
Iversen T, Luraas H: Capitation and Incentives in primary care. The Elgar Companion to Health Economics. Edited by: Jones AM. 2006, Edward Elgar; UK
9.
OECD Economic Surveys: Norway: The performance of the Norwegian Health care sector. 2005, OECD
10.
Sandvik H: Evaluering av fastlegereformen 2001-2005. 2005, Oslo: Norges forskningsråd, ["Assessment of the RGP Scheme Reform". The Norwegian Research Council. English summary.]
11.
Vrangbæk K, Õstergren K, Okkels Birk K, Winblad U: Patient reactions to hospital choice in Norway, Denmark, and Sweden. Health Economics, Policy and Law. 2007, 2: 125-152. 10.1017/S174413310700401X.CrossRef
12.
Sosial-og helsedirektoratet: Innsatsstyrt finansiering i helsetjenesten. En vurdering og aktuelle tiltak. Rapport IS-1479, 2007. [The Norwegian Directorate on Health: "Activity-Based Financing of Health Care. An Assessment and potential policies". In Norwegian.]
13.
Aarbu KO: Demand patterns for Treatment Insurance in Norway. CESifo Working paper 2010, no.3021
14.
Iversen T, Lurås H: The effect of capitation on GPs' referral decisions. Health Economics. 2000, 9: 199-210. 10.1002/(SICI)1099-1050(200004)9:3<199::AID-HEC514>3.0.CO;2-2.CrossRefPubMed
15.
Ot prp nr 99 (1998-1999): Om lov om endringer i lov 19. November 1982 nr 66 om helsetjenesten i kommunene og visse andre lover (fastlegeordningen). Statens forvaltningstjeneste. Oslo (Law document, Ministry of Health and Social Affairs, 1999. In Norwegian)
16.
Gravelle H, Masiero G: Quality incentives in a regular market with imperfect information and switching costs: capitation in general practice. Journal of Health Economics. 2000, 19: 1067-1088. 10.1016/S0167-6296(00)00060-6.CrossRefPubMed
17.
Carlsen B, Norheim OF: Introduction of the Patient-list System in General Practice: Changes in Norwegian Physicians' Perception of their Gatekeeper Role. Scandinavian Journal of Primary Health Care. 2003, 21 (4): 209-213. 10.1080/02813430310004155.CrossRefPubMed
18.
Paulsen B: Etter innføring av fastlegeordning - brukervurderinger av allmennlegetjenesten. Statistics Norway 2005, Report 2005/1, ("After implementation of the RGP Scheme - users' assessment of general practise services". In Norwegian)
19.
van Doorslaer E, Koolman X: Explaining the di¡erences in income-related health inequalities across European countries. Health Economics. 2004, 13: 609-628. 10.1002/hec.918.CrossRefPubMed
20.
Scott A, Shiell A, King AM: Is general practitioner decision making associated with patient socio-economic status?. Social Science and Medicine. 1996, 42 (1): 35-46. 10.1016/0277-9536(95)00063-1.CrossRefPubMed
21.
Øvretveit J: Nordic privatization and private health care. International Journal of Health Planning and Management,. 2003, 18: 233-246. 10.1002/hpm.712.CrossRef
22.
O'Donnell O, van Doorslaer E, Wagstaff A, Lindelow M: Analyzing Health Equity Using Household Survey Data. A guide to Techniques and their Implementation. 2008, Washington DC:The World Bank
23.
Bago d'Uva T, Jones A, van Doorslaer E: Measurement of Horizontal Inequity in HealthCare Utilisation using European Panel Data. Tindbergen Institute Discussion Paper, TI 2007-059/3, 2007
24.
Wagstaff A, van Doorslaer E, Watanabe N: On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam. Journal of Econometrics. 2003, 112: 207-223. 10.1016/S0304-4076(02)00161-6.CrossRef
25.
van Doorslaer E, Koolman X, Jones AM: Explaining income-related inequalities in doctor utilization in Europe. Health Economics. 2004, 13: 629-647. 10.1002/hec.919.CrossRefPubMed
26.
Oaxaca RL: Male-female wage differentials in urban labour markets. International Economic Review. 1973, 14: 693-709. 10.2307/2525981.CrossRef
27.
Islam KM, Gerdtham UG., Clarke P, Burstrøm K: Does Income Related Health Inequality change as Population ages? Evidence from Swedish Panel Data. Health Economics. 2010, 19: 334-349. 10.1002/hec.1479.CrossRefPubMed
28.
Hernández-Quevedo C, Jones A, López-Nicolás A, Rice N: Socioeconomic inequalities in health: A comparative longitudinal analysis using the European Community Household Panel. Social Science & Medicine. 2006, 63: 1246-1261. 10.1016/j.socscimed.2006.03.017.CrossRef
29.
Bago d'Uva T, van Doorslaer E, Lindeboom M, O'Donnell O: Does reporting heterogeneity bias the measurement of health disparities?. Health Economics. 2008, 17: 351-375. 10.1002/hec.1269.CrossRefPubMed
30.
Gravelle H, Morris S, Sutton M: Economic studies of equity in the consumption of health care. The Elgar Companion to Health Economics. Edited by: Jones AM. 2006, Edward Elgar; UK
31.
Gjelsvik R, Holmås TH, Monstad K: Socio-economic differences in treatment intensity in GP practice. HEB Working Papers 2009, no.17/09
32.
Magnussen J, Hagen T, Kaarboe O.: Centralized or Decentralized? A case study of Norwegian hospital reform. Social Science and Medicine. 2007, 64: 2129-2137. 10.1016/j.socscimed.2007.02.018.CrossRefPubMed
Metadata
Title
Inequity in the use of physician services in Norway before and after introducing patient lists in primary care
Authors
Astrid L Grasdal
Karin Monstad
Publication date
01-12-2011
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2011
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/1475-9276-10-25

Other articles of this Issue 1/2011

International Journal for Equity in Health 1/2011 Go to the issue

Research

Challenges and opportunities for policy decisions to address health equity in developing health systems: case study of the policy processes in the Indian state of Orissa

Research

Association of Household and Community Characteristics with Adult and Child Food Insecurity among Mexican-Origin Households in Colonias along the Texas-Mexico Border

Research

A systematic assessment of the concept and practice of public-private mix for tuberculosis care and control

Research

Social support needs for equity in health and social care: a thematic analysis of experiences of people with chronic fatigue syndrome/myalgic encephalomyelitis

Research

Gender relations and health research: a review of current practices

Research

Do enhancements to the urban built environment improve physical activity levels among socially disadvantaged populations?