Trial Lecture – time and place
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Adjudication committee
- First opponent: Professor emeritus Kjell Haug, University of Bergen
- Second opponent: Special Adviser Lise Balteskard, Helse Nord HF
- Third member and chair of the evaluation committee: Professor Ragnhild Hellesø, University of Oslo
Chair of the Defence
Professor Anne Moen, University of Oslo
Principal Supervisor
Head of Institute Terje P Hagen, University of Oslo
Summary
Several countries with tax-based universal health systems struggle to contain healthcare costs without compromising quality of care and equal access to health services. Increased use of private for-profit hospitals (PFPs) is often discussed and used as a policy option. However, limited knowledge exists about the effects of expanded use of PFPs in universal health systems.
This thesis investigates whether the Norwegian government can contain costs through outsourcing elective surgical procedures to private for-profit hospitals, without compromising quality of care and the fundamental principle of equal access to health services irrespective of socioeconomic status.
The analyses performed in the thesis employed a variety of regression models and techniques for risk adjustment. We analyzed contracts between PFPs and the respective regional health authority, and studied all publicly-financed patients in the ‘free hospital choice system’ in Norway using patient data from the Norwegian Patient Register, and data on education and income from Statistics Norway.
The thesis found indications that the way Norway uses PFPs results in lower prices per procedure without compromising quality of care. However, public hospitals treated the most severe patients and received the larger share of the readmitted patients across hospital types. Public hospitals thus play an essential role in the care of more complex patients. The evidence from our study also suggests that equal access to PFPs compared to non-profit hospitals may be compromised for patients at the lowest income and education levels. The findings raise questions about patient preferences versus cream skimming, and whether the differences are appropriate in terms of both payment levels and achieving the best possible outcomes.
Additional information
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