1,721,036 research outputs found
New Public Management in the Norwegian Hospital Sector: Budgeting, efficiency, and economies of scope
No full textIn the 1990s, the Norwegian hospital sector struggled with long waiting lists and a lack of cost control. In response to this, several reforms labelled under the umbrella term “New Public Management” (NPM) were introduced in the Norwegian hospital sector in the late 1990s and early 2000s. In brief terms, NPM consists of introducing management practices inspired from the private sector into the public sector, with the goal of making the public sector more efficient. The reforms introduced radical changes in how the hospitals were organized, managed, and financed. The most extensive reform was the 2002 Hospital Ownership Reform. This reform moved the ownership of the hospitals from the counties to the state, while reorganizing the hospitals as health trusts. These health trusts were organized as self-governing entities with control of their own personnel and capital.
This thesis covers a study period between 2011-2019, when the Norwegian hospital sector was relatively stable, in terms of both financing and organization. The thesis consists of three papers, as empirical studies, investigating three different aspects of the 2002 Hospital Ownership Reform one decade after its initial implementation.
Paper 1 investigates how the health trusts adapted to a model whereby they are responsible for financing both the day-to-day operations of the health trust, as well as investments. Specifically, we look at both at the degree to which the health trusts have planned for budget surpluses, and the accuracy of this planning. We furthermore investigate whether there have been any associations between structural/organizational characteristics and the accuracy of budgeted surpluses. We find that the health trust for the most part budgets for a positive result of between 0-3 per cent of total operating costs. When comparing the budgeted results with the actual results, we find indications pointing towards the health trusts being too optimistic when planning future surpluses, but we also find examples of pessimism. Larger health trusts seem to have a greater accuracy in their budgeted results than smaller health trusts, while health trusts with more a more complex pool of patients have lower accuracy in their surplus budgeting.
Paper 2 investigates one of the main objectives of the NPM reforms, namely efficiency. In the study, we first measure the efficiency of the whole hospital sector through a non-parametric method. Secondly, we investigate how NPM-related tools are related to the efficiency. We find that from 2011 to 2019, the average efficiency level of Norwegian health trusts increased somewhat. We find that a variable capturing the NPM component of incentivization is associated with the efficiency score, while a variable capturing the NPM component of competition is not associated with the efficiency of the health trusts.
Paper 3 investigates the potential presence of economies of scope in the Norwegian hospital sector. Following the 2002 Hospital Ownership Reform, the Regional Health Authorities had the freedom to decide on the separation of functions within the health region. The individual health trusts were also given greater management autonomy. Economies of scope refer to situations where cost savings occur from the joint production of services in the same unit, rather than from separate production in specialized units. For the 2013-2019 period, the study investigates whether there were any differences in average efficiency between relatively specialized and differentiated hospitals, and whether the Norwegian hospital sector was characterized by economies or diseconomies of scope While the findings concerning the first question are somewhat ambiguous, the findings concerning the second question indicate that the sector is characterized by economies of scope
Productivity in the Norwegian hospital sector: Financing, quality, coding and comparability
Get PDFNorsk sammendrag
Produktivitet blant norske sykehus: Finansiering, kvalitet, koding og internasjonal sammenlignbarhet
I en tid med aldrende befolkning og teknologisk utvikling er sykehustjenester i offentlige og universelle helsesystemer under stadig sterkere press. Sykehusforbruket til eldre er høyt, og forventninger om medisinsk og teknologisk fremskritt vil øke kostnadene ytterligere. Formålet med denne avhandlingen er å se på utviklingen i sykehusproduktivitet i perioden 1999 til 2014, og hvordan denne utviklingen har vært i forhold til måten sykehusene er finansiert på. Avhandlingen består av fire studier som belyser ulike sider av dette: 1) produktivitet og produktivitetsendringer i perioden 1999 til 2014, 2) komparativ analyse av produktivitetsendring i nordiske land, 3) forholdet mellom kvalitet og produktivitet og 4) forholdet mellom finansiering og diagnosekoding.
Studie 1 viser at produktiviteten til norske sykehus hadde en samlet gjennomsnittlig vekst på 24.6 prosent fra 1999 til 2014, eller en årlig vekst på 1.5 prosent. Den største produktivitetsveksten skjedde i årene rundt helseforetaksreformen i 2002. Etter sykehusreformen har de fleste sykehus blitt større enn det vi estimerer som optimal størrelse.
Videre sammenligner vi produktivitet blant sykehus i Norge, Sverige, Danmark og Finland. I studie 2 fant vi at gjennomsnittsproduktiviteten blant norske sykehus kun var 56.6 prosent sammenlignet med de mest produktive i Norden, som alle var finske. Dersom vi kun sammenligner norske sykehus med andre norske sykehus er den (tekniske) effektiviteten imidlertid like høy innad i Norge som innad i Finland. En mulig forklaring på ulik produktivitet er kvalitetsforskjeller. I studie 3 finner vi store forskjeller mellom sykehus når det gjelder både reinnleggelsesrater og mortalitet. Norske sykehus har generelt høyere reinnleggelsesrater enn de andre nordiske landene, men lavest mortalitetsrater. Sammenhengen mellom kvalitet og produktivitet er ikke entydig.
En alternativ forklaring på produktivitetsforbedringene er at sykehusene har blitt bedre til å dokumentere diagnosene til pasientene. Dette kan føre til at sammenligninger over tid vil overdrive utviklingen av økt produksjon. Vi finner i studie 4 at det er en viss sammenheng mellom prisinsentiv og bruk av kompliserende diagnosekoder. Imidlertid er effekten av prisendring langt mindre. Studiene i denne avhandlingen er alle basert på analyser av data fra Norsk pasientregister i tillegg til data innsamlet fra sykehusregnskap. Statistiske metoder velegnet for store datasett har blitt benyttet.English summary
Productivity in the Norwegian hospital sector: Financing, quality, coding and comparability
In a time of aging populations and technology improvements, hospital services in universal public systems are under increasing pressure. Hospital utilization rates are also relatively greater for elderly, and expectations of medical and technological improvements will continue to increase costs.
The aim of this thesis is to identify developments in hospital productivity and its relation to the funding of the hospital sector in Norway during the period 1999 to 2014. The thesis contains four studies: 1) hospital productivity and productivity changes during the period 1999 to 2014, 2) a comparative analysis of hospital productivity growth in Nordic countries, 3) the relationship between hospital quality and productivity, and 4) the relationship between hospital financing and diagnostic coding.
In study 1 we found that the productivity of Norwegian hospitals had an average weighted growth of 24.6% from 1999 to 2014, or an annual increase of 1.5%. The largest gains occurred around the implementation of the hospital ownership reform in 2002. After the hospital reform, most hospitals are larger than what we estimate as optimal size.
Further we compare productivity amongst hospitals in Norway, Sweden, Denmark and Finland. In study 2 we estimated the mean productivity in Norway to be 56.6 per cent compared to the best Nordic hospitals, all being Finnish. If we compare productivity only within each country, the (technical) efficiency in Norway is as high as in Finland. A possible explanation of productivity differences is quality differences. In study 3 we found large differences between hospitals regarding both readmission rates and mortality. Norway had higher readmission rates than the other countries, but the lowest mortality rates. No clear cost–quality trade-off pattern was revealed.
An alternative explanation of productivity growth is that hospitals have changed diagnostic coding practices. This would exaggerate the measurable productivity growth over time. Study 4 show that there is an association between price incentive and the use of complicated diagnoses. However, the effect of price changes is smaller. The studies in this these are all based on register data from the Norwegian Patient Registry, as well as hospital cost accounting data. Statistical methods suited for large dataset have been utilized
User need and resource allocation in public long-term care. The use of disability and impairment instruments: Application on a large Norwegian municipality
Get PDFSummary:
In the coming decades, the European countries will witness great demographic changes.
Within the next 25 years, the number of people aged 80 years or older will double. The
elderly’s overall use of resources will increase considerably. Disability is the most
important cause of the amount of care needed. The overall aim of this thesis is to assess
the relationship between factors describing disability and impairment and the use of
long-term care services both in a nursing home setting and at home.
Since 2006, all Norwegian municipalities have been required to assess user needs using
a standardised national registration system (IPLOS) that contains variables describing
physical disability and cognitive impairment. This is the only instrument used across all
Norwegian municipalities. Here, we utilised the same variables as those used in the
national registration system and combined them with detailed time studies with
recipients in the municipality of Trondheim.
Our findings from study 3 show that the Norwegian instrument had difficulties in
differentiating the need of the least disabled elderly individuals. However, this is a wellknown
problem of disability instruments due to the trade-off between administrative
burden and an “ideal” instrument. Introducing new variables to close these gaps should
be considered.
In study 1, we found that the amount of individual care received depends on both
individual disability and differences between nursing homes. Approximately ¼ of
individual differences could be explained by differences between nursing homes.
Furthermore, we found that within a financial reimbursement model with no adjustment
for case-mix, the amount of care that patients receive depends not only on the patients’
own needs but also on the needs of all the other residents. Thus, if one lives with less
disabled patients, one receives more care than an individual who lives with more
heavily disabled patients.
In study 2, we found that home-dwelling elderly’s public use of care could largely be
explained by disability and cognitive impairment. IPLOS seems to explain use of public
care to the same extent as other indices. Those with comorbidity received 21 percent
more public care than others. Those living alone received more public care than those
living with others. Cohabiting women received approximately 30 percent less care than
those living alone, while cohabiting men received approximately 50 percent less care.
Furthermore, we found that behaviour is the most important predictor of the amount of
public care for intellectually disabled persons but that help in performing everyday
activities is also important for these persons, as it is for elderly individuals. Care from
relatives or other private care is complementary and does not affect the amount of
public care. Thus care from relatives or others act as a substitute for public care for
home-dwelling elderly while it is complementary to public care for intellectually
disabled persons.
The results from this study could be used in overall administrative planning of public
long-term care. The municipality of Trondheim has changed its reimbursement model
for nursing homes and home-dwelling elderly since these results were found.
Furthermore, the municipality is now changing its reimbursement system for
intellectually disabled persons according to the results of this study.Oppsummering (Norwegian summary):
Europeiske land står overfor store demografiske endringer. Antall eldre over 80 år vil
dobles i løpet av de neste 25 årene og sterkest vil veksten bli etter 2020. Samfunnets
ressursinnsats til eldre med hjelpebehov kommer til å øke kraftig. Vi vet videre at
funksjonsnivå er den viktigste predikatoren for eldre sitt hjelpebehov. Hovedmålet med
denne studien var å undersøke sammenhengen mellom individuelle variasjoner i
funksjonsnivå og offentlig ressursinnsats. Både for de som mottar heldøgns tjenester
som for eksempel sykehjemstjenester, og hjemmeboende som mottar punkthjelp.
I 2006 ble det innført et nasjonalt system i Norge (IPLOS) som innehar en
funksjonsevaluering. Instrumentet brukes i alle norske kommuner og for alle personer
som mottar offentlige pleie og omsorgstjenester. I denne studien har vi brukt de
funksjonsvariablene som brukes i IPLOS. Studien har sett på mottakere av tjenester i
Trondheim kommune.
Funnene fra studie 3 viser at det norske instrumentet har problemer med å predikere
forskjeller i hjelpebehov hos de friskeste eldre. Det må hele tiden gjøres avveininger
mellom ideell utforming og administrativ ressursbruk. Og de fleste instrumenter har
problemer med å predikere hjelpebehov langs deler av kontinuumet fra helt frisk til fult
hjelpebehov. Likevel er vurderingen at det norske systemet burde hatt flere variabler
som kunne bidratt til en bedre predikering av hjelpebehov hos de friskeste eldre.
I studie 1 fant vi at forskjeller i mengde hjelp den enkelte pasient mottar på sykehjem
kan forklares både ut fra individuelle forskjeller i funksjonsnivå og forskjeller mellom
sykehjem. Totalt kan ¼ av individuelle forskjeller forklares med ulik praksis mellom
sykehjemmene. Videre fant vi at i en situasjon hvor alle pasienter budsjetteres med
samme beløp så vil hjelpen den enkelte pasient mottar ikke bare avhenge av den enkelte
pasients funksjonsnivå, men også funksjonsnivå til alle andre pasienter på samme
sykehjem. Det vil si; bor du sammen med friskere pasienter så mottar du mer hjelp enn
dersom du bor sammen med sykere pasienter, gitt at du har samme funksjonsnivå i
begge tilfeller.
I studie 2 fant vi at offentlig ressursbruk til hjemmeboende eldre i stor grad kan
forklares med funksjonsnivå. Her ser IPLOS ut til å kunne forklare ressursbruk på lik
linje med andre brukte instrumenter. Videre fant vi at de med mer komplekse
sykdomsbilder (målt med comorbiditet) mottar 21 prosent mer offentlig hjelp enn andre.
Aleneboende eldre mottar mer offentlig hjelp enn de som bor sammen med noen.
Kvinner med samboere mottar omtrent 30 prosent mindre hjelp enn aleneboende, mens
menn med samboere mottar omtrent 50 prosent mindre hjelp enn aleneboende. Videre
fant vi at for personer med psykisk utviklingshemming er adferd den viktigste
predikatoren for offentlig ressursbruk, men hjelp til dagligdagse aktiviteter er også
viktig for denne gruppen. Hjelp fra pårørende eller andre bistandspersoner kommer i
tillegg til og ikke som erstatning for offentlig hjelp. Pårørende sin innsats slår dermed
ulikt ut i offentlig ressursbruk for eldre hjemmeboende enn for psykisk
utviklingshemmede.
Resultatene fra denne studien kan brukes i planlegging av tjenester til eldre og psykisk
utviklingshemmede personer. Trondheim kommune har etter denne studien endret sine
budsjetteringssystemer på sykehjem og for hjemmeboende eldre, og er i gang med å
endre sine budsjetteringssystemer for psykisk utviklingshemmede
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
An Assessment on the Effect of Capitation on Cost and Utilization of Health Services: A Case of The National Health Insurance Authority of Ghana
Get PDFIt is common knowledge that responsiveness towards healthcare utilization, cost of service delivery in terms of cost containment may be influenced by the method of reimbursing service providers. Most often it has the hypothesis is that, capitation form of reimbursement reduces cost of drugs and services, checks over prescription, unnecessarily referral which in the long run leads to over utilization of services. The aforementioned, if left unchecked culminates in escalating cost of health care. To assess the impact of capitation as a provider payment method in the operations of the National Health Insurance Authority of Ghana. We use data categorized under two main groups; the capitated group and the non-capitated group to examine the impact of the capitation policy on health service utilization and expenditure in the outpatient department. The study employed difference-in-difference approach in analyzing the difference in the trends before and after the introduction of the capitation policy. Multiple linear regression model was used to estimate effects on cost per member and utilization per member between the two groups and the two periods.
Findings from the study reveals that, there was a general decline in the in OPD cost per member and OPD utilization per member at result of the capitation policy. Evidence from the study indicates that enrollees in the Ashanti region which represent the capitated group significantly consumed less health services per member by 1.793 units as compared to the Brong-Ahafo region (non-capitated group). Although the capitation coefficient on OPD cost per member indicated a decline, evidence from the results shows that the decline was not statistically significant. In conclusion, there was a considerable evidence to reject the claim that there is statistically significant difference between OPD utilization per member between the capitated and the noncapitated group before and after the introduction of the capitation policy. In contrast to the study hypothesis, it failed to reject the null hypothesis that trend between the two groups within the two period has no different effect on the cost of services per member because of the capitation policy. Access to data and the use of data on cost which was not adjusted for inflation were the limitations that challenged the study
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
An Assessment on the Effect of Capitation on Cost and Utilization of Health Services: A Case of The National Health Insurance Authority of Ghana
No full textIt is common knowledge that responsiveness towards healthcare utilization, cost of service delivery in terms of cost containment may be influenced by the method of reimbursing service providers. Most often it has the hypothesis is that, capitation form of reimbursement reduces cost of drugs and services, checks over prescription, unnecessarily referral which in the long run leads to over utilization of services. The aforementioned, if left unchecked culminates in escalating cost of health care. To assess the impact of capitation as a provider payment method in the operations of the National Health Insurance Authority of Ghana. We use data categorized under two main groups; the capitated group and the non-capitated group to examine the impact of the capitation policy on health service utilization and expenditure in the outpatient department. The study employed difference-in-difference approach in analyzing the difference in the trends before and after the introduction of the capitation policy. Multiple linear regression model was used to estimate effects on cost per member and utilization per member between the two groups and the two periods.
Findings from the study reveals that, there was a general decline in the in OPD cost per member and OPD utilization per member at result of the capitation policy. Evidence from the study indicates that enrollees in the Ashanti region which represent the capitated group significantly consumed less health services per member by 1.793 units as compared to the Brong-Ahafo region (non-capitated group). Although the capitation coefficient on OPD cost per member indicated a decline, evidence from the results shows that the decline was not statistically significant. In conclusion, there was a considerable evidence to reject the claim that there is statistically significant difference between OPD utilization per member between the capitated and the noncapitated group before and after the introduction of the capitation policy. In contrast to the study hypothesis, it failed to reject the null hypothesis that trend between the two groups within the two period has no different effect on the cost of services per member because of the capitation policy. Access to data and the use of data on cost which was not adjusted for inflation were the limitations that challenged the study
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
- …
