The private-public puzzle of a decentralised national health system
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AbstractAlthough the Norwegian healthcare system serves as a typical example of a Scandinavian welfare state model, based on public funding and ownership of the hospitals, the turn of the millennium introduced an increase in the supply of private specialised healthcare. While the increase was mainly in services produced by private for-profit hospitals, the private contract specialists represent a rather stable private element within the Norwegian healthcare system. Analysing the supply of private contract specialists and public medical specialist man labour years within the Norwegian counties during the 1991-2001 period, high revenues were found to increase the supply of public specialists, whereas low revenues forced the counties to be innovative and utilise more private supply. Moreover, counties with a high share of the representatives coming from a conservative party had a higher share of private medical specialist man labour years than other counties.
As for medical specialists’ sector choices, high valuation of autonomy and flexibility in the job situation was positively associated with having a private sector job. Conversely, high appreciation of professional values was positively correlated to having a public sector job. Positive assessment of professional and payment and benefit values was strongly associated with combining private and public jobs rather than working full-time privately. Furthermore, geographical proximity to a city was positively associated with having a position within the private sector. Physicians working in the private sector and physicians combining private and public jobs spent more time on patient assignments than publicly employed physicians do. Publicly employed physicians allocate more time to administrative and research/educational tasks. This suggests that work time allocations mirror the differences in on-call commitments, wage incentives and the division of labour between the sectors.
List of papers
|I: The private–public mix of healthcare: evidence from a decentralised NHS country. Health Economics, Policy and Law (2006) 1(3): 277– 298. (With Terje P. Hagen). Health Economics, Policy and Law (2006) 1(3): 277–298. The paper is not available in DUO. The published version is available at: http://dx.doi.org/10.1017/S1744133106003045|
|II: Private or public? An empirical analysis of the importance of work values for work sector choice among Norwegian medical specialists. Social Science & Medicine (2007) 64(6):1265–1277. The paper is not available in DUO. The published version is available at: http://dx.doi.org/10.1016/j.socscimed.2006.11.003|
|III: Labour supply among medical specialists in private and public sector: Pecuniary and non-pecuniary explanations. (UPUBLISERT) The paper is not available in DUO.|
|IV: Medical specialists’ allocation of working time. Health Policy (2007), doi: 10.1016/j.healthpol.2007.01.010 (artikkelen var “in press” da avhandlingen ble levert, men har senere blitt trykt i Health Policy: volume 83, issue 1, pages 114-127). Health Policy: volume 83, issue 1, pages 114-127). The paper is not available in DUO. The published version is available at: http://dx.doi.org/10.1016/j.healthpol.2007.01.010|