Essays on policy instruments and incentives in health care in Norway

Abstract

Equal access to quality health care services, efficient resource use and cost containment are Norway’s health care policy objectives. To reach these goals, policymakers use financial incentives and organizational structures. Efficient use of these policy instruments requires that policymakers understand how health care providers and users react to them. This thesis contributes to this knowledge. The first two papers present research into financial incentives. In 2008, policymakers changed the reimbursement scheme for radiology providers to cut costs. Paper 1 examines how the change supplemented the general practitioner (GP) gatekeeping role. Paper 2 evaluates how the change affected the provision of radiology at the municipality level in different regions and centralities, depending on difference in travel time between private and public radiology providers. Paper 3 studies the organizational structure of the Norwegian regular GP scheme where patients can change GPs twice a year. This paper identifies patterns in disenrollment among patients with chronic diseases. Such patterns could indicate otherwise unobserved care quality.