RESUMEN

KNOWLEDGE TRANSFER STATEMENT: The EU PRUDENT project aims to enhance the financing of oral health systems through novel evidence and implementation of better financing solutions together with citizens, patients, providers, and policy makers. The multicountry nature of the project offers unique windows of opportunity for rapid learning and improving within and across various contexts. PRUDENT is anticipated to strengthen capacities for better oral care financing in the EU and worldwide.

Asunto(s)

Odontología , Motivación , Humanos

RESUMEN

OBJECTIVES: This paper describes the principles of economics and their application to the promotion, protection and restoration of oral health in populations and the planning, management and delivery of oral health care. After illustrating the economic determinants of oral health, the demand for oral health care is discussed with particular reference to asymmetric information between patient and provider. The reasons for the market failure in (oral) health care and their implications for efficiency and equity are explained. We go on to describe how economic evaluation contributes to policies aimed at maximising oral health gains where resources are constrained. The behavioural aspects of patients´ demand for and dental professionals´ provision of oral health services are discussed. Finally, we outline methods for planning the dental workforce in ways that reflect system goals.

Asunto(s)

Atención a la Salud , Economía , Análisis Costo-Beneficio , Humanos

RESUMEN

OBJECTIVE: To compare the prevalence of pre-eclampsia in migrant women with Norwegian women, and to study the prevalence of pre-eclampsia by length of residence in Norway. DESIGN: Observational study. SETTING: The Medical Birth Registry of Norway. POPULATION: All Norwegian, Pakistani, Vietnamese, Somali, Sri Lankan, Filipino, Iraqi, Thai and Afghan women who gave birth after 20 weeks of gestation during the period 1986-2005 in Norway. METHODS: The prevalence of pre-eclampsia was calculated by country of birth. The association of country of birth and length of residence in Norway with pre-eclampsia was estimated as the odds ratio (OR) with 95% confidence interval (CI), using Norwegian women as a reference. We made adjustments for maternal age, parity, multifetal pregnancy, year of delivery and maternal diabetes in multivariable analysis. MAIN OUTCOME MEASURE: Pre-eclampsia. RESULTS: Migrant women had a lower prevalence of pre-eclampsia than Norwegian women (2.7% versus 3.7%, P < 0.001). Vietnamese (OR, 0.36; CI, 0.29-0.45), Afghan (OR, 0.52; CI, 0.30-0.90) and Thai (OR, 0.57; CI, 0.45-0.73) women had the lowest risk of pre-eclampsia relative to Norwegian women. Adjustment for the variables above or separate analyses for nulliparous women did not change the estimates notably. Using Norwegian women as the reference, the risk of pre-eclampsia increased by length of residence for migrant women: adjusted OR of 0.64 (0.59-0.70) at <5 years and 0.91 (0.84-0.99) at ≥5 years of residence. CONCLUSIONS: The risk of pre-eclampsia was lower in migrants relative to Norwegian women, but increased by length of residence in Norway.

Asunto(s)

Emigrantes e Inmigrantes , Preeclampsia/etnología , Adulto , Femenino , Humanos , Modelos Logísticos , Análisis Multivariante , Noruega/epidemiología , Oportunidad Relativa , Preeclampsia/epidemiología , Embarazo , Prevalencia , Sistema de Registros , Riesgo

RESUMEN

In the present investigation we aimed to analyse causally the pattern of determinants leading to the maintenance of functional teeth in adults. Clinical and self-reported information was used. The hypothesis was that socio-economic conditions operate through psychosocial circumstances that influence lifestyle, and are thus related to oral hygiene and levels of remaining teeth. Testing of the patterns for adults residing in high- and low-fluoride areas did not reveal any principal differences in dental health, therefore further testing was combined for both fluoride areas. Further analysis also indicated that testing should be performed separately for each gender. Social structure and dental health-related lifestyle were important in an overall pattern of maintaining functional teeth, but general lifestyle and psychosocial conditions were not found to be part of the pattern influencing dental health. Gender-specific patterns were revealed. New hypotheses may be suggested for further research with regard to studying patterns of dental health in Lithuanian adults.

Asunto(s)

Caries Dental/epidemiología , Salud Bucal , Clase Social , Pérdida de Diente/epidemiología , Adulto , Causalidad , Índice CPO , Atención Odontológica/estadística & datos numéricos , Dieta , Femenino , Conductas Relacionadas con la Salud , Humanos , Estilo de Vida , Lituania/epidemiología , Masculino , Modelos Estadísticos , Higiene Bucal , Factores de Riesgo , Factores Sexuales

RESUMEN

The focus of the present study is to examine whether supplier-induced demand exists for primary care physician services in Norway. We compare how two groups of physicians, with and without incentives to induce, respond to increased competition. Contract physicians receive their income from fee-for-item payments. They have an incentive to compensate for a lack of patients by inducing demand for services. Salaried physicians receive a salary which is independent of output. Even though increased competition for patients reduces the availability of patients, they have no financial incentive to induce. Neither of the two groups of physicians increased their output as a response to an increase in physician density. This result could be expected for salaried physicians, while it provides evidence against the inducement hypothesis for contract physicians.

Asunto(s)

Servicios Contratados/economía , Empleo/economía , Medicina Familiar y Comunitaria/economía , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Pautas de la Práctica en Medicina/economía , Planes de Aranceles por Servicios , Humanos , Modelos Econométricos , Noruega , Atención Primaria de Salud/estadística & datos numéricos , Salarios y Beneficios , Factores Socioeconómicos , Encuestas y Cuestionarios , Recursos Humanos

RESUMEN

The aim of this study was to identify possible factors associated with the marked geographical variation in supply of public dental services in Norway. We identified three sources for this uneven distribution: differences in dental care needs, differences in revenue levels between counties, and differences in the party composition of the county councils. Analyses were undertaken to ascertain whether these factors were related to the variation in the number of man-labor years of public dental officers. The analyses were performed on a set of data from Norwegian counties for the period 1985-92. There was an association between the number of man-labor years of public dental officers and our indicators of dental care needs, county revenue, and party composition of the county councils. Our findings are encouraging, as they indicate that the county councils seemed to respond to the dental care needs of the local population. On the other hand, there were inequalities in supply of public dental services that were due to differences in revenue between counties. From an equity point of view, this inequality is undesirable. The inequality could most likely be reduced by decreasing the variation in revenue between counties. Differences in party composition of the county councils had only a small effect on the geographical variation in the number of man-labor years of public dental officers.

Asunto(s)

Servicios de Salud Dental/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Odontología en Salud Pública/estadística & datos numéricos , Adolescente , Niño , Preescolar , Servicios de Salud Dental/economía , Odontólogos/provisión & distribución , Accesibilidad a los Servicios de Salud/economía , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Humanos , Renta , Lactante , Gobierno Local , Noruega , Política , Odontología en Salud Pública/economía , Análisis de Regresión , Análisis de Área Pequeña , Recursos Humanos

RESUMEN

BACKGROUND: The aim of this study was to examine general practitioners' choice of contract and location in Norway. GPs can choose between two types of contract: a contract by which they are paid a salary, and a contract by which they are paid on a fee-for-service basis plus a fixed grant. METHOD: The data were collected by a questionnaire sent to a representative sample of GPs in Norway (N = 1,639). RESULTS: Salaried physicians and contract physicians show different characteristics. Salaried physicians tend to be younger than contract physicians and to prefer leisure to higher income. Most salaried physicians were located in rural areas. The following tendencies were observed with respect to location: GPs wanted to move from rural to central areas. Physicians who reported that their workload was too high, wanted to move to an area where the workload was lower. Physicians who reported that they had too few patients did not want to move. Physicians who were often on duty to provide emergency services wanted to move. INTERPRETATION: According to standard market theory, physicians are expected to move to areas where demand is high when demand in their own areas falls. Our results indicate that public regulation is necessary in order to obtain an optimal distribution of physicians.

Asunto(s)

Medicina Familiar y Comunitaria/economía , Planes de Aranceles por Servicios , Médicos de Familia/psicología , Salarios y Beneficios , Adulto , Factores de Edad , Actitud del Personal de Salud , Medicina Familiar y Comunitaria/estadística & datos numéricos , Femenino , Necesidades y Demandas de Servicios de Salud , Humanos , Satisfacción en el Trabajo , Actividades Recreativas , Masculino , Área sin Atención Médica , Persona de Mediana Edad , Noruega , Médicos Mujeres/psicología , Salud Rural , Encuestas y Cuestionarios , Salud Urbana , Carga de Trabajo

RESUMEN

Dental services for adults are different from all other Norwegian health services in that they are provided by private producers (dentists) who have full freedom to establish a practice. They have had this freedom since the end of World War II. A further liberalization of the market for dental services occurred in November 1995, when the so-called normal tariff was repealed. The system changed from a fixed fee system to a deregulated fee system. In principle, the market for dental services for adults operates as a free competitive market, in which dentists must compete for a market share. The aim of this study was to study the short-term effects of competition. A comprehensive set of data on fees, practice characteristics, treatment profiles and factors that dentists take into account when determining fees was analysed. The main finding was that competition has a weak effect. No support was found for the theory that the level of fees is the result of monopolistic competition or monopoly. The results also provided some evidence against the inducement hypothesis. At this stage, it is interesting to notice that dentists do not seem to exploit the power they have to control the market. One explanation, which is consistent with the more recent literature, is that physicians' behaviour to a large extent is influenced by professional norms and caring concerns about their patients. Financial incentives are important, but these incentives are constrained by norms other than self-interest. The interpretation of the results should also take into account that the deregulation has operated for a short time and that dentists and patients may not yet have adjusted to changes in the characteristics of the market.

Asunto(s)

Competencia Económica , Honorarios Odontológicos/estadística & datos numéricos , Administración de la Práctica Odontológica/economía , Adulto , Sector de Atención de Salud , Necesidades y Demandas de Servicios de Salud , Humanos , Modelos Econométricos , Noruega

RESUMEN

The paper examines productivity in the provision of public dental services in Norway. The main responsibility of the public dental services is to provide care for all children up to 18 years of age. Most dental care is provided by public dental officers. Productivity was measured by estimating a stochastic production frontier from input and output data from the public dental service in Norway. The results indicate that there are increasing returns to scale. Our measure of technical efficiency showed that the level of inefficiency is fairly small. However, the inefficiency is greater when estimated from a deterministic production frontier rather than from a stochastic frontier. One limitation of the present methodology is that it does not say anything about the level of efficiency in the Norwegian public dental service in absolute terms. A greater level of inefficiency would have been identified if a few counties had performed clearly better than the rest.

Asunto(s)

Servicios de Salud Dental/organización & administración , Eficiencia Organizacional , Odontología en Salud Pública/normas , Adolescente , Niño , Servicios de Salud del Niño/organización & administración , Preescolar , Atención a la Salud , Humanos , Modelos Econométricos , Noruega , Evaluación de Programas y Proyectos de Salud

RESUMEN

Most western countries employ a combination of fee-for-service, fixed salary and per capita subsidies to finance the services of general practitioners. Based on Norwegian data, the authors demonstrate that these financial schemes have been used in different types of municipalities. The authors argue that the fee-for-service and per capita components should be allowed to vary between primary physicians and municipalities: (a) If the patient population per primary physician is low and patient supply is unstable, the per capita subsidy or work-free income should be differentiated to ensure recruitment of physicians. (b) Physicians in municipalities with low physician coverage should be allotted a low basic grant, whilst per capita subsidy and fee-for-service payments should be used to stimulate service production. The opposite situation exists where there is a potential of supplier inducement due to high physician coverage. (c) The responsibility for designing contracts should be assigned to local rather than national authorities. These suggestions go against important elements in the reform of primary physician services in Norway.

Asunto(s)

Capitación/organización & administración , Servicios Contratados/organización & administración , Medicina Familiar y Comunitaria/organización & administración , Planes de Aranceles por Servicios/organización & administración , Pautas de la Práctica en Medicina/organización & administración , Ubicación de la Práctica Profesional/estadística & datos numéricos , Selección de Profesión , Humanos , Modelos Econométricos , Noruega , Densidad de Población , Salarios y Beneficios/estadística & datos numéricos , Carga de Trabajo

Asunto(s)

Odontología Comunitaria/organización & administración , Servicios de Salud Dental/organización & administración , Eficiencia Organizacional , Investigación sobre Servicios de Salud/métodos , Niño , Odontología Comunitaria/normas , Servicios de Salud Dental/normas , Política de Salud , Humanos , Noruega , Odontología en Salud Pública/organización & administración , Odontología en Salud Pública/normas , Análisis de Regresión , Reproducibilidad de los Resultados , Procesos Estocásticos , Reino Unido

RESUMEN

This study examines the relationship between supply of primary physicians and consumer satisfaction with access to, and quality of, primary physician services in Norway. The purpose is to throw light on a long-standing controversy in the literature on supplier inducement (SID): the interpretation of the positive association between physician density and per capita utilization of health services. We find that an increase in the number of physicians leads to improved consumer satisfaction, and that the relationship between satisfaction and physician density exhibits diminishing returns to scale. Our results suggest that policy-makers can compute the socially optimal density of physicians without knowledge about whether SID exists, if one accepts the (controversial) assumption that consumer satisfaction is a valid proxy for patient utility.

Asunto(s)

Comportamiento del Consumidor/estadística & datos numéricos , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Médicos de Familia/provisión & distribución , Asignación de Recursos para la Atención de Salud , Accesibilidad a los Servicios de Salud , Humanos , Área sin Atención Médica , Modelos Estadísticos , Noruega

RESUMEN

The present paper examines whether supplier-induced demand exists for primary physician services in Norway. The research design is adapted to the institutional setting of Norwegian primary physician services, where there is a fixed fee schedule. More than 50% of primary care physicians receive a payment for treatment from the National Insurance Administration on a fee-for-item basis. The results showed that increased competition, measured as a high physician:population ratio, led to a decline in the number of consultations per contract physician. However, the contract physicians in high physician density areas did not compensate for the lack of patients by providing more items of treatment in order to maintain their income. Contract physicians' revenue from items of treatment per consultation were unaffected both by physician density and by the number of consultations per contract physician. These results are further corroborated by data that showed that contract physicians' gross revenue and profits were declining functions of physician density. This paper argues that, from an efficiency point of view, a deregulated health care market with fixed fees may operate well.

Asunto(s)

Competencia Económica/economía , Tabla de Aranceles/economía , Planes de Aranceles por Servicios/economía , Necesidades y Demandas de Servicios de Salud/economía , Atención Primaria de Salud/economía , Femenino , Política de Salud , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Humanos , Análisis de los Mínimos Cuadrados , Masculino , Modelos Econométricos , Noruega , Factores Socioeconómicos , Recursos Humanos

RESUMEN

The future demand for dental care in Norway is discussed on the basis of economic theory. During the next 30 years gross national income will increase substantially due to a marked increase in national income from the sale of oil and gas. On the basis of the model we predict that this increase in income will lead to an increase in demand for dental services in the short run, say for the next 10-15 years. To a large extent this increase in demand is supported by evidence from dental epidemiology. In particular, an increasing proportion of elderly dentate people will demand more services. This picture is different in the long run, say from the year 2010-15 and onwards. Evidence from dental epidemiology indicates that at that stage there will be a fairly high proportion of disease-free individuals in the population who will demand less dental care. Such a trend is also supported by economic theory as long as disease-free individuals consume less dental care irrespective of their income.

Asunto(s)

Atención Odontológica/tendencias , Predicción , Necesidades y Demandas de Servicios de Salud/tendencias , Control de Costos/economía , Control de Costos/estadística & datos numéricos , Control de Costos/tendencias , Atención Odontológica/economía , Atención Odontológica/estadística & datos numéricos , Necesidades y Demandas de Servicios de Salud/economía , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Humanos , Noruega , Factores Socioeconómicos

RESUMEN

A number of empirical studies have shown that there is a negative association between population:physician ratio and utilization of medical services. However, it is not clear whether this relationship reflects supplier-inducement, the effect of lower prices on patient demand, a supply response to variation in health status, or improved availability. In Norway, patient fees and state reimbursement fees are set centrally. Therefore, the correlation between utilization and population:physician ratio either reflects supplier-inducement, a supply response or an availability effect. We applied a theoretical model which distinguished between an inducement and an availability effect. The model was implemented on a cross-sectional data set which contained information about patient visits and laboratory tests for all fee-for-service primary care physicians in Norway. Since population:physician ratio is potentially endogenous, an instrumental variable approach is used. We found no evidence for inducement either for number of visits or for provision of laboratory services.

Asunto(s)

Encuestas de Atención de la Salud/métodos , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Modelos Econométricos , Médicos de Familia/provisión & distribución , Técnicas de Laboratorio Clínico , Servicios Contratados/estadística & datos numéricos , Estudios Transversales , Planes de Aranceles por Servicios/estadística & datos numéricos , Honorarios Médicos/estadística & datos numéricos , Necesidades y Demandas de Servicios de Salud/economía , Humanos , Noruega , Visita a Consultorio Médico/estadística & datos numéricos , Médicos de Familia/economía , Densidad de Población , Análisis de Regresión

Asunto(s)

Eficiencia , Práctica Odontológica de Grupo/economía , Costos de la Atención en Salud/estadística & datos numéricos , Administración de la Práctica Odontológica/economía , Pautas de la Práctica en Odontología/estadística & datos numéricos , Práctica Privada/economía , Toma de Decisiones , Práctica Odontológica de Grupo/estadística & datos numéricos , Investigación sobre Servicios de Salud , Modelos Econométricos , Noruega , Administración de la Práctica Odontológica/estadística & datos numéricos , Práctica Privada/organización & administración , Análisis de Regresión , Encuestas y Cuestionarios

RESUMEN

Future treatment needs for dental services are discussed in the perspective of the objective which the services are meant to fulfill. These are, broadly speaking, equal distribution of services and economic efficiency. Within the Nordic countries, the emphasis has been on equity, perhaps less on efficiency. Equity of utilization is best understood as being a situation where patients with equal needs for oral health care receive equal treatment, in terms of both the volume and the quality of the services. The justification for arguing that equality of utilization is the appropriate measure is mainly based on the externality argument: health-care consumption by one person may be the source of utility to another person. According to that view there are two beneficiaries of dental care: the patient who is sick, and the rest of society who care for the sick patient and who derive utility from seeing the patient become healthy. The public dental services for children in the Nordic countries are organized according to the principle of equity of utilization. Equity of access is best understood as being a situation where people with equal needs have equal opportunity to use dental services. It is a supply-side phenomenon; equal access is achieved when patients with the same needs face the same costs of dental-care consumption in terms of both time and money. The oral health situation among children, adults and the elderly is exemplified by national service data and recent studies.

Asunto(s)

Cuidado Dental para Ancianos/tendencias , Atención Dental para Niños/tendencias , Atención Odontológica/tendencias , Necesidades y Demandas de Servicios de Salud/tendencias , Adolescente , Adulto , Anciano , Niño , Preescolar , Atención Odontológica/economía , Atención Odontológica/organización & administración , Atención Odontológica/estadística & datos numéricos , Cuidado Dental para Ancianos/economía , Cuidado Dental para Ancianos/organización & administración , Cuidado Dental para Ancianos/estadística & datos numéricos , Atención Dental para Niños/economía , Atención Dental para Niños/organización & administración , Atención Dental para Niños/estadística & datos numéricos , Predicción , Costos de la Atención en Salud , Accesibilidad a los Servicios de Salud/tendencias , Humanos , Persona de Mediana Edad , Programas Nacionales de Salud/economía , Programas Nacionales de Salud/organización & administración , Programas Nacionales de Salud/estadística & datos numéricos , Programas Nacionales de Salud/tendencias , Odontología en Salud Pública/economía , Odontología en Salud Pública/organización & administración , Odontología en Salud Pública/tendencias , Calidad de la Atención de Salud , Países Escandinavos y Nórdicos

RESUMEN

Public responsibility for health care can be justified by ambitious egalitarian objectives, as it is commonly believed that the private sector generates greater disparities than the public sector. Government institutions can be designed to achieve equality in provision of health services. The article addresses the geographical distribution of primary care physicians in Norway, where primary physician services are the responsibility of local governments, primarily financed by general taxation. The authors analyze the allocation of physicians using a local government demand model, a synthesis of consumers' demand and local government resource allocation. Analyses were performed on a panel data set of all Norwegian municipalities covering the period 1986-1992. The results are encouraging. A decentralized system of primary physician services does seem to be fairly effective in securing equity in access to these services for the municipal population. In particular, local governments seem to respond well to the health care needs of their populations. Distribution of physicians is only to a very small extent dependent on the wealth of the municipality.

Asunto(s)

Toma de Decisiones en la Organización , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Gobierno Local , Atención Primaria de Salud , Medicina Estatal/estadística & datos numéricos , Comportamiento del Consumidor , Asignación de Recursos para la Atención de Salud/legislación & jurisprudencia , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Humanos , Noruega , Atención Primaria de Salud/legislación & jurisprudencia , Medicina Estatal/legislación & jurisprudencia , Recursos Humanos

RESUMEN

The present paper discusses the geographical distribution of physicians employed in municipal primary care. In Norway, primary medical services are the responsibility of the local public authority (the municipality) and are financed primarily by the general taxation. The allocation of physicians is analysed using a municipal demand model. The model is a synthesis of consumers' demand and allocation of municipal funds. Analyses were performed on a panel data set of all Norwegian municipalities covering the period 1986-92. The results are encouraging, since they indicate that a decentralised system of primary medical services does seem to be fairly effective in securing the municipal population equity of access to the services. In particular, the municipalities seem to respond well to the health care needs of their population. Distribution of physicians depends to only a very small extent on the wealth of the municipality.

Asunto(s)

Servicios de Salud Comunitaria/normas , Medicina Familiar y Comunitaria/normas , Servicios de Salud Comunitaria/organización & administración , Servicios de Salud Comunitaria/estadística & datos numéricos , Medicina Familiar y Comunitaria/organización & administración , Medicina Familiar y Comunitaria/estadística & datos numéricos , Prioridades en Salud , Accesibilidad a los Servicios de Salud , Humanos , Noruega

RESUMEN

An important part of Norwegian welfare policy is provision of free dental care for children up to the age of 18. After that age some counties have introduced a public subsidy scheme for young people aged 19-20 years, where 75% of their dental care expenses are covered. After the age of 21, all patients have to pay the costs for dental care themselves. The focus of the present work was to examine the effect that the public subsidy scheme for young adults had on demand for dental care, and its effect on dental health. The analyses were performed on 2 extensive sets of survey data. The major finding was that the public subsidy scheme had no effect on demand for dental care. In addition, there was no relationship between whether these young adults were covered by the subsidy scheme and dental health.

Asunto(s)

Servicios de Salud Dental/estadística & datos numéricos , Financiación Gubernamental/economía , Seguro Odontológico/economía , Programas Nacionales de Salud/economía , Adolescente , Adulto , Niño , Servicios de Salud Dental/economía , Femenino , Necesidades y Demandas de Servicios de Salud/economía , Humanos , Masculino , Noruega , Aceptación de la Atención de Salud , Revisión de Utilización de Recursos