Inequity in the use of physician services in Norway before and after introducing patient lists in primary care

Abstract

BackgroundInequity in use of physician services has been detected even within health care systems with universal coverage of the population through public insurance schemes. In this study we analyse and compare inequity in use of physician visits (GP and specialists) in Norway based on data from the Surveys of Living Conditions for the years 2000, 2002 and 2005. A patient list system was introduced for GPs in 2001 to improve GP accessibility, strengthen the stability of the patient-doctor relationship and ensure equity in the use of health care services for the entire population.MethodWe measure horizontal inequity by concentration indices and investigate changes in inequity over time when decomposing the concentration indices into the contribution of its determinants.ResultsWe find that pro-rich inequity in the probability of seeing a private outpatient specialist has declined, but still existed in 2005.ConclusionImproved patient-doctor stability as well as better GP accessibility facilitated by the introduction of patient lists improved access to private specialist services. In particular the less well off benefited from this reform.

Public and private health service in Norway: a comparison of patient characteristics and surgery criteria for patients with nerve root affections due to discus herniation

“…Our findings regarding differences in sociodemographic and lifestyle characteristics are in line with previous Scandinavian studies [1-3, 6, 10]. For example, data from Norway [2,3,10] have showed that people with high level of education and high income are more likely to have a private supplementary health insurance, and that private health insurance is an important contributor to inequities in health care utilization in specialist care. A recently published review of the literature on what characterize individuals with voluntary private health insurance in universal health care systems [2,3,6] supports that the probability of being privately insured increases with income and education level.…”

“…During the last decade there has been a remarkable growth in private supplementary health insurance in Norway, especially employment-based private health insurance [1][2][3]. Most of the health care provided by private hospitals has public funding through contracts with the public regional health authorities.…”

“…One explanation might therefore be that the threshold for offering surgical treatment is lowered due to increased supply of private health services, in particular for those who can afford a private insurance or have an employment-based private health insurance. Several studies have showed that private health insurance is an important contributor to inequities in health care utilization in specialist care [1,3,6]. This implies that sociodemographic and lifestyle characteristics, and the severity of health problems indicating need for operative treatment for lumbar disc herniation might be different between patients who are accepted for surgery at public and private hospitals.…”

Socio‐economic status and physicians' treatment decisions

“…1 2 Of course, if individuals move to another municipality they are also allowed to switch GP across municipalities. 9 4 Data…”

“…Therefore, all available (survey) information on patient need is included as controls. In comparative studies, di¤erences are detected between countries with di¤erent health care systems, but in most developed countries, specialist visits is distributed in favour of high-income individuals while GP visits are more equitably distributed (Grasdal and Monstad, 2011). 5 The key contributions of our paper to the existing literature are the following.…”