Simulating patient flow and health care costs in Norway

A part of the project was focusing on modelling of patient treatment in the Norwegian hospital sector, in order to predict how the total expenditures may develop over the next decades. This is a complex issue, because the expenditures are affected by the age distribution in the population, in combination with technological and organizational changes. It is well known that average hospital expenditures pr year are higher for elderly inhabitants. A central question is whether this is due to old age itself, or if it is the length of the remaining life that is crucial. This is important, because the expected longevity in the population is increasing. If the expenditures are mainly associated with the end of life, rather than age itself, longer lives will have only a small effect on the total hospital expenditures. The project has analyzed data on admissions to Norwegian hospitals for 1998 ? 2010, and found that approximately 10 % of the expenditures take place in the last year of living. The analyses also showed that expenditures increase faster for the elderly than for younger people, which is labelled ?steepening?. The hospital expenditure part of the project has resulted in a PhD degree of Fredrik Alexander Gregersen, based on four published scientific articles. The other main part of the project has focused on stroke patients. Data has been collected through the Stroke Units at Akershus Unversity Hospital, covering close to 2000 patient admissions. Medical data have been collected, and the patients have filled in questionnaires on function and quality of health. Follow-up data on quality of health, activities of daily living and rehabilitation have been collected at 3 and 12 months after discharge, and also include information on the health and burden of care for the patients? next of kin. Preliminary analyses show interesting results, e.g. on associations between depression and desire for rehabilitation, which will be published in scientific journals. The project has also contributed to continuous analyses of patient logistics in the hospital, including the central surgery and emergency departments.

To reach important health policy goals the Norwegian health care system has undergone comprehensive reforms the latest years, and in policy documents further changes and adjustments are suggested. With the complexity and interdependency that characterize the health care system it might be difficult to predict the exact consequences of changes, and it follows that unexpected effects on patient flow and health care costs might occur. The aim of this project is to develop problem oriented simulation models f or the health care sector that can be a tool for policymakers in their striving to adjust and develop health policy means. The project is important, as health care is a large sector, for which policymakers lack valid prediction models.