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HELSEVEL-Gode og effektive helse-, omsorgs- og velferdstjenester

Geographic Distribution of Health Care - Regional differences in demand and supply, costs and quality (GeoHealth)

Alternative title: GeoHelse - Geografisk fordeling av helsetjenester

Awarded: NOK 18.1 mill.

Substantial regional differences exist in the utilization of health care within OECD countries, but knowledge remains scarce on the causes and consequences thereof. Understanding mechanisms behind the regional differences is crucial to enable the construction of efficient policies to meet the surging needs of an aging, multicultural and relatively decentralized Norwegian population. We will provide policy relevant knowledge on effects of travel distances on regional distribution of health care personnel, on regional utilization of health care and on possible regional variation in indicators of patient recovery. Since travel distance and consequences thereof can be affected by policy, perhaps most easily by the geographic location of health care services, our suggested analyses will be directly relevant for policy design. Indeed, securing qualified personnel, and knowledge on what makes them allocate rurally, may be one of the most important challenges in meeting the expected surge in health care needs of aging OECD-populations. We will combine several population-wide, individual-level data registers to undertake these novel analyses. Using the exact geographic location of the home of all Norwegian residents and health care providers (hospital, office of one's general practitioner, etc.), we calculate travel distance between the locations. We also know everyone's education and where they work, and we have several indicators of health care utilization and health outcomes, by health care provider (consultations, hospitalizations, disability benefits, employment, mortality, etc.). The extremely rich data allow us to use plausibly exogenous variation and quasi-experimental methods to reliably estimate causal effects. Our project group draw on knowledge and inspiration from national and international researchers within the field of health economics, as well as representatives from the user side. We therefore regularly arrange workshops where we invite talented researchers from other institutions in Norway, as well as from the other Nordic countries and the U.S., in addition to physicians with knowledge on the workings and challenges of the Norwegian healthcare system. Both invited researchers and the internal researchers from the project group are given time to present their own work, and we thoroughly discuss institutional and methodological challenges, as well as potential shared interests. Our results show that there is a large difference in the total use of health services between public hospitals. Factors related to hospitals explain about half of this difference, while the rest can be explained by the patients' background. There is also great geographical variation in the use of private hospitals financed by the public sector. Free choice of treatment (FBV) was introduced in November 2015 and opened for private providers to apply to become approved providers of selected treatments, to treat patients at the state's expense. Our analyzes show that FBV is used almost exclusively by patients living in the large cities in southern Norway. It is reasonable to link this to the strong geographical concentration of the locations of private providers. We also find that people who use FBV are more often young and have higher education. The explanations for this, however, are more complex. Our results also show large geographical variation in the capacity occupancy at maternity wards. We find that women who come to maternity clinics on more hectic days receive fewer and less invasive treatments, and their children get at least as good APGAR scores. We also study the primary health care service. Our analyzes show that patients use the website legelisten.no when choosing a GP. Patients choose doctors with higher ratings, and it is especially women and patients with high socio-economic status who use the online information. We finally find that the number of visits to the GP is drastically reduced when children turn 16 and thus have to pay a deductible. The reduction is greatest for children who live close to their GP. This means that those with a short travel distance to service providers are more sensitive to prices in the health service.

Substantial regional differences exist in the utilization of health care within OECD countries, but knowledge remains scarce on the causes and consequences thereof. Understanding mechanisms behind the regional differences is crucial to enable the construction of efficient policies to meet the surging needs of an aging, multicultural and relatively decentralized Norwegian population. We will provide policy relevant knowledge on effects of travel distances on regional distribution of health care personnel, on regional utilization of health care (primary and specialist) and on possible regional variation in indicators of patient recovery. Since travel distance and consequences thereof can be affected by policy, perhaps most easily by the geographic location of health care services, our suggested analyses will be directly relevant for policy design. Indeed, securing qualified personnel, and knowledge on what makes them allocate rurally, may be one of the most important challenges in meeting the expected surge in health care needs of aging OECD-populations. We will combine several population-wide, individual-level data registers to undertake these novel analyses. Using the exact geographic location of the home of all Norwegian residents and health care providers (hospital, office of one's general practitioner, etc.), we calculate travel distance between the locations. We also know everyone's education and where they work, and we have several (admittedly imperfect) indicators of health care utilization and health outcomes, by health care provider (consultations, hospitalizations, disability benefits, employment, mortality, etc.). The extremely rich data allow us to use plausibly exogenous variation and quasi-experimental methods to reliably estimate causal effects. The research team has extensive experience in undertaking top-quality research on these data registers.

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HELSEVEL-Gode og effektive helse-, omsorgs- og velferdstjenester