Back to search

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

Modernizing the GP scheme: towards sustainable health policy

Alternative title: Hvordan kan fastlegeordningen tilpasses og gjøres mer bærekraftig?

Awarded: NOK 15.0 mill.

We are studying coordination of health care by General Practitioners (GPs) by analysing their decisions regarding continuity of care, treatment, and referral. The project is comparative as it combines data from Denmark and Norway in several analyses. The project is directly related to structural, organizational and financial aspects that i) hinder and foster coordinated and integrated health services, and ii) that contribute to a sustainable health sector with greater equality among users of equal need. Furthermore, one main point is to emphasise how the regular general practitioner scheme affects the prioritised themes. One of the studies investigates whether socioeconomic status, measured by education and income, affects waiting time when we control for patients' medical condition (severity of illness) and for factors shaping the supply of health services faced by the patients. The factors include patients' general practitioner and hospital fixed effects, and socioeconomic status is matched at the individual level with individual-level administrative patient data. Our data also allow us to investigate where and how the socioeconomic gradient originates as we can decompose the gradient on different pathways into the hospital. Our key findings are. The socioeconomic inequalities in waiting times are relatively modest compared with the usual findings in the literature. The total effect is about a 3-4% reduction in waiting time for those with highest socioeconomic status relative to those with lowest socioeconomic status. The effects are similar for both sexes. Furthermore, all channels contribute to inequalities, but the main effects are through an increased probability of 2-3 percentage point of being admitted through the direct pathway. Again the results are similar for both sexes. For all analyses the gradients are dampened, and sometimes not significant, when health sector controls are included. In another study, we investigate whether audit and feedback can be used to change clinical practice of the general practitioners in Norway, which are largely remunerated based on a fee-for-service scheme. One of the most widely used fees is a duration dependent fee that can be used if consultations have a duration for 20 min or longer. We measured the effect an email-based intervention following an audit of the use of this fee in 2019, conducted by the Norwegian Heath Economics Administration (HELFO). In the audit, the 700 GPs with the highest use of the duration dependent fee were identified and thereafter randomized into three groups in an experiment: A control group and a mild and strong intervention group. The two latter groups received an email informing a about usage of the fee, only differing in the intensity of the feedback. Our analysis shows an initial 2-5 percentage points drop in the use of the fee for intervention groups, which was sustained over the whole 14-month study period. While there was no significant difference between the two intervention groups, the control group also saw a borderline significant drop of around 1 percentage points 0-4 months following the intervention. The project involves cooperation between researchers from different disciplines (economics, medicine and public health) and different institutions; University of Oslo, NORCE, The University of Southern Denmark, NTNU, and cooperation with University of York, the leading centre in Europe for research in health economics.

We are studying coordination of health care by General Practitioners (GPs) by analysing their decisions regarding continuity of care, treatment, and referral. The project is comparative as data from Denmark and Norway will be combined in several analyses. The project is directly related to structural, organizational and financial aspects that i) hinder and foster coordinated and integrated health services, and ii) that contribute to a sustainable health sector with greater equality among users of equal need. Furthermore, one main point is to emphasise how the regular general practitioner scheme affects the prioritised themes. The project involves cooperation between researchers from different disciplines (economics, medicine and public health) and different institutions (University of Oslo, Uni Research Rokkan centre, The University of Southern Denmark, NTNU, and cooperation with University of York, the leading centre in Europe for research in health economics). An important aim is to establish a unique longitudinal data set with detailed patient level information from both primary and secondary care, as well as individual information on socioeconomic status, ethnicity and family relations. We will use different panel data and multilevel estimators combined with innovative empirical strategies to analyse the effects on the GPs allocation of health care. The project is organized in four work packages: 1) Continuity in GP-patient relationship and quality of care 2) Remuneration (Payments) 3) Equality 4) Evaluating primary care quality for patients with type 2 diabetes (T2D)

Activity:

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