Norwegian Centre for Health Service Research

Innovation is necessary for achieving a sustainable health system. NORCHER's primary objectives are to search for, invent, implement, evaluate and inform stakeholders about models of health service delivery that are cost effective and deliver high quality services for citizens, now and in the future The researchers in NORCHER have disseminated research results throughout the period (available at NORCHER webpage).. NORCHER has organized two external seminars (User-initiated Health Services Research and Consequences of disrupted screening programs due to COVID-19 pandemic), two internal workshops and contributed to the EU-HEA conferences in Oslo 2022. The research activities in NORCHER are organized through work packages (WPs) (see the web page for more details). In WP2, we both apply and further develop Horizon scanning as a method to identify innovative and potentially promising health care technologies at an early stage. During the reporting period, there have been several sub-projects in collaboration with master students and decision-makers in the health sector. Results have been published and the WP are finalized in 2022. In WP3, an extensive register database based on the entire population of Norway is developed. The database will support sub-projects in NORCHER that use register data in the research. We have recently received the data and are intensively working with data management and initial analysis. In WP4, collaboration has been initiated with health regions and municipalities to develop methods for health economic evaluation of new technologies and working methods. Several sub-projects are already underway and several patient groups are included. There is a special emphasis on mentally ill people and people with chronic disorders. Three projects from WP3 were presented at the NORCHER seminar in November 2021. In WP5, we are well under way with protocols and collaboration with other research environments nationally and internationally to develop knowledge about how policy changes and changes in payment methods affect decisions in the health sector. Both registry data and experimental data are used in the exploration. WP6 focus on the ability of the health services to provide high quality treatment, partly measured by the share of patients who return to employment or education, how fast they return to work, or related outcomes such as sickness benefit duration, disability payments or social income support. Socioeconomic and demographic variables may potentially influence return to work directly or indirectly via severity and case-mix of the treatment groups. As data are now “in-house” and analysis are ongoing. In WP7, we develop in collaboration with research centers in Denmark, Finland and Sweden a Nordic data infrastructure that includes specialist health services, primary health services and care services. With data “in-house”, we will be able to start the comparative analysis. In parallel with the data collection, projects are being developed to investigate the effect of changes in health policy using the Nordic comparative perspective. As a whole, there has been a great deal of activity since the last reporting period. At the same time, the work has been affected by the limitations created by the pandemic. For details on WPs, researcher and activity, see NORCHER’s website https://www.med.uio.no/helsam/forskning/prosjenester/norcher-helsetjenesteforskning/index.html

Focus will be on the effects of variation in health care delivery models, where delivery models are defined as institutions that promote, restore, or maintain health. In particular, we will concentrate our research on the effects of formal institutional mechanisms like organizational forms, financing and reimbursement systems, policies, regulations and routines related to hospitals, primary care organisations, and cooperation between these institutions. Public, voluntary and private organizations will be included. Effects will be evaluated broadly and will include variation in access to services, quality and cost of services, and ultimately the health, welfare and quality of life of the population. In collaboration with South Eastern Regional Health Authority (SERHA) in Norway as well as local stakeholders in health enterprises and municipalities we will select, adapt and evaluate models of a set of tailored improvements in the healthcare delivery systems. Of particular interest, is decentralized service models targeting multimorbid patients and patients with addiction/psychiatric problems (see WP4 for details). The research will be based on a mixed methods methodology (see 1.3). NORCHER will further develop register-based analyses focusing on: 1. the effects of differences in reimbursement systems for GPs, 2. the effects of health care services on the return to the labor market for previously ill persons, and 3. comparative effectiveness studies between Nordic countries. Several patient groups will be analysed. However, since many health care systems have significant shortcomings in delivering care for mentally ill persons and patients with chronic conditions and/or multimorbidity, we will specifically analyse the aforementioned effects among these patient groups. There is a need to identify factors linked to high-quality care for these populations. As such, NORCHER will prioritize this area of research.