Norwegian health services in comparative perspective. Terje P. Hagen Department of Health Management and Health Economics
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1 Norwegian health services in comparative perspective Terje P. Hagen Department of Health Management and Health Economics
2 1) What are the values and the pitfalls of international comparisons? Values Identify variability in performance (access, cost efficiency, mortality, others) Explain variation by variables describing the system, after control for relevant confounders Pitfalls Heterogeneity along all dimensions makes it difficult to do even descriptive analyses
3 Which type of analyses? System level analysis (WHO 2000) Challenges in output measurement: How to measure the impact of health services on health? Disease level analysis (OECD aging-related disease (ARD) project, Technological Change in Healthcare (TECH)) Possible to relate inputs to outputs Requires nationally representative patient level data that are linkable (patient register, mortality registers, socioeconomic variable registers, others)
4 The EuroHOPE project Disease level analysis, five different diseases acute myocardial infarction (AMI) hip fracture stroke breast cancer children with very low birth weight The methodology Links data on inputs and outputs on patient level The data covers among others: Access and utilization Treatment practices (hospitals) Cost and outcomes Common protocol: definitions and rules for risk adjustments Seven countries Finland (THL, Unto Häkkinen) Sweden, Norway, Scotland, Netherlands, Italy, Hungary Health Economics: December 2015 Volume 24, Issue Supplement S2 Pages
5 2) How does the Norwegian health system perform from a European perspective? National and regional level indicators (AMI/ACS, stroke and hip fracture) covering the years 2006/ were calculated from Finland, Denmark, Hungary, Italy, Norway and Sweden available ( The figures depicts national differences in mortality but also within country between regions
6 Hip fracture: Regional* variation in one-year mortality Regional age- and sex-standardised one-year mortality and confidence intervals, Reference population: Finnish hip fracture patients. *In Italy, differences shown reflect the four provinces of the Friuli-Venezia-Giulia region
7 Ischemic stroke: Regional* variation in one-year mortality Regional age- and sex-standardised one-year mortality and confidence intervals, Reference population: Finnish stroke patients. *In Italy, differences shown reflect the four provinces of the Friuli- Venezia-Giulia region
8 AMI: Regional* differences in one-year mortality Regional age- and sex-standardised one-year mortality and confidence intervals, (%). Reference population: Finnish AMI patients. *In Italy, differences shown reflect the four provinces of the Friuli-Venezia-Giulia region
9 More data on regional variations
10 3) What are the most important areas in which to increase comparative health systems research? Linking of hospital, cause-of-death registers, data on prescribed medicines to the registers of primary and long-term care Data from capital areas Oslo and Helsinki Copenhagen 2014 Stockholm (only primary care) Three diseases Acute myocardial infarction (AMI)/Acute coronary syndrome ACS Ischemic stroke Hip fracture
11 Andel (%) Pasientforløp, hoftebrudd Dager fra indeksinnleggelse Hjemme Død Sykehus Hjemmesykepleie Sykehjem Rehabilitering
12 Length of stay of surgery admission decreased in both cities but is still lower in Helsinki 14 Hip fracture: Lenght of surgery admission age, sex and type of fracture adjusted Days year Oslo Helsinki Helsetjenest 13 ekonferanse n 2018
13 But the length of the first institutional episode even increased in Oslo 50 Hip fracture: Lenght of the first institutional episode age, sex and type of fracture adjusted 40 Days year Oslo Helsinki Helsetjenest 14 ekonferanse n 2018
14 Share of patients discharged to home has somewhat decreased in Oslo Hip fracture: Share of patients discharged to home within 90 days age, sex and type of fracture adjusted % year Home total, Oslo Home with help, Oslo Home total, Helsinki Home with help, Helsinki Helsetjenest 15 ekonferanse n 2018
15 Cost of the first institutional episode has been stable in Oslo but decreased in Helsinki Hip fracture: cost of the first institutional episode age, sex and type of fracture adjusted /patient year Oslo Helsinki Helsetjenest 16 ekonferanse n 2018
16 The difference in 30-day mortality between the cities has decreased 25 Hip fracture: 30-day and one-year mortality age, sex and type of fracture adjusted 20 % year 30-day, Oslo One-year, Oslo 30-day, Helsinki One-year, Helsinki Helsetjenest 17 ekonferanse n 2018
17 That s all for now
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