Biomedical subjects

Jostein Grytten

Publications and source records attributed to Jostein Grytten.

14 recordsLinked to original sources

PubMed2007

Better primary physician services lead to fewer hospital admissions.

The aim of the study was to examine whether improved quality of primary physician services, measured by patient satisfaction, leads to fewer admissions to somatic hospitals. We studied differences in hospital admissions at the municipality level in Norway. In addition to the standard explanatory variables for use of hospitals--gender, age, socio-economic status and travelling distance to the nearest hospital--we also included a measure of patient satisfaction with primary physician services in the municipality. Data on patient satisfaction was obtained from an extensive questionnaire survey of 63,798 respondents. We found a statistically significant negative relationship between patient satisfaction and the number of hospital admissions. This conclusion was robust with regard to the empirical specification, and the effect was large.

Health Services Accessibility↗

PubMed2005

[The list patient scheme and the growth insurance expenditure in general practice].

BACKGROUND: Fee-for-item payments, mainly from the National Insurance Administration, are the main source of remuneration for primary care physicians in Norway. The aim of the present study was to describe the development in the National Insurance Administration's expenditure for primary physician services before and after the introduction of a list patient scheme in 2001. MATERIAL AND METHODS: The analyses were performed on data from the National Insurance Administration and data on the number of physician in relation to population from Statistics Norway. RESULTS: During the period 1998-2003, expenditure increased by 84%, from NOK 1.37 billion to NOK 2.52 billion. The main finding is that nearly all the increase can be explained by increases in the number of physicians, population size and the level of fees. INTERPRETATION: One interpretation of our findings is that to a large extent the National Insurance Administration's expenditure on primary physician services can be controlled by regulating the number of physicians and the level of fees.

Family Practice↗

PubMed2005

[Population's satisfaction with hospitals before and after a hospital reform in Norway].

BACKGROUND: We investigated patients' satisfaction with availability and quality of hospital services in 2000 and 2003, that is before and after the Norwegian hospital reform. MATERIAL AND METHODS: The data were collected from two national surveys in 2000 and 2003. The participants were asked about their satisfaction with availability (choice and waiting time for an appointment) and quality (result of treatment, professional skills, service-mindedness, punctuality, information and available time). For each question, changes in mean satisfaction from 2000 to 2003, corrected for changes in the composition of the sample, were estimated. RESULTS: A clear and statistically significant improvement in patient satisfaction with the availability and quality of hospital services took place from 2000 to 2003. In general, patients were more satisfied with the quality than with the availability of hospital services. INTERPRETATION: The hospital reform may have contributed to improved satisfaction with hospitals, though other factors may also have played a part.

Adolescent↗

PubMed2005

[Differences in workload for male and female physicians].

BACKGROUND: In this article we describe differences in workload for male and female physicians according to the gender of their patients. MATERIAL AND METHODS: Data from the National Insurance Service for the autumn of 2001 (1637 general practitioners) and from a comprehensive questionnaire survey among general practitioners in the autumn of 2002 (2306). RESULTS: 62 % of the patients of female physicians are women, compared to 47 % of the patients of male physicians. Female physicians have a mean of 200 fewer patients on their lists than have their male colleagues. Female physicians also have a high proportion of women on their list irrespective of the length of their list. Of those with a long patient list (>1800 patients), almost 50 % of the female physicians wanted a shorter list, compared to only 26 % of their male colleagues. INTERPRETATION: The total workload in terms of length of patient list and gender distribution of patients on the list is not necessarily different for male and female physicians. Female physicians may have chosen to have a shorter patient list in order to compensate for the fact that their patients on average have more consultations and receive more services. On the other hand, male physicians may allow themselves to have a longer patient list because they have patients who on average require less treatment.

Family Practice↗

PubMed2005

[Characteristics of solo and group practices in Norwegian general practice].

BACKGROUND: The article describes changes in the size of practices after the introduction of the new Norwegian list patient system for general practitioners (GPs) and how length of patient lists, number of consultations, working hours and waiting time for an appointment vary according to the number of physicians in the practice. MATERIAL AND METHODS: The data were collected by a comprehensive questionnaire survey among general practitioners in the autumn of 2002. A total of 2306 physicians took part (response rate: 70%). RESULTS: Before the list patient system was introduced, 18% of GPs worked in solo practices. With the new system in place, the proportion went down to 15%. About 60% of GPs worked in practices with 2-4 GPs. Out of young GPs in solo practices, 78% wished to work in practices with several colleagues, while 26% of GPs in practices with more than six physicians wished to reduce the size of the practice. The number of patients on the list and the number of curative working hours per GP decreased with increasing practice size. The number of consultations per hour did not vary with the number of GPs in the practice. Waiting time for an appointment for non-emergency treatment increased with increasing practice size. INTERPRETATION: A lower service production per physician in large practices may partly be an effect of a relatively high proportion of women wanting to work fewer hours than their male colleagues. Irrespective of gender, group practices also attract GPs who want slightly reduced working hours.

Adult↗

PubMed2005

Models for financing dental services. A review.

The aim of this review article is to give a brief description of the most important models for financing dental services, and then to describe the effects that the different models can have on patients' and dentists' behaviour. The advantages and disadvantages of the different models will be discussed. The first section focuses on the relationship between insured people and insurance providers. The justifications for a private insurance scheme and a public insurance scheme for dental treatment are discussed. A purely private insurance market for dental services will fail. This is because the benefits of a private dental insurance scheme are few in relation to the costs of having insurance, and because of the problem of adverse selection. There are also problems with public insurance schemes, for example, high transaction costs for collection of taxes and problems with cost containment as a result of moral hazard. The second section focuses on the relationship between the dentist and the patient, more specifically on how different remuneration schemes influence dentists' behaviour. The advantages and disadvantages of three types of remuneration scheme are discussed: fixed salary, per capita remuneration and pure fee-for-item remuneration. One important conclusion is that per capita payments secure effectiveness, while fee-for-item payments secure quality. With per capita payments there is a potential for patient-selection and undertreatment, while cost containment is a problem with fee-for-item payments. In order to counteract the adverse side-effects of each financing system, focus should be placed on the individual dentist in relation to ethics, norms and quality control.

Cost Control↗

PubMed2004

[Patient satisfaction with general practice services before and after the list patient reform].

BACKGROUND: The aim of this study was to investigate how satisfied people are with general practitioners' (GPs') services before and after the introduction of a list patient system in Norway. MATERIAL AND METHODS: Data were collected from two national questionnaire surveys carried out in 2000 and 2003. Satisfaction was measured on two dimensions: satisfaction with access and satisfaction with the physician and the actual treatment. RESULTS: The level of satisfaction with GPs' services was high before the reform. This was particularly the case with regard to the second dimension: satisfaction with the GP and the actual treatment (for example, evaluation of the GP's competence). There were only small changes in these indicators from 2000 to 2003, but the changes were for the better. The changes in the indicators for the first dimension (those with the lowest scores before the reform): satisfaction with access (e.g. physicians-to-population ratio in the district and waiting time for an appointment)--were greater and also positive. Respondents in large and medium-sized municipalities reported the highest increase in satisfaction with access. There were no changes with regard to emergency services. The proportion of people who had used more than one physician during the last year was down from 38% to 29%. INTERPRETATION: Higher satisfaction with GPs' services has occurred after the introduction of a list patient system and the associated improvement in the GPs-to-population ratio. That fewer people changed their GP may be the result of more stability in physician posts. It may also be associated with greater satisfaction with people's access to their own GP after the reform.

Clinical Competence↗

PubMed2004

[Physicians' work situation a year after the list patient system reform].

BACKGROUND: We describe general practitioners' (GPs') degree of satisfaction with the recently introduced Norwegian list patient system, based on information provided by GPs on the number of patients on their lists and their own assessment of their work situation. MATERIAL AND METHODS: Data were collected by an extensive questionnaire survey among GPs in the list patient system during the autumn of 2002. A total of 2306 GPs returned the questionnaire (70% response rate). RESULTS: Most GPs were satisfied with the list patient system. 60% were satisfied with the number of patients on their list, 21% wanted more patients; 19% would have liked to have fewer patients. In general GPs feel that they have enough time for each patient and that it is not difficult to fit emergency cases into their daily schedule. About half of them are of the opinion that the list patient system has not given them a better insight into their patients' medical needs or better treatment options. INTERPRETATION: Most GPs were satisfied with the new system and with the number of patients on their list. The importance to patients of being assigned to one GP is highlighted by the fact that GPs think they can do a better job when the practice has a high proportion of regular patients.

Adult↗

PubMed2004

[Change in service provision and availability under the list patient system reform].

BACKGROUND: In this article, we analyse the relationship between length of patient lists and general practitioners' (GPs') service provision in order to investigate whether the list patient system reform has led to reduced accessibility and/or supplier inducement. MATERIAL AND METHODS: The data were collected from a comprehensive questionnaire survey among GPs in the list patient system in 2002 (2306 GPs) and from the National Insurance Administration in 2001 (1637 GPs). The relationship between length of patient lists and service provision was analysed using regression analysis. RESULTS: The relationship between length of patient lists and number of consultations per GP was almost proportional, as was the relationship between length of patient list and number of consultations initiated by GPs. GPs who wanted more patients on their list had fewer consultations than those who were satisfied with the length of their lists and they did not compensate by taking more laboratory tests per consultation. Analysis of the two independent sets of data gave almost identical results. INTERPRETATION: Patients' access to their GPs is independent of the length of his or her patient list. Even GPs with long lists do not ration consultations. This probably reflects efficient organisation of the practice. Our results do not support the theory that GPs induce demand for their services; one explanation is that GPs with short lists have chosen to have precisely that and have no need to induce demand.

Efficiency, Organizational↗

PubMed2003

Financial incentives and the supply of laboratory tests.

This study examined how the number of laboratory tests taken by a sample of Norwegian contract physicians is influenced by their private economy outside of the practice and by changes in remuneration. The data are drawn from 40,000 consultations carried out by 44 contract physicians in 1991-1994. Two factors which led to changes in the level of physicians' income are considered: changes in remuneration for consultations and laboratory tests and changes in interest rates on loans and bank deposits. The effect which changes in interest rates have on physicians' disposable income was calculated using information about their financial assets and debts obtained from tax assessments. The main finding was that changes in private economy and changes in remuneration have no or only a small effect on the number of laboratory tests taken. Our results suggest that fee regulation can be an effective means of controlling physicians' income and therefore government expenditure on primary physician services.

Journal Article↗

PubMed2003

Practice variation and physician-specific effects.

This study provides estimates of practice variation for primary physician services in Norway. Nearly all previous studies on practice variation have encompassed mainly specialist and hospital services. Thus we provide evidence for treatment variation for a health care sector where information about treatment variation is relatively scarce. Our analyses were carried out on a large set of data from individual physician practices. We estimated the extent of practice variation according to type of diagnosis and type of treatment option. The main finding is that variation in clinical practice between physicians is an important determinant of expenditure for primary physician services. Depending on the type of diagnosis, physician-specific effects explained 47-66% of the variation in expenditure for laboratory tests, 59-66% of the variation in expenditure for consultations lasting over 20min and 49-61% of the variation in expenditure for specific procedures. The age and gender of the patients explained only about 1% of the variation in expenditure. This finding supports the results from previous studies, which have shown that patients' age and gender are inadequate when used as risk adjusters. We also identified physicians who moved their practice from one municipality to another, i.e. they changed their patient population completely. Our results showed that those physicians who moved did not change practice style after they moved, i.e. that physician's style of practice is stabile. This indicates that practice style reflects a deeply rooted behaviour with respect to how to practice medicine.

Contract Services↗

PubMed2003

Service production and contract choice in primary physician services.

Since payment systems for physicians may affect the efficiency of health care service provision, the design of compensation schemes is a major policy concern. According to standard labour economics and agency theory, fee-for-service contracts are likely to induce higher service production than salary contracts and (pure) capitation contracts. Payment systems may also influence service quality and the overall cost control. Despite the obvious policy significance of these issues, the available empirical research is very limited. This paper is an attempt to remedy this situation by addressing the impact of alternative contracts and payment systems on primary care physicians' service supply. The Norwegian primary physician service is an ideal setting for exploring the impact of payment systems. It is a centralised scheme where health services are mostly publicly financed. Until the June 1st 2001, there were two main types of primary care physicians: local government employees remunerated by a fixed salary, and contract physicians mostly financed by fee-for-service payments. We find that physicians with a fee-for-service contract produce a higher number of consultations and other patient contacts than physicians with a fixed salary. This difference is mostly due to longer working hours, but time efficiency is greater as well. Moreover, a part of the difference is due to a selection effect: salaried physicians prefer shorter working hours and prefer to work less intensively. When these and other effects are taken into account, we find that a change from a salary contract to a fee-for-service contract will increase service production by 20-40%.

Capitation Fee↗

PubMed2002

[What explains the growth of national insurance expenditure for primary health care?].

BACKGROUND: Fee-for-item payments are the main source of remuneration for primary care physicians in Norway. Physicians receive a major part of these payments from the National Insurance Administration. The present study describes the development in the National Insurance Administration expenditure for primary physician services in Norway from 1990 to 2000. MATERIAL AND METHODS: The analyses were performed on accounting data from the National Insurance Administration and data on the number of physician per 10,000 population from Statistics Norway. RESULTS: From 1990 to 2000, expenditure increased by 84%, from NOK 863.8 million to NOK 1.58 billion. Our main finding is that a substantial part of this increase can be explained by increases in the number of primary care physicians, population size, and the level of fees. INTERPRETATION: One interpretation of our findings is that National Insurance Administration expenditure on primary physician services to some extent can be controlled by regulating the number of physicians practicing with reimbursement from the National Insurance Administration and the level of fees.

Fee-for-Service Plans↗

PubMed2002

Do young adults demand more dental services as their income increases?

Several studies from the USA have shown that there is a positive and strong relationship between income and demand for dental care. All these studies have been performed on populations where treatment needs were high. Today, young adults represent one group of the population where treatment needs are low. But young adults will not necessarily demand or utilize more dental services as their income increases. As we do not know the extent to which demand will increase when income increases among young adults, future needs for dental manpower could be less than predicted from previous studies. The aim of the present study was to examine the relationship between income and demand/utilization for dental services among young adults in Norway. The analyses were performed on two large sets of survey data, collected in 1985 and 1995, which were representative of the Norwegian population aged 20 years and above. The main finding was that the increase in demand with an increase in income was less for young adults than for older adults. In particular, there was a marked fall in the income elasticities among young adults from 1985 to 1995. The fall in the income elasticity corresponds to a marked decrease in the prevalence of dental diseases among young adults during that period. Our results imply that future policies for dental manpower should take into account the lower income elasticity for young adults compared to for older adults, and that future needs for dental personnel should be planned accordingly.

Adult↗