Geir Godager

Dual job holding general practitioners: the effect of patient shortage

In 2001, a listpatient system with capitation payment was introduced in Norwegian general practice. After an allocation process where each inhabitant was listed with a general practitioner (GP), a considerable share of the GPs got fewer persons listed than they would have preferred. We examine whether GPs who experience a shortage of patients to a larger extent than other GPs seek to hold a second job in the community health service even though the wage rate is low compared with the wage rate in general practice. Assuming utility maximization, we model the effect of patient shortage on a GPs decision to contract for a second job in the community health service. The model predicts a positive relationship between patient shortage and participation in the community health service. This prediction is tested by means of censored regression analyses, taking account of labour supply as a censored variable. We find a significant effect of patient shortage on the number of hours the GPs supply to community health service. The estimated marginal effect is 1.72 hours per week.

Hospital expenses towards the end of life.

BACKGROUND International research indicates that a considerable proportion of health expenditure is concentrated in the final phase of life, but to date, reliable Norwegian figures have not been available in this area. The purpose of this study is to investigate the proportion of Norwegian hospital expenditure for outpatient and hospital treatment which is devoted to persons who die in the course of the year. MATERIAL AND METHOD To estimate the proportion of hospital resources devoted to treatment of patients who die in the course of the year, we use data from the Norwegian Patient Registry, which contains information on all individual treatment episodes of outpatient and hospital treatment in the period 2010, and information from the National Resident Registry on deaths that have occurred during the same year. RESULTS In total, NOK 4.2 billion, or 10.6% of all hospital expenses for outpatient and hospital treatment in 2010, was devoted to patients who died during the same year. The bulk of the expenses was incurred during the three months immediately prior to death. Hospital expenses towards the end of life declined with increasing age of the patient, and were more than halved for ninety-year-olds compared to seventy-year-olds. More than 50% of the expenses incurred during the last year of life were spent during the three final months of life. INTERPRETATION These results are relevant for estimating future hospital expenses in the health services. They are also relevant for decision-making related to priorities, but the figures for expenses cannot be used to determine whether too much or too little is spent on a given age group or disease.