The effects of the Norwegian Coordination Reform on the use of rehabilitation services: panel data analyses of service use, 2010 to 2013.

Lars C Monkerud,Trond Tjerbo

doi:10.1186/s12913-016-1564-6

Abstract

BackgroundIn 2012 the Norwegian Coordination Reform was implemented. The main motivation was to encourage municipalities to expand local, primary health care services. From 2012 to 2014, under the Municipal Co-Financing regime, municipalities were obliged to cover 20 % of the costs of health services provided at the specialist (hospital) level. Importantly, use of rehabilitation services in private institutions was not part of the cost-sharing mechanism of Municipal Co-Financing. Rehabilitation services may be seen as quite similar in nature whether they be provided by municipalities, hospitals or private institutions. Thus, with rehabilitation patients readily “transferrable” between levels, the question is whether the reform brought with it a sought after shift towards more municipal rehabilitation and less specialist rehabilitation.MethodsData from the Norwegian Patient Register and from Statistics Norway/KOSTRA were utilized to gauge annual expenditures and inputs in specialist, municipal and private institution rehabilitation services respectively. Fixed effects and first difference regression analyses for the period 2010–2013 were carried out to account for certain time-invariant traits of municipalities and/or hospital regions, and results were adjusted for contemporaneous trends in local needs.ResultsExpenditures in specialist rehabilitation services declined sharply (typically by 8–10 %) from 2011 (pre-reform) to 2012 (post-reform), while expenditures in private rehabilitation services rose markedly in the same period (typically by 42–44 %). The results do not suggest any general expansion of municipal rehabilitation services.ConclusionsThe results of the analyses suggest that municipalities shift away from the use of specialist rehabilitation services and towards the use of rehabilitation services in private institutions since the latter becomes relatively cheaper (free-of charge) than both municipal and specialist services in post-reform periods (as specialist services come at a cost to municipalities post-reform). While the main goal of the reform has not materialized the results nevertheless suggest that incentives (of cost-shifting) do play a significant role in rehabilitation service use.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1564-6) contains supplementary material, which is available to authorized users.

Highlights

In 2012 the Norwegian Coordination Reform was implemented
Data In the empirical analyses, we use aggregate data from the Norwegian Patient Registry (NPR) recording (i) annual municipality-level utilization of six specialist rehabilitation Diagnostic-Related Groups (DRG) and (ii) annual municipality-level use of private rehabilitation services (24 h stays) over the period 2010–2013.4 We calculate (i) the annual costs of specialist rehabilitation DRGs per capita in each municipality by annually aggregating individual DRG diagnoses multiplied by the annual DRG weight attached to each DRG type multiplied by the annual DRG price5 [17] and dividing by the annual average municipal population; (ii)the annual costs of private rehabilitation services per capita in each municipality by annually aggregating individual stays in private rehabilitation institutions multiplied by the average price per stay (NOK 2886 in 2012) and dividing by the annual average municipal population
Our findings suggest that municipalities shifted away from the use of specialist rehabilitation services and toward the use of rehabilitation services in private institutions because the latter are relatively cheaper than either municipal or specialist services in the postreform period

Summary

Introduction

In 2012 the Norwegian Coordination Reform was implemented. The main motivation was to encourage municipalities to expand local, primary health care services. The subsequent division of responsibilities between the specialist and primary health care level within rehabilitation has been described as unclear [3], in the sense that both levels maintain much the same rehabilitation capabilities and competencies As both municipalities—charged with primary health care responsibilities—and specialist health care hospital regions are reasonably well suited to provide such services, the incentives to shift costs onto the other part perhaps constitutes the core “coordination problem” in this area. In this way, the case of rehabilitation services constitutes something of a litmus test for the CR in terms of the prospects for simple coordination. This is not necessarily because the reform was tailored for rehabilitation services, but rather because this is where the potential for simple coordination should be evident

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Results

Discussion

Conclusion