An new report studying differences in hospital costs between the Nordic countries point to governance, hospital structure and organisation of care as factors that may affect differences in the costs of hospital services. In addition, a statistical analysis show that conditions at country level rather than at the hospital level, have the greatest explanatory power for productivity differences between countries. The project was a collaboration between SINTEF Technology and Society, Department of Health Research and the Frisch Centre in Oslo. The study was financed by the Health Directorate and the Ministry of Health. The report is based on a systematic mapping and overview of the hospital structure in the Nordic countries. As far as we know, this has not been done before.
In the period from 2005 to 2007 Finland had lower costs on specialist health care than Sweden, Denmark and Norway. A previous analysis carried out by SINTEF and the Frish Centre in 2009 showed that price and wage inequalities, less use of services for some patient groups and higher productivity in Finnish hospitals, could explain parts of the difference. Although, there were some differences in the countries' health profile, this did not go in a direction that obviously would imply a much lower cost in Finland than in Norway.
The report also looked at other factors that directly or indirectly could affect resource use and productivity differences in specialist services. In addition, a new statistical analysis of data from 2005-2007 presented in an earlier report was performed, based on other methods and with some new variables included.
Aspects of governance, hospital structure and course of treatment which may affect differences in the costs of specialist:
- Finland has the most decentralised governance system and the Finnish hospital districts seem to have the greatest autonomy on hospital service production and decisions regarding investments.
- Norway appears to have a more decentralised hospital structure, having more hospitals with emergency services and maternity care in relation to its population. This may partly be due to differences in settlement patterns and geography.
- Health centers in Finland seems to play an important role in patient care, both prior to and after hospitalisation (case studies).
- There were indications of lower level of personnel usage in Finnish hospitals (case studies).
- There were also indications of a lesser degree of bottlenecks related to internal collaboration challenges between personnel groups in Finnish hospitals (case studies).
- Productivity differences between Finland and the other Nordic countries seems primarily to reflect conditions that are common for hospitals within countries rather than factors that vary between hospitals in each country.
- Differences in average travel time to hospitals offering emergency care are reflected in productivity differences between regions in Norway. This is consistent with findings in previous analyses, including NOU 2008:2. Travelling time as an explanatory factor seems to apply only in Norway and can therefore reflect the underlying conditions that are less correlated with travel time in the other countries.
We also find differences between countries that are not reflected in differences in cost and productivity levels. This does not mean that these factors are not relevant, but that they do not themselves have such great explanatory power that they systematically correlate with costs and productivity levels at the country level.