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Costs and quality at the hospital level in the nordic countries


This article develops and analyzes patient register-based measures of quality for the major Nordic countries. Previous studies show that Finnish hospitals have significantly higher average productivity than hospitals in Sweden, Denmark, and Norway and also a substantial variation within each country. This paper examines whether quality differences can form part of the explanation and attempts to uncover quality–cost trade-offs.

Data on costs and discharges in each diagnosis-related group for 160 acute hospitals in 2008–2009 were collected. Patient register-based measures of quality such as readmissions, mortality (in hospital or outside), and patient safety indices were developed and case-mix adjusted. Productivity is estimated using bootstrapped data envelopment analysis.

Results indicate that case-mix adjustment is important, and there are significant differences in the case-mix adjusted performance measures as well as in productivity both at the national and hospital levels. For most quality indicators, the performance measures reveal room for improvement. There is a weak but statistical significant trade-off between productivity and inpatient readmissions within 30 days but a tendency that hospitals with high 30-day mortality also have higher costs. Hence, no clear cost–quality trade-off pattern was discovered. Patient registers can be used and developed to improve future quality and cost comparisons. Copyright © 2015 John Wiley & Sons, Ltd.
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Academic article


  • Research Council of Norway (RCN) / 214338
  • EU / 241721




  • Sverre A.C. Kittelsen
  • Kjartan Sarheim Anthun
  • Fanny Goude
  • Ingrid Marie Schaumburg Huitfeldt
  • Unto Häkkinen
  • Marie Kruse
  • Emma Medin
  • Clas Rehnberg
  • Hanna Rättö


  • Ragnar Frisch Centre for Economic Research
  • Norwegian University of Science and Technology
  • SINTEF Digital / Health Research
  • Karolinska Institutet
  • National Institute for Health and Welfare
  • University of Southern Denmark



Published in

Health Economics






140 - 163

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