Supplier inducement--its relative effect on demand and utilization.

The present study examined the relative effect of supplier inducement on demand as opposed to on utilization. Supply of dentists was measured as population: dentist ratio at the level of trade areas. The dependent variable was number of dental visits during the last year. The probability of having any visit was used as the measure of demand. Number of visits, conditional upon having any visit, was used as the measure of utilization. The data were analyzed using Tobit analysis. This analysis gave the fraction of the total effect of a marginal increase in supply that is due to an increase in utilization as opposed to an increase in demand. The analysis was performed on a national sample comprising 1186 adult Norwegians. Supplier inducement had nearly the same effect on demand as on utilization. This finding may be a result of the payment system for dental care, which relates each item of service to the average time it takes to perform that item. Income opportunities for dentists are then fairly independent of whether they spend their time doing check-ups or treatment. The finding indicates that supplier induced demand is a factor to consider in addition to supplier induced utilization when one tries to explain how supplier inducement may affect the unequal distribution of dentists.

A comparative study of costs for dental services and dentists' income in the United States and Norway.

The United States and Norway have approximately the same per capita Gross Domestic Product (GDP) and average personal income, but their per capita health spending patterns are quite different. In 1982, the US spent 6.5% of its total health expenditures on dental services while Norway spent 5.4%. A higher percentage of Norwegian adults see a dentist annually as compared to US adults. In 1984, the mean net income of dentists in private practice was $66,940 in the US and $27,125 in Norway; this is respectively 5 and 1 3/4 times the average per capita income in those countries. The American publicly-employed dentist earned approximately two-thirds of what the American private practitioner made, while still earning approximately 50% more than his Norwegian counterpart. Some basic information concerning the ratios of dentists, specialists, and dental hygienists to the population is given. The relative proportion of women dentists in the two countries is contrasted. Finally, data on graduates from the dental schools, enrollment cuts, and estimated dentist to population ratios by the year 2000 are described to compare future manpower that will be available to the two countries. Several dissimilarities in the political and social systems are described and discussed. It is emphasized that caution should be used when interpreting and comparing data about countries with different dental delivery, political, and social systems.

[Physicians employed by municipalities--how big are the differences?]. / Kommunelegetjenesten--hvor store er ulikhetene?

The present paper discusses the geographical distribution of physicians employed in municipal primary care. In Norway, primary medical services are the responsibility of the local public authority (the municipality) and are financed primarily by the general taxation. The allocation of physicians is analysed using a municipal demand model. The model is a synthesis of consumers' demand and allocation of municipal funds. Analyses were performed on a panel data set of all Norwegian municipalities covering the period 1986-92. The results are encouraging, since they indicate that a decentralised system of primary medical services does seem to be fairly effective in securing the municipal population equity of access to the services. In particular, the municipalities seem to respond well to the health care needs of their population. Distribution of physicians depends to only a very small extent on the wealth of the municipality.