Are general practitioner hospitals cost-saving? Evidence from a rural area of Norway.

OBJECTIVE: We aimed to determine whether general practitioner GP hospitals, compared with alternative modes of health care, are cost-saving. METHODS: Based on a study of admissions (n = 415) to fifteen GP hospitals in the Finnmark county of Norway during 8 weeks in 1992, a full 1-year patient throughput in GP hospitals was estimated. The alternative modes of care (general hospital, nursing home or home care) were based on assessments by the GPs handling the individual patients. The funds transferred to finance GP hospitals were taken as the cost of GP hospitals, while the cost of alternative care was based on municipality and hospital accounts, and standard charges for patient transport. RESULTS: The estimated total annual operating cost of GP hospitals was 32.2 million NOK (10 NOK = 1 Pound) while the cost of alternative care was in total 35.9 million NOK. Sensitivity analyses, under a range of assumptions, indicate that GP care in hospitals incurs the lowest costs to society. CONCLUSION: GP hospitals are likely to provide health care at lower costs than alternative modes of care.

[Utilization of the National Hospital 1985-89. How many beds should there be in a new National Hospital?]. / Bruk av Rikshospitalet 1985-89. Hvor mange senger bør det vaere i et nytt rikshospital?

The Norwegian Parliament (Stortinget), has approved a proposal for construction of a new national hospital in Oslo. White Paper no. 38 (1987/88) proposes a hospital with 610 beds. The number of inpatient days at the present Rikshospitalet (The National Hospital) has declined by 19.4% during the period 1985 to 1989. In 1989 the use of inpatient services was equivalent to 530 beds with an occupancy rate of 80%. Based on an assumed further reduction in hospital use in the years to come, we estimate the need for beds to be 340 at the new national hospital. This lower number is assumed to cover local hospital functions (54 beds), regional hospital functions (220 beds) and national services (65 beds). The authors assert that the White Paper is based on outdated assumptions. The construction of a 610-bed national hospital involves a health care structure which could obstruct the reorganization of hospital care (more use of outpatient services) elsewhere in Norway. The County Councils responsible for financing hospitals will be forced to fund a hospital use that is motivated essentially by teaching and research rather than by caring for patients.

[Efficiency analysis of university hospitals]. / Effektivitetsanalyse av regionsykehus.

The Norwegian Institute for Hospital Research has published several studies on hospital running costs. Judging from reports in the media these studies have attracted much public interest. It has been maintained that Haukeland sykehus is the most efficient regional hospital, while results from both Ullevål sykehus and the Rikshospitalet have been poor. In an alternative analysis undertaken in 1988 the main aim was to analyse medical efficiency, number of admissions, and length of stay in every department at all regional hospitals. This study showed great variation in the period of hospitalization within the same speciality at different hospitals. The Regionsykehuset in Tromsø was shown to be the most efficient medically, with the shortest period of hospitalization in all departments except in the departments of surgery and gynecology. In these cases the period of hospitalization was shortest at Ullevål sykehus. Haukeland sykehus and the Regionsykehuset in Trondheim both came out at the bottom of the list, with consistently the longest period of hospitalization for patients in regional hospitals. When the variation in results depend on the methods of evaluation used then it is time to stop and think. Are the methods of evaluation inferior to what is being evaluated? In which case, it is time to discuss the following question-what criteria are applicable and of value when comparing hospitals and/or departments?