Medical specialists' allocation of working time.

The aim of this study is to map the time-allocation of medical specialists and to examine how it relates to internal organising of work, wage incentives, physicians' preferences and the demand structure in the population. With regards to internal organising of work and wage incentives, special attention is granted to the private-public divide in specialised healthcare. Survey data from 1183 Norwegian physicians is employed and the empirical models are estimated by means of ordinary least squares (OLS) regression analysis, linear logit analysis, binomial logistic regression analysis and multilevel analysis. Physicians working in the private sector and physicians combining private and public work spend relatively more time on patient-assignments than their public counterparts, while public physicians allocate more time to administrative and research/educational tasks. These findings support the proposition that work time allocations mirror the differences in on-call commitments, wage incentives and the division of labour between the sectors. Furthermore, whereas the demand-specific set of variables in the model contributes moderately to the explanation of working time allocation, internal organising of work and physicians' preferences exert significant effects across the sectors. Future research should focus on physicians' time allocation since the topic will remain relevant as the European Union's (EU's) Working Time Directive continues to shake the European healthcare systems with traditions for long workdays.

Private or public? An empirical analysis of the importance of work values for work sector choice among Norwegian medical specialists.

In the aftermath of the Norwegian hospital reform of 2002, the private supply of specialized healthcare has increased substantially. This article analyses the likelihood of medical specialists working in the private sector. Sector choice is operationalized in two ways: first, as the likelihood of medical specialists working in the private sector at all (at least 1% of the total work hours), and second, as the likelihood of working full-time (90-100%) privately. The theoretical framework is embedded in work values theory and the results suggest that work values are important predictors of sector choice. All analyses are based on a postal questionnaire survey of medical specialists working in private contract practices and for-profit hospitals and a control group of specialists selected from the Norwegian Medical Association's member register. The analyses revealed that while autonomy values impact positively on the propensity for allocating any time at all to the private sector, professional values have a negative effect. Given that the medical specialist already works in the private sector, a high valuation of professional values and payment and benefit values increases the likelihood of having a dual sector job rather than a full-time private position. However, due to the cross-sectional structure of the data and limitations in the dataset, causality questions cannot be fully settled on the basis of the analyses. The relationship between work values and sector choice should, therefore, be regarded as associations rather than causality links. Finally, the likelihood of working in the private sector varies significantly at the municipality level, suggesting that medical specialist's location is important for sector choice.

The private-public mix of healthcare: evidence from a decentralised NHS country.

Privatizations of public services are often driven by economic scarcity and changes in political leadership, in particular election victories for conservative or neoliberal political parties. Data from Norwegian counties on numbers of medical specialists in secondary care over a period of 11 years (1991-2001) allow us to analyse effects of economic, socioeconomic, and political factors on supply of both public and private specialists and the private-public mix. We find striking variations between the main explanatory factors related to public and private supply. Supply of public specialists is explained by counties' revenue levels and demographic factors and is not affected by the party composition of councils. The supply of private specialist medical services is negatively related to the proportion of elderly patients. The scarcity hypothesis is confirmed as lower county revenue levels increase both the absolute and relative proportions of private supply. Political composition of councils affects the private proportion of medical specialists as increased representation of conservatives leads to privatization.

Hospital waiting time in Norway: what is the role of organizational change?

BACKGROUND: During the last five years the Norwegian hospital sector has experienced massive reorganization efforts. The aim of this study is to establish whether two such initiatives - the introduction of ring fencing of elective surgery and activity-based budgets at department level - have had any effects on one of the most profiled objectives on the health political agenda: reduction in waiting time. METHODS: The sample studied includes 41 hospitals observed at two points of time, 1999 and 2001. Waiting time is expected to be a result of imbalance between demand and supply. Measures representing the supply side (ring fencing, activity-based budgets at departmental level, physician rate, share of emergency admissions, technical efficiency, and hospital type) and the demand side (living conditions and share of persons aged 67 or older) are included in the operationalized model. The model is estimated via stepwise OLS regression. RESULTS: The results document a negative relationship between ring fencing and waiting time, with the estimated waiting time reduction amounting to 22 days. Both the demand side variables also exert significant effects on waiting time. CONCLUSION: Although information on ring fencing, living conditions, and age distribution renders possible some predictions concerning waiting time, the current research topic should be revisited when a longer time period has elapsed. When the organizational changes have become more thoroughly embedded in the hospitals, more refined conclusions regarding hospital organizations' behaviour and effects of reorganization can be drawn.

Day surgery and hospital efficiency: empirical analysis of Norwegian hospitals, 1999-2001.

Day surgery has gained increasing significance in Norwegian health care during the 1990s, and now constitutes more than 50% of all elective surgery. Although the underlying general assumption is that this mode of delivering surgery will increase the efficiency of hospitals, most former studies have focused only on the cost-efficiency for specific types of surgical operations. The present study therefore uses data from Norwegian hospitals to test whether the proposition that day surgery spells efficiency also holds true at the hospital level. Hospital efficiency is measured as the technical efficiency of hospitals. This indicator captures how efficient hospitals are in utilising their total resources, and builds on a variety of hospital inputs (inpatient care, outpatient care) and hospital outputs (physician full-time equivalents (FTEs), other labour equivalents, medical expenses). Our empirical analysis is based on a simple decision model where the hospitals maximise utility functions of income, patients and effort under the constraint of the budget and various structural characteristics. The empirical model thus controls for several other important determinants of efficiency, such as hospital budget, the outpatient revenue share, irregularly long length of stay, hospital type and the share of emergency admissions. After accounting for these variables, our results document significant effects of day surgery on technical efficiency. The results furthermore show that the positive effect of day surgery is contingent upon hospital budget, as hospitals with large budgets experience stronger efficiency effects of day surgery.