Specialist health service - StatRes (discontinued), 2008

Input - Central Government spending in specialist health services

Operating costs for the Central Government’s own production of specialist health services amounted to NOK 84 billion in 2008. This is an increase of 6.1 per cent from 2007. Operating costs for the production of public health enterprises includes purchase of goods counted as input in production (i.e. rental of health personnel), while purchase of complete health services from other producers is excluded.

The operating costs increased for all of the public health enterprises in all four health regions. The South-Eastern health region is the biggest health region, and accounts for 55 per cent of the total operating costs. In this region we also find the largest health enterprises, Ullevål universitetssykehus HF and Rikshospitalet HF. They account for 8.9 and 8.2 per cent of all Central Government spending on specialist health services respectively. In the other health regions we find Helse Bergen HF (8.0 per cent) and St Olavs Hospital HF (7.2 per cent) as other large health enterprises.

The privately owned part of the specialist health service is excluded from the statistics in StatRes. For comparison between the different institutional sectors see www.ssb.no/sykehus_en/ . Operating costs in private specialist health services amount to almost NOK 8 billion. The three largest enterprises are Lovisenberg Diakonale Sykehus AS (NOK 1 billion), Diakonhjemmet Sykehus AS (NOK 1 billion) and Haraldsplass (NOK 0.5 billion).

Input - Man-years in Central Government specialist health services

The number of contracted man-years¹(adjusted for long-term illness and maternity leave) in Central Government specialist health services was 82 000 in 2008. General hospitals account for 72.5 per cent of these, psychiatric institutions account for 18.7 per cent, institutions for the treatment of drug abuse for 1.5 per cent and other services for 7.3 per cent.

Central Government is the dominant institutional sector in specialist health services. A total of 87 per cent of all contracted man-years belong to Central Government. General hospitals, the largest type of service in specialist health services, are also the type of service with the largest Central Government domination. A total of 91 per cent of man-years in the area of general hospitals are employed by Central Government. Drug abuse treatment is the type of service least owned by Central Government. Forty-four per cent of all contracted man-years are employed by Central Government. The health regions in South-Eastern and Western Norway are less dominated by the Central Government than Mid and Northern Norway.

Activities and services - continued decline in the number of discharges and increased outpatient treatment

The number of discharges continues to decrease as in past years. The number of outpatient treatments is increasing. The decrease in the number of day-cases may be explained by the redefinition of the treatments offered in specialist health service in general, and in psychiatry in particular.

Main groups of diagnosis may give some insight into explaining the developments in specialist health services. In the period 2002-2008, there was an increase in the number of discharges, day-cases and outpatient treatments. The number of discharges experienced the lowest increase; 10 per cent. For some main diagnosis, i.e. diseases of the eye and adnexa, and diseases of the skin and subcutaneous tissue, the number of discharges decreased. The number of day-cases experienced the highest relative increase in 2002-2008, with 50 per cent. Diseases in the blood etc., diseases in the nervous system and diseases in the musculoskeletal system are some main groups of diagnosis where the number of day-cases increased significantly.

Adjusted DRGs is a new key figure in the activities in the Central Government specialist health service. The DRG system is the central instrument to calculate activity-based financing of the specialist health service. Activity-based financing is limited to the general hospitals. In the number of adjusted DRGs the South-East health region accounted for 57 per cent, Western health region 18 per cent, the Mid-Norway health region 15 per cent and the Northern health region 10 per cent of the production in Central Government somatic services.

The DRG system is adjusted for the expected resource intensity of the treatment. A short-term outpatient treatment and a long-term hospital stay are weighted relatively to an average hospital contact. The DRGs are adjusted by a price deflator given by the health authorities.

Productivity and unit costs

This year StatRes also includes new key figures on productivity and unit costs for the somatic part of Central Government. The key figures are compiled by SINTEF in the annual SAMDATA reports ( www.samdata.no ). The underlying population used in these figures differs from the population used in the other StatRes figures. These are operating costs (with and without depreciation) per DRG. The unit costs for the country as a whole have been stable from 2007 to 2008. The relative level of costs seems to be higher in the northern part of Norway than in the south-eastern part.

Outcomes - average period of waiting

The indicator “average period of waiting for ordinary effected referrals” is also new in StatRes, and the first indicator defined as a measurement for results in StatRes specialist health services. The indicator shows the number of days from receipt of a referral until effectuation. The average period of waiting for ordinary effected referrals increased in the period 2006-2008 from 71 to 73 days. The average waiting period increased for general hospitals and institutions for drug abuse treatment, while in the field of psychiatry the average waiting period decreased.

¹Figures for contracted man-years corrected for long-term sick leave (doctor-certified sick leave) and maternity leave.