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Accessibility of dental services according to family income in a non-insured population.

https://arctichealth.org/en/permalink/ahliterature73260
Source
Soc Sci Med. 1993 Dec;37(12):1501-8
Publication Type
Article
Date
Dec-1993
Author
J. Grytten
D. Holst
P. Laake
Author Affiliation
Institute of Community Dentistry, University of Oslo, Blindern, Norway.
Source
Soc Sci Med. 1993 Dec;37(12):1501-8
Date
Dec-1993
Language
English
Publication Type
Article
Keywords
Adult
Dental Care - economics - utilization
Female
Health Services Accessibility - economics
Humans
Income
Male
Medically Uninsured
Norway
Abstract
The aim of this study was to examine the effect of family income on accessibility to dental services among adults in Norway. The analysis was performed on a set of national data collected in 1989, which was representative of the non-institutionalized Norwegian population aged 20 years and above. The sample size was 1200 individuals. The data were analyzed according to a two-part model. The first part determined the probability of whether the consumer had demanded the services or not during the last year according to family income. The second part estimated how the amount of services utilized depended on family income, for those with demand. The elasticity of the odds of having demanded the services with respect to family income was 0.48. Family income had no effect on the amount of services utilized. Additional analyses also showed that there was no effect of family income on the probability of having received a filling or a crown when visiting the dentist. In Norway, almost all costs for dental services are paid by the consumer. It is not possible from the data alone to say whether subsidized dental care is an effective way of reducing the inequalities in demand.
PubMed ID
8303334 View in PubMed
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Accessibility of Norwegian dental services according to family income from 1977 to 1989.

https://arctichealth.org/en/permalink/ahliterature75798
Source
Community Dent Oral Epidemiol. 1992 Feb;20(1):1-5
Publication Type
Article
Date
Feb-1992
Author
J. Grytten
Author Affiliation
Institute of Community Dentistry, University of Oslo, Norway.
Source
Community Dent Oral Epidemiol. 1992 Feb;20(1):1-5
Date
Feb-1992
Language
English
Publication Type
Article
Keywords
Adult
Dental Health Services - statistics & numerical data - utilization
Dental Restoration, Permanent - statistics & numerical data - utilization
Health Services Accessibility - statistics & numerical data
Health Services Needs and Demand - statistics & numerical data
Humans
Income
Logistic Models
Norway - epidemiology
Odds Ratio
Tooth Extraction - statistics & numerical data - utilization
Abstract
During the last 10-20 yr there has been a marked increase in demand for dental services in most western countries. An important issue is how this increase in demand has influenced inequalities in use of services among different income groups in the population. It is of particular interest to study this in Norway, as almost all the costs for dental care among adults are borne by the patient. The aim of the present study was to examine how the effect of family income on demand for dental services has changed over time. The analyses were performed on three sets of national data from 1977, 1983, and 1989. The samples were representative of the non-institutionalized Norwegian population aged 20 yr and above. Inequalities in use of dental services among different income groups have decreased between 1977 and 1989. However, separate analyses on the data from 1989 showed that some inequalities still exist. A non-selective subsidizing policy for dental care is unlikely to have any great effect in reducing these inequalities. Subsidized dental care is likely to raise the total amount of dental care demanded. However, it is difficult to assess accurately the size of this increase as the elasticity of demand for dental care in Norway with respect to price is unknown.
PubMed ID
1547604 View in PubMed
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Can a public health care system achieve equity? The Norwegian experience.

https://arctichealth.org/en/permalink/ahliterature35183
Source
Med Care. 1995 Sep;33(9):938-51
Publication Type
Article
Date
Sep-1995
Author
J. Grytten
G. Rongen
R. Sørensen
Author Affiliation
Institute of Community Dentistry, University of Oslo, Norway.
Source
Med Care. 1995 Sep;33(9):938-51
Date
Sep-1995
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Comparative Study
Fees and Charges
Female
Health Services Accessibility
Health services needs and demand
Health status
Humans
Income
Male
Middle Aged
Models, Theoretical
National Health Programs - organization & administration - standards
Norway
Physicians - supply & distribution
Primary Health Care - organization & administration
Research Support, Non-U.S. Gov't
Social Justice
Time Factors
Travel
Abstract
Equity in health care provision is an important policy goal in Norway. This article addresses equality in the services provided by primary care physicians. These services are the responsibility of local government financed mainly through public funding. Patient fees are low. The local government system results in geographical variation in the number of physicians relative to local health demands. The authors present the hypothesis that this generates inequalities in health care utilization. The system of government finance is based on the assumption that utilization of health services is independent of patient income. Therefore, variation in income is expected to have only a small impact on utilization. The authors estimate a demand model by combining extensive micro data with aggregate data on municipal supply. There is very little relationship between indicators of access and health care utilization. The estimated income elasticities approximate zero, supporting the argument that equality in utilization has been achieved. However, the authors results also raise the question of whether equality has been achieved at the cost of limiting supply of services for people who could afford to consume more, or to pay for services of higher quality.
PubMed ID
7666707 View in PubMed
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Changing trends in caries experience among male military recruits in Norway.

https://arctichealth.org/en/permalink/ahliterature218052
Source
Community Dent Oral Epidemiol. 1994 Jun;22(3):206-7
Publication Type
Article
Date
Jun-1994
Author
O. Asmyhr
L. Grytten
J. Grytten
Author Affiliation
Joint Norwegian Medical Service, Dental Branch, Oslo Mil/Huseby.
Source
Community Dent Oral Epidemiol. 1994 Jun;22(3):206-7
Date
Jun-1994
Language
English
Publication Type
Article
Keywords
Adult
DMF Index
Dental Caries - epidemiology
Dental Restoration, Permanent - statistics & numerical data
Humans
Male
Military Personnel
Norway - epidemiology
Prevalence
PubMed ID
8070251 View in PubMed
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A comparative study of costs for dental services and dentists' income in the United States and Norway.

https://arctichealth.org/en/permalink/ahliterature73191
Source
Community Dent Oral Epidemiol. 1994 Apr;22(2):65-70
Publication Type
Article
Date
Apr-1994
Author
L A Helöe
J. Grytten
G B Warren
L J Brown
Author Affiliation
Institute of Community Dentistry, University of Oslo, Norway.
Source
Community Dent Oral Epidemiol. 1994 Apr;22(2):65-70
Date
Apr-1994
Language
English
Publication Type
Article
Keywords
Comparative Study
Dental Health Services - economics
Dentists - economics
Fees, Dental - statistics & numerical data
Female
Health Expenditures - statistics & numerical data
Humans
Income - statistics & numerical data
Male
Norway
Practice Management, Dental - economics
United States
Abstract
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.
PubMed ID
8205781 View in PubMed
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Source
Health Econ. 2000 Jul;9(5):447-61
Publication Type
Article
Date
Jul-2000
Author
J. Grytten
R. Sørensen
Author Affiliation
Dental School, University of Oslo, Oslo, Norway. josteing@odont.uio.no
Source
Health Econ. 2000 Jul;9(5):447-61
Date
Jul-2000
Language
English
Publication Type
Article
Keywords
Adult
Economic Competition
Fees, Dental - statistics & numerical data
Health Care Sector
Health services needs and demand
Humans
Models, Econometric
Norway
Practice Management, Dental - economics
Abstract
Dental services for adults are different from all other Norwegian health services in that they are provided by private producers (dentists) who have full freedom to establish a practice. They have had this freedom since the end of World War II. A further liberalization of the market for dental services occurred in November 1995, when the so-called normal tariff was repealed. The system changed from a fixed fee system to a deregulated fee system. In principle, the market for dental services for adults operates as a free competitive market, in which dentists must compete for a market share. The aim of this study was to study the short-term effects of competition. A comprehensive set of data on fees, practice characteristics, treatment profiles and factors that dentists take into account when determining fees was analysed. The main finding was that competition has a weak effect. No support was found for the theory that the level of fees is the result of monopolistic competition or monopoly. The results also provided some evidence against the inducement hypothesis. At this stage, it is interesting to notice that dentists do not seem to exploit the power they have to control the market. One explanation, which is consistent with the more recent literature, is that physicians' behaviour to a large extent is influenced by professional norms and caring concerns about their patients. Financial incentives are important, but these incentives are constrained by norms other than self-interest. The interpretation of the results should also take into account that the deregulation has operated for a short time and that dentists and patients may not yet have adjusted to changes in the characteristics of the market.
PubMed ID
10903544 View in PubMed
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Competition and supplier-induced demand in a health care system with fixed fees.

https://arctichealth.org/en/permalink/ahliterature72286
Source
Health Econ. 1999 Sep;8(6):497-508
Publication Type
Article
Date
Sep-1999
Author
R J Sorensen
J. Grytten
Author Affiliation
Norwegian School of Management, Sandvika, Norway.
Source
Health Econ. 1999 Sep;8(6):497-508
Date
Sep-1999
Language
English
Publication Type
Article
Keywords
Economic Competition - economics
Fee Schedules - economics
Fee-for-Service Plans - economics
Female
Health Policy
Health services needs and demand - economics - statistics & numerical data
Humans
Least-Squares Analysis
Male
Models, Econometric
Norway
Primary Health Care - economics - manpower
Research Support, Non-U.S. Gov't
Socioeconomic Factors
Abstract
The present paper examines whether supplier-induced demand exists for primary physician services in Norway. The research design is adapted to the institutional setting of Norwegian primary physician services, where there is a fixed fee schedule. More than 50% of primary care physicians receive a payment for treatment from the National Insurance Administration on a fee-for-item basis. The results showed that increased competition, measured as a high physician:population ratio, led to a decline in the number of consultations per contract physician. However, the contract physicians in high physician density areas did not compensate for the lack of patients by providing more items of treatment in order to maintain their income. Contract physicians' revenue from items of treatment per consultation were unaffected both by physician density and by the number of consultations per contract physician. These results are further corroborated by data that showed that contract physicians' gross revenue and profits were declining functions of physician density. This paper argues that, from an efficiency point of view, a deregulated health care market with fixed fees may operate well.
PubMed ID
10544315 View in PubMed
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Consumer satisfaction and supplier induced demand.

https://arctichealth.org/en/permalink/ahliterature195945
Source
J Health Econ. 2000 Sep;19(5):731-53
Publication Type
Article
Date
Sep-2000
Author
F. Carlsen
J. Grytten
Author Affiliation
Department of Economics, Norwegian University of Science and Technology, NTNU, Trondheim, Norway. fredrik.carlsen@svt.ntnu.no
Source
J Health Econ. 2000 Sep;19(5):731-53
Date
Sep-2000
Language
English
Publication Type
Article
Keywords
Consumer Satisfaction - statistics & numerical data
Health Care Rationing
Health Services Accessibility
Health Services Needs and Demand - statistics & numerical data
Humans
Medically underserved area
Models, Statistical
Norway
Physicians, Family - supply & distribution
Abstract
This study examines the relationship between supply of primary physicians and consumer satisfaction with access to, and quality of, primary physician services in Norway. The purpose is to throw light on a long-standing controversy in the literature on supplier inducement (SID): the interpretation of the positive association between physician density and per capita utilization of health services. We find that an increase in the number of physicians leads to improved consumer satisfaction, and that the relationship between satisfaction and physician density exhibits diminishing returns to scale. Our results suggest that policy-makers can compute the socially optimal density of physicians without knowledge about whether SID exists, if one accepts the (controversial) assumption that consumer satisfaction is a valid proxy for patient utility.
PubMed ID
11184802 View in PubMed
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Contract design for primary care physicians: physician location and practice behaviour in small communities.

https://arctichealth.org/en/permalink/ahliterature198802
Source
Health Care Manag Sci. 2000 Feb;3(2):151-7
Publication Type
Article
Date
Feb-2000
Author
R J Sørensen
J. Grytten
Author Affiliation
Norwegian School of Management, Sandvika, Norway. rune.sorensen@bi.no
Source
Health Care Manag Sci. 2000 Feb;3(2):151-7
Date
Feb-2000
Language
English
Publication Type
Article
Keywords
Capitation Fee - organization & administration
Career Choice
Contract Services - organization & administration
Family Practice - organization & administration
Fee-for-Service Plans - organization & administration
Humans
Models, Econometric
Norway
Physician's Practice Patterns - organization & administration
Population Density
Professional Practice Location - statistics & numerical data
Salaries and Fringe Benefits - statistics & numerical data
Workload
Abstract
Most western countries employ a combination of fee-for-service, fixed salary and per capita subsidies to finance the services of general practitioners. Based on Norwegian data, the authors demonstrate that these financial schemes have been used in different types of municipalities. The authors argue that the fee-for-service and per capita components should be allowed to vary between primary physicians and municipalities: (a) If the patient population per primary physician is low and patient supply is unstable, the per capita subsidy or work-free income should be differentiated to ensure recruitment of physicians. (b) Physicians in municipalities with low physician coverage should be allotted a low basic grant, whilst per capita subsidy and fee-for-service payments should be used to stimulate service production. The opposite situation exists where there is a potential of supplier inducement due to high physician coverage. (c) The responsibility for designing contracts should be assigned to local rather than national authorities. These suggestions go against important elements in the reform of primary physician services in Norway.
PubMed ID
10780283 View in PubMed
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The effect of supplier inducement on Norwegian dental services; some empirical findings based on a theoretical model.

https://arctichealth.org/en/permalink/ahliterature62890
Source
Community Dent Health. 1991 Sep;8(3):221-31
Publication Type
Article
Date
Sep-1991
Author
J. Grytten
Author Affiliation
Institute of Community Dentistry, University of Oslo, Norway.
Source
Community Dent Health. 1991 Sep;8(3):221-31
Date
Sep-1991
Language
English
Publication Type
Article
Keywords
Adult
Costs and Cost Analysis
Dental Health Services - economics - utilization
Dentists - supply & distribution
Female
Health Care Rationing
Health Services Accessibility - economics
Health services needs and demand
Humans
Income
Logistic Models
Male
Motivation
Norway
Population
Probability
Socioeconomic Factors
Abstract
The aim of the present study was to ascertain whether the amount of dental care demanded and the amount of dental care received in Norway were influenced by supplier inducement. There is a fixed price schedule for dental care in Norway, which establishes the framework for the theoretical model on which the empirical studies were based. The model has been developed by Birch (1988), and it describes how the utilisation of dental services may be influenced both by supplier inducement and reduced shadow prices (access costs) when the population to dentist ratio decreases. The sample of 1200 individuals was representative of the non-institutionalised Norwegian population aged 20 years and over. Variables measuring access costs, rationing of care, oral health, unmet need, family income and socio-demographic characteristics of the population were included as control variables. Supplier inducement effects were found on dentist-initiated visits, and on the cost per visit. It was concluded that dentists in areas of excess supply were able to maintain their workload by increasing the demand for and the utilisation of their services. Also, that the existing maldistribution of dentists between the northern and southern parts of Norway is not likely to be altered by allowing market mechanisms to operate on the dental care market.
PubMed ID
1933548 View in PubMed
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30 records – page 1 of 3.