Effects of a reimbursement change and travel times on the delivery of private and public radiology services in Norway: a register-based longitudinal study of Norwegian claims data

Abstract

Background The variation in the impact of the 2008 reimbursement change for Norwegian radiology providers, depending on the travel times to private and public providers in different municipalities, was examined. The activity-based fund allocation for radiology providers was reduced from approximately 50% to 40%, which was compensated by an increased basic grant. The hypothesis was that the Norwegian population would be affected by the reimbursement change unevenly depending on their distances to different types of the providers. Methods The study of the effect of the reimbursement change and travel time difference between private and public radiology providers in Norway (Time_difference) on the number of the services was performed using fixed-effects regressions applied to panel data at the municipality level with monthly observations for the period 2007–2010. Results After the reimbursement change, the number of private services decreased more than the number of public services. Private services declined after 2008, but the absolute value of the effect was smaller as the Time_difference became greater. The number of public services increased as the Time_difference grew. The total number of services decreased until the Time_difference was equal to 40 min and increased for time differences greater than 40 min. Conclusions The messages for policymakers are as follows. Populations that only had private providers nearby were more affected by the reimbursement change in terms of a reduced number of services. The reimbursement change contributed to the reallocation of patients from private to public providers. The difference between the centralities of municipalities in their consumption patterns was reduced and the difference between different Regional Health Authorities was increased due to the reimbursement change.

The use of low-value imaging: the role of referral practice and access to imaging services in a representative area of Norway

“…This may indicate that healthcare services fulfil the goal of providing equal healthcare to all citizens despite varying travel distances. Moreover, our findings demonstrate that people in rural areas are willing to travel for services, which is in line with other studies [ 17 ]. Higher examination rates for patients in rural parts of the catchment area may be due to a more elderly population [ 35 ], thus needing more health services.…”

“…Access to services is a driver for utilisation, where the distance to the provider has proven to play a substantial role in healthcare consumption [ 17 ]. Also, geographical variations may mean less equal access to radiological services and poor allocation of health resources [ 18 ].…”

“…The hospital trust provides specialist health care services in more than 20 municipalities for approximately 500,000 people [ 29 ], which is about 10% of the Norwegian population. Two private imaging centres had a contract with regional health authorities in 2019 for delivering radiology services on public terms in this area [ 17 ] (see Fig. 1 for details).…”

“…Travelling distance to the imaging facility is one factor influencing access. Norway is a long and narrow country with several remote municipalities where travel time to imaging providers can take several hours [ 17 ]. Therefore, variation in service access may result in unwarranted geographical variations, indicating over- or underutilisation.…”