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ABSTRACT: It is not uncommon that publicly employed physicians also have income from work outside the hospital, sometimes termed moonlighting. There is little empirical evidence of such activity. In this article, we investigate which factors that may influence physicians’ choice of work between the public hospital sector and elsewhere. An exceptionally high wage increase in 1996 for one group of hospital physicians (physician assistants) serves as a natural experiment, and we analyse whether wages in general and this reform in particular have affected physicians’ external earnings. For physician assistants we find that higher wages at public hospitals affect negatively both the decisions to earn income externally, and level of income once active. For chief physicians, on the other hand, there was no such response to the wage increase. Several hospital specific factors representing job specific work characteristics also matter for physicians’ decisions to earn income externally.
Applied Economics. 01/2013; 45(3):397-406.
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ABSTRACT: This paper investigates the existence of markups and their cyclical behaviour at the industry sector level. Markups are given
as a price-cost relation that is estimated from a dynamic, structural model of the firm. The firms face costly adjustment
of labour and potential financial constraints. The model is tested on a panel of firm- and plant-level data from Norwegian
manufacturing industries. The results indicate a frequent presence of moderate pro-cyclical markups. Labour adjustment costs
are present in four out of seven sectors but small in magnitude. The results are related to the role played by unions in a
setting with high union density.
KeywordsMarkups-Business cycles-Panel data-Adjustment costs
JEL ClassificationE32-D92
Empirical Economics 04/2012; 38(2):409-428. · 0.60 Impact Factor
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ABSTRACT: This paper presents a new way to monitor priority settings in public health-care systems. We take departure in medical guidelines prescribing acceptable waiting times for different medical descriptions. Allocating ICD10 codes to the medical descriptions, we are able to compare actual waiting times to the recommended maximum waiting times. This way we use the medical guidelines as a tool for monitoring prioritisation in the health sector. In an application, using data from the Norwegian Patient Register, we test statistically for compliance with the guidelines. The results indicate that patients suffering from the most severe conditions are receiving too low priority in the Norwegian health-care sector relative to patients of lower priority.
Health Economics 08/2011; 20(8):958-70. · 2.12 Impact Factor
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ABSTRACT: We aimed to estimate the societal treatment-related costs of COPD in hospital- and population-based subjects with spirometry defined COPD, relative to a control group.
81 COPD cases and 132 controls without COPD were randomly recruited from a general population, as were 205 COPD patients from a hospital register. All participants were ever-smokers of at least 40 years of age, followed for 12 months. Data on comorbid conditions and spirometry were collected at baseline. Standardized telephone interviews every third month gave information on use of healthcare services and exacerbations of respiratory symptoms.
The increased (excessive) median annual costs per case having stage II, stage III and stage IV COPD were € (95% CI) 400 (105-695), 1918 (1268-2569) and 1870 (1031-2709), respectively, compared to the population-based controls. Costs increased with €81 (95% CI 50-112) per exacerbation of respiratory symptoms and €461 (95% CI 354-567) per comorbid condition. Excessive costs for hospital COPD patients were threefold that of the population-based COPD cases.
The excessive treatment-related cost of COPD stage II+ in ever-smokers of at least 40 years was estimated to €105 million for Norway. Comorbidity was a dominant predictor of excessive cost in COPD.
Respiratory medicine 10/2010; 105(3):485-93. · 2.33 Impact Factor
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ABSTRACT: The right to equal treatment, irrespective of age, gender, ethnicity, socio-economic status and place of residence, is an important principle for several health care systems. A reform of the Norwegian hospital sector of 2002 may be used as a relevant experiment for investigating whether centralization of ownership and management structures will lead to more equal prioritization practices over geographical regions. One concern was variation in waiting times across the country. The reform was followed up in subsequent years by some other policy initiatives that also aimed at reducing waiting lists. We measure prioritization practice by a method that takes departure in recommended maximum waiting times from medical guidelines. We merge the information from the guidelines with individual patient data on actual waiting times for the period 1999-2005. This way we can monitor whether each patient in the available register of actual hospital visits has waited shorter or longer than what is considered medically acceptable by the guideline. The results indicate no equalization between the five new health regions, but we find evidence of more equal prioritization within four of the health regions. Our method of measuring prioritizations allows us to analyse how prioritization practice evolved over time after the reform, thus covering some further initiatives with the same objective. The results indicate that an observed reduction in waiting times after the reform have favoured patients of lower prioritization status, something we interpret as a general worsening of prioritization practices over time.
Social Science & Medicine. 01/2010; 70(2):199-208.
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ABSTRACT: Utilisation of healthcare resources because of pulmonary diseases have previously been presented according to lung function or symptom severity. We aimed to compare the associations of symptoms and lung function to healthcare and social service utilisation in subjects with self-reported obstructive lung diseases (OLDs) (asthma, chronic obstructive pulmonary disease, chronic bronchitis, emphysema).
Of 2819 participants aged 27-82 years in the Hordaland County Respiratory Health Survey, 200 subjects (7.1%) self-reported OLD. They answered 13 questions on respiratory symptoms and 5 questions on use of healthcare and social services. Altogether, 161 participants (81%) completed post-bronchodilation spirometry.
Use of anti-asthmatic drugs, regular physician's appointment, sick leave payment for the last 12 months, hospital admission for the last 12 months and disability pension were reported by 68%, 63%, 18%, 8% and 7% of those with self-reported OLD, respectively. Twenty per cent of subjects with self-reported OLD had not received any healthcare or social services. In adjusted multivariate logistic regression analyses, increase in the respiratory symptom score was significantly associated with more healthcare and social services. Lower forced expiratory volume in 1 s in % predicted, however, was not significantly associated with more use of healthcare and social services.
The majority (80%) of subjects in a general population with self-reported OLD received healthcare services. The utilisation of healthcare and social services was strongly associated to the burden of respiratory symptoms, and, to a lesser degree, to the level and pattern of lung function.
The Clinical Respiratory Journal 01/2009; 3(1):34-41. · 1.06 Impact Factor
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ABSTRACT: The Norwegian health care system gives patients with a diagnostic description meeting certain criteria concerning seriousness of the illness, prospects of treatment, and cost-effectiveness of relevant treatment, a prioritised right to treatment in the specialised health care system within a set time frame. This maximum waiting time will vary for different diagnoses. However, the operationalisation of these criteria varies quite dramatically over health care trusts and among hospitals within the health care trusts. This was the case before the government take-over of hospitals in 2002, and it is tills the case. In relation to objectives of equal access to health care for everyone, this variation is of considerable public concern. We raise the question whether the reduction in number of owners resulting from the governmental take-over of hospitals and merging smaller hospitals into a regional health care trusts, has resulted in a more equal prioritization practice. We compare the practise of giving the right to treatment among health care trusts, and among hospitals within the heath care trusts, before and after the reform. We use individual level observations for all patients within several diagnoses that differ in the maximum acceptable waiting time for treatment. Patients within these diagnoses are grouped into five groups, which differ according to maximum waiting time. We control for several other variables affecting treatment intensities, thus isolating a reform effect in terms of changes in geographical variation of waiting time for the patients in the five priority groups. The results show a significant tendency for more homogenous practises at the level of health care trusts, whereas the picture is mixed for actual waiting times among patients within the regional health care trusts.
HEN: Scandinavia (Sub-Topic). 06/2007;
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ABSTRACT: Sickness absence tends to be negatively correlated with unemployment rates. In addition to pure health effects, this may be due to moral hazard behavior by workers who are fully insured against income loss during sickness and to physicians who meet demand for medical certificates. Alternatively, it may reflect changes in the composition of the labor force, with more sickness-prone workers entering the labor force in upturns. A panel of Norwegian register data is used to analyze long-term sickness absences. The unemployment rate is shown to be negatively associated with the probability of absence, and with the number of days of sick leave. Restricting the sample to workers who are present in the whole sample period, the negative relationship between absence and unemployment becomes clearer. This indicates that procyclical variations in sickness absence are caused by established workers and not by the composition of the labor force.
Health Economics 12/2005; 14(11):1087-101. · 2.12 Impact Factor
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ABSTRACT: Shortage of nurses is a problem in several countries. It is an unsettled question whether increasing wages constitute a viable policy for extracting more labour supply from nurses. In this paper we use a unique matched panel data set of Norwegian nurses covering the period 1993-1998 to estimate wage elasticities. The data set includes detailed information on 19,638 individuals over 6 years totalling 69,122 observations. The estimated wage elasticity after controlling for individual heterogeneity, sample selection and instrumenting for possible endogeneity is 0.21. Individual and institutional features are statistically significant and important for working hours. Contractual arrangements as represented by shift work are also important for hours of work, and omitting information about this common phenomenon will underestimate the wage effect.
Health Economics 10/2003; 12(9):705-19. · 2.12 Impact Factor
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ABSTRACT: Sickness absence tends to be negatively correlated with unemployment. This may suggest disciplining effects of unemployment but may also reflect changes in the composition of the labour force. A panel of Norwegian register data for the years 1990-1995 is used to analyse sickness absences lasting more than two weeks. We estimate fixed effects models of the probability of absence and the number of days on sick leave conditional on absence. The county unemployment rate is found to affect the probability of absence negatively. When restricting the sample to workers who are present in the whole sample period, the negative relationship between absence and unemployment remains. The evidence on duration goes in the same direction. This indicates that the revealed procyclical variation in sickness absence is not driven by changes in the composition of the labour force.
05/2002;
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ABSTRACT: Shortage of nurses is a problem in several countries. It is an unsettled question whether increasing wages constitute a viable policy for extracting more labor supply from nurses. In this paper we use a unique matched panel data set of Norwegian nurses covering the period 1993-1997 to estimate wage elasticities. This data includes detailed information on 18,066 individuals over 5 years totaling 56,832 observations. The estimated elasticity when controlling for individual and time invariant fixed effects is significantly positive but not very high in magnitude. Individual and institutional features are significant and important for working hours. We have also access to information about contractual arrangements. It turns out that shift work is important for hours of work, and that omitting information about this common phenomenon will underestimate the wage effect.
04/2002;
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European Journal of Political Economy 02/2002; 18(2):345-363. · 1.44 Impact Factor
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ABSTRACT: Shortage of nurses is a problem in several countries. It is an unsettled question whether increasing wages constitute a viable policy for extracting more labour supply from nurses. In this paper we use a unique matched panel data set of Norwegian nurses covering the period 1993-1998 to estimate wage elasticities. The data set includes detailed information on 19,638 individuals over 6 years totalling 69,122 observations. The estimated wage elasticity after controlling for individual heterogeneity, sample selection and instrumenting for possible endogeneity is 0.21. Individual and institutional features are statistically significant and important for working hours. Contractual arrangements as represented by shift work are also important for hours of work, and omitting information about this common phenomenon will underestimate the wage effect.
02/2002;
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ABSTRACT: Absenteeism is affected by the sickness benefit system. Countries with generous compensation during sick leaves also experience high numbers of sick leave. Sick leaves may vary over the business cycle due to unemployment disciplining effects or changes in labour force composition. The latter hypothesis maintains that sickness may be pro-cyclical due to employment of `marginal' workers with poorer health when demand increases. Using individual records of labour force participants in Norway, we investigate the explanatory factors behind differing spells of work absence at different stages of the business cycle. We find no indication that new entrants explain increases in absence, on the other hand workers who stay in the labour force increase absences when the economy improves. Thus there is some evidence that unemployment has a disciplining effect.
Econometric Society, Econometric Society World Congress 2000 Contributed Papers. 01/2000;
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ABSTRACT: Sickness absence tends to be negatively correlated with unemployment. This may suggest disciplining effects of unemployment but may also reflect changes in the composition of the labour force. A panel of Norwegian register data for the years 1990-1995 is used to analyse sickness absences lasting more than two weeks. We estimate fixed effects models of the probability of absence and the number of days on sick leave conditional on absence. The county unemployment rate is found to affect the probability of absence negatively. When restricting the sample to workers who are present in the whole sample period, the negative relationship between absence and unemployment remains. The evidence on duration goes in the same direction. This indicates that the revealed procyclical variation in sickness absence is not driven by changes in the composition of the labour force.
