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Health care cost containment in Denmark and Norway: a question of relative professional status?

Published online by Cambridge University Press:  28 June 2013

Lotte B. Andersen*
Affiliation:
Department of Political Science and Government, Aarhus University, Århus C, Denmark
*
*Correspondence to: Lotte B. Andersen, Department of Political Science and Government, Aarhus University, Bartholins alle 7, 8000 Århus C, Denmark. Email: Lotte@ps.au.dk

Abstract

The demand for publicly subsidised health care services is insatiable, but the costs can be contained in different ways: formal rules can limit access to and the number of subsidised services, demand and supply can be regulated through the price mechanism, the relevant profession can contain the costs through state-sanctioned self-regulation, and other professions can contain the costs (e.g. through referrals). The use of these cost containment measures varies between countries, depending on demand and supply factors, but the relative professional status of the health professions may help explain why different countries use cost containment measures differently for different services. This article compares cost containment measures in Denmark and Norway because these countries vary with regard to the professional status of the medical profession relative to other health care providers, while other relevant variables are approximately similar. The investigation is based on formal agreements and rules, historical documents, existing analyses and an analysis of 360 newspaper articles. It shows that high relative professional status seems to help professions to avoid user fees, steer clear of regulation from other professions and regulate the services produced by others. This implies that relative professional status should be taken into consideration in analyses of health care cost containment.

Type
Articles
Copyright
Copyright © Cambridge University Press 2013 

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References

Abel-Smith, B.Mossialos, E. (1994), ‘Cost containment and health care reform: a study of the European Union’, Health Policy, 28: 89132.Google Scholar
Andersen, L. B. (2009), ‘What determines the behaviour and performance of health professionals? Public Service Motivation, professional norms or economic incentives’, International Review of Administrative Sciences, 75(1): 7997.CrossRefGoogle Scholar
Berg, O. (1987), Medisinens logikk: Studier i medisinens sosiologi og politick, Oslo: Universitetsforlaget.Google Scholar
Berntsen, K. (1982), ‘1957–1962’, in Formændene beretter 1947–1982, Copenhagen: The Danish Psychological Association, pp. 3648.Google Scholar
Bratbo, J. (1997), ‘En moderne fagforening’, Psykolog Nyt, 12: 1621.Google Scholar
Burrage, M.Torstendahl, R. (eds) (1990), Professions in Theory and History: Rethinking the Study of Professions, London: Sage.Google Scholar
Byrkjeflot, H., Neby, S. (2004), ‘The decentralized path challenged? Nordic health care reforms in Comparison’, Bergen, Rokkansenteret. Working paper 2-2004.Google Scholar
Byrkjeflot, H.Neby, S. (2008), ‘The end of the decentralised model of healthcare governance? Comparing developments in the Scandinavian hospital sectors’, Journal of Health Organization and Management, 22: 331349.Google Scholar
City and Guilds Centre for Skills Development (2010), ‘Old age dependency 2009’, http://www.skillsdevelopment.org/docs/Old%20Age%20Dependency%202009.xls [10 December 2010].Google Scholar
Cliff, H. (2002), Fast ansat ved mysteriet. Den Almindelige Danske Jordemoderforening 1902–2002, Copenhagen: DADJ.Google Scholar
Danske Fysioterapeuter (1993), ‘Den almindelige danske massageforening’ (unknown author), 75(6): 4–17, 20.Google Scholar
DeVries, R., Benoit, C., Van Teijlingen, E. R.Wrede, S. (eds) (2001), Birth by Design: Pregnancy, Maternity Care and Midwifery in North America and Europe, London: Routledge.Google Scholar
Diepeveen, M. (1998), ‘I dag og for 80 år siden’, Danske fysioterapeuter, 80(11): 1015.Google Scholar
dknyt (2009), KL: - Fysioterapeuter tager 3800 handicappede som gidsler, http://www.dknyt.dk/sider/artikel.php?id=44369 [14 December 2010].Google Scholar
Donabedian, B. (1995), ‘Self-regulation and the enforcement of professional codes’, Public Choice, 85: 107118.Google Scholar
Downs, A. (1960), ‘Why the Government Budget is too small in a Democracy’, World Politics, 12: 541563.Google Scholar
Erichsen, V. (1996a), ‘Den særegne norske tannpleien’, in V. Erichsen (ed.), Profesjonsmakt: På sporet av en norsk helsepolitisk tradisjon, Oslo: Tano Aschehoug, 217237.Google Scholar
Erichsen, V. (1996b), ‘Legene og staten’, in V. Erichsen (ed.), Profesjonsmakt. På sporet av en norsk helsepolitisk tradisjon, Oslo: Tano Aschehoug, 81106.Google Scholar
European Observatory on Health Care Systems (2000), ‘Health care systems in transition: Norway’, http://www.euro.who.int/__data/assets/pdf_file/0010/95149/E68950.pdf [9 December 2010].Google Scholar
F.a.y.L.'s praksisudvalg (1971), ‘Den praktiserende læges stilling i fremtidens sundheds- og socialvæsen. Betænkning afgivet af F.a.y.L.'s praksisudvalg maj 1971’, Ugeskrift for Læger, 133(32): 15901600.Google Scholar
Florander, J. (1982), ‘1947–52’, in Formændene beretter 1947–1982, Copenhagen: Danish Psychological Association, pp. 318.Google Scholar
Fohlmann, R. J. (1970), Hvad er kiropraktik?, Aarhus: Aros.Google Scholar
Freidson, E. (2001), Professionalism: The Third Logic, Cambridge: Polity Press.Google Scholar
Gaarde, T. (1995), ‘Kiropraktikkens udvikling’, in A. Jordan and K. Østergaard (eds), Kiropraktik, Copenhagen: Dansk Kiropraktor-Forenings Forlag, 1315.Google Scholar
Grimmeisen, S., Rothgang, H. (2004), ‘The changing role of the state in Europe's health care systems’, Paper prepared for the Second Annual ESPAnet Conference, University of Oxford, 9–11 September 2004, http://www.spsw.ox.ac.uk/fileadmin/static/Espanet/espanetconference/papers/ppr.9.SG.pdf [20 May 2010].Google Scholar
Hafferty, F. W.Light, D. W. (1995), ‘Professional dynamics and the changing nature of medical work’, Journal of Health and Social Behavior, 36: 132153.Google Scholar
Hagen, T.Vrangbæk, K. (2009), ‘The Changing Political Governance Structures of Nordic Health Care Systems’, in J. Magnussen, K. Vrangbæk and R. B. Saltman (eds), Nordic Health Care Systems: Recent Reforms and Current Policy Challenges, Maidenhead: McGraw-Hill, 107125.Google Scholar
Hamran, O. (2010), Riktig medisin? En historie om apotekvesenet, Oslo: Pax Forlag.Google Scholar
Hansen, H. C. (1974), Historien om sygekasserne, Copenhagen: De samvirkende centralforeninger af sygekasser i Danmark.Google Scholar
Häkkinen, U.Jonsson, P. M. (2009), ‘Harnessing Diversity of Provision’, in J. Magnussen, K. Vrangbæk and R. B. Saltman (eds), Nordic Health Care Systems: Recent Reforms and Current Policy Challenges, Maidenhead: McGraw-Hill, 198213.Google Scholar
Heaney, M. T. (2006), ‘Brokering health policy: coalitions, parties, and interest group influence’, Journal of Health Politics, Policy and Law, 31(5): 887944.Google Scholar
Hellberg, I., Saks, M.Benoit, C. (eds) (1999), Professional Identities in Transition, Södertälje, Sweden: Almqvist and Wiksell International.Google Scholar
Hernes, S. (1996), ‘Barnevern I 1950-årene: om psykologiens profesjonalisering’, in V. Erichsen (ed.), Profesjonsmakt. På sporet av en norsk helsepolitisk tradisjon, Oslo: Tano Aschehoug, 150168.Google Scholar
Hofgaard, T. L. (2009), ‘Noen gikk foran’, Tidsskrift for Norsk Psykologforening, 46(1): 108.Google Scholar
Horn, M. J. (1995), The Political Economy of Public Administration: Institutional Choice in the Public Sector, Cambridge: Cambridge University Press.Google Scholar
International Monetary Fund (2010), ‘GDP report for selected countries’, http://www.imf.org/external/data.htm [10 December 2010].Google Scholar
Jespersen, P. K.Wrede, S. (2009), ‘The Changing Autonomy of the Nordic Medical Professions’, in J. Magnussen, K. Vrangbæk and R. B. Saltman (eds), Nordic Health Care Systems: Recent Reforms and Current Policy Challenges, Maidenhead: McGraw-Hill, 151179.Google Scholar
Johnsen, J. R. (2006), Health Systems in Transition: Norway. Copenhagen, WHO Regional Office for Europe on behalf of the European Observatory on Health Systems and Policies.Google Scholar
Johnson, T. J. (1972), Professions and Power, London: Macmillan.Google Scholar
Johnson, T., Larkin, G.Saks, M. (eds) (1995), Health Professions and the State in Europe, London: Routledge.Google Scholar
Kanavos, P.Yfantopoulus, J. (1999), ‘Cost Containment and Health Expenditure in the EU: A Macroeconomic Perspective’, in E. Mossialos and J. Le Grand, J. (eds), Health Care and Cost Containment in the European Union, Aldershot: Ashgate, 155198.Google Scholar
Kjølsrød, L. (1993), Jordmor der mor bor? En sociologisk studie av jordmoryrket etter 1945, Oslo: Universitetsforlaget.Google Scholar
Kravitz, R. L. (2008), ‘Beyond gatekeeping: enlisting patients as agents for quality and cost-containment’, Journal of General Intern Medicine, 23: 17221723.Google Scholar
Kringlen, E. (2007), Norsk psykiatri gjennom tidene, Oslo: Damm.Google Scholar
Kruse, P. R.Møller, N. (2001), Apotekervæsenets historie i Danmark, Copenhagen: The Association of Danish Pharmacies.Google Scholar
Kuhlmann, E.Allsop, J. (2008), ‘Professional self-regulation in a changing architecture of governance: comparing health policy in the UK and Germany’, Policy and Politics, 36(2): 173189.CrossRefGoogle Scholar
Kuhlmann, E., Allsop, J.Saks, M. (2009), ‘Professional governance and public control: a comparison of healthcare in the United Kingdom and Germany’, Current Sociology, 57: 511528.Google Scholar
Larson, M. (1977), The Rise of Professionalism: A Sociological Analysis, Berkeley: University of California Press.Google Scholar
Le Grand, J. (2003), Motivation, Agency and Public Policy, Oxford: Oxford University Press.Google Scholar
Light, D. W. (1993), ‘Escaping the traps of postwar western medicine’, European Journal of Public Health, 3(4): 281289.Google Scholar
Martinussen, P. E.Magnussen, J. (2009), ‘Health Care Reform: The Nordic Experience’, in J. Magnussen, K. Vrangbæk and R. B. Saltman (eds), Nordic Health Care Systems: Recent Reforms and Current Policy Challenges, Maidenhead: McGraw-Hill, 2152.Google Scholar
Mikkelsen, O.Østergaard, P. (1998), ‘DTF i 125 år: En krønike om Dansk Tandlægeforenings nyere historie’, Danish Dental Journal, 102(16): 182.Google Scholar
Moran, M. (1999), Governing the Health Care State: A Comparative Study of the United Kingdom, the United States and Germany, Manchester: Manchester University Press.Google Scholar
Moran, M.Wood, B. (1993), States, Regulation and the Medical Profession, Buckingham and Philadelphia: Open University Press.Google Scholar
Mossialos, E.Le Grand, J. (1999), Health Care and Cost Containment in the European Union, Aldershot, Brookfield: Ashgate.Google Scholar
Norsk Kiropraktorforening (2010), ‘Om norsk kiropraktorforening’, http://www.kiropraktikk.no/?pageID=17andItemID=11 [9 December 2010].Google Scholar
Rapoport, J., Jonsson, E.Jacobs, P. (2009), ‘Introduction and Summary’, in J. Rapoport, P. Jacobs and E. Jonsson (eds), Cost Containment and Efficiency in National Health Systems: A Global Comparison, Hoboken, NJ: Wiley-Blackwell.Google Scholar
Regionernes Lønnings- og Takstnævn and Danske Fysioterapeuter (2008), ‘Landsoverenskomst om fysioterapi’, www.okportal.dk [10 December 2010].Google Scholar
Rikstrygdeverket Prosjektgruppen for Ny folketrygdlov (1997), ‘Folketrygden – En oversikt’, http://www.nav.no/rettskildene/Rundskriv/147743.cms [13 December 2010].Google Scholar
Roberts, J.Dietrich, M. (1999), ‘Conceptualizing professionalism: why Economics needs Sociology’, American Journal of Economics and Sociology, 58: 977998.Google Scholar
Starr, P. (1982), The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry, New York: Basic.Google Scholar
Stortinget (1999), Document no. 8:34 (1998–99), www.stortinget.no [15 May 2012].Google Scholar
Strandberg-Larsen, M., Nielsen, M. B., Vallgårda, S., Krasnik, A., Vrangbæk, K. (2007), Health Systems in Transition: Denmark. Health System Review, Vol. 9. Copenhagen: World Health Organization.Google Scholar
Sverre, N. A. (1982), Et studium av farmasiens historie, Oslo: Norwegian Pharmacy Association.Google Scholar
Vrangbæk, K.Christiansen, T. (2005), ‘Health policy in Denmark: leaving the decentralized welfare path?’, Journal of Health Politics, Policy and Law, 30: 2952.Google Scholar