How do medical doctors consider different steering instruments’ effects on quality and equity in health care? / Norske legers syn på styringsinstrumentenes betydning

Chapter in: Aasen HS, Bringedal B, Bærøe K, Magnussen A-M (ed). Prioritering, styring og likebehandling: Utfordringer i norsk helsetjeneste. Oslo: Cappelen Damm Akademisk, 2018.



Bringedal B, Carlsen B. Kapittel 6: Styring for kvalitet og likebehandling. Norske legers syn på styringsinstrumentenes betydning. I: Aasen HS, Bringedal B, Bærøe K, Magnussen A-M (red). Prioritering, styring og likebehandling: Utfordringer i norsk helsetjeneste. Oslo: Cappelen Damm Akademisk, 2018: 166-187.

Article in Norwegian.

Abstract in English of Bringedal & Carlsen's article:
How do medical doctors consider different steering instruments’ effects on quality and equity in health care? The current chapter presents the results of a postal survey of a representative sample of Norwegian doctors. The sample belongs to a panel of doctors established in 1994, which is surveyed biannually. The current survey took place in 2014. 1261 of a total of 1612 doctors responded (78,2 percent); the steering instruments in the questionnaire included legal and economic measures, audit and control systems, clinical support, and organizational measures. Overall, the doctors consider economic measures, reporting requirements (excluding clinical records) and, to some extent, structural measures to yield negative effects on quality and equity, while they consider that all other measures in the survey have positive influence. The responses vary between GPs and hospital specialists; relatively more hospital doctors consider economic, legal and structural measures to have a negative impact on quality and equity. One fourth of the doctors answered the open question: “If any of the measures hinders you in delivering medical help as you would like to, which group(s) of patients are particularly suffering from this?” A majority mention co-morbid patients, especially those of high age, patients with psychiatric and/or addiction related disease, as well as the chronically ill.

The anthology is the result of the research project Prioritizing Health Care - Tensions and Interplay between Legal, Political, Economic and Professional Perspectives,  funded by the Norwegian Research Council. The book has open accecc and every chapter has abstracts in English. 

Summary of the anthology
Prioritization is a necessity in healthcare, in the allocation of limited resources. Which criteria and considerations prove decisive, however, when it comes to prioritization in practice?
The dominant political objective of the Norwegian public healthcare system is to provide services of high quality, fairly distributed among Norway’s citizens. Regulatory and economic policies, professional values, administrative organization and distribution of resources are among the factors that influence everyday decision-making and the realization of healthcare objectives. How do healthcare providers experience these factors? Which hidden prioritization mechanisms are at play? How are equal treatment and fair distribution of services understood in practice? These are among the questions discussed in the various chapters of the book, written by scholars in social science, law, philosophy and medicine.

While researchers, academics, students and healthcare providers are the targeted readers, this book will be of interest to everyone engaged in today´s challenges related to healthcare prioritization, including decision-makers at various political and administrative levels.

Read more about the anthology here (mostly in Norwegian).