title: Costs and Quality at the Hospital Level in the Nordic Countries.
abstract: This article develops and analyzes patient register-based measures of quality for the major Nordic countries. Previous studies show that Finnish hospitals have significantly higher average productivity than hospitals in Sweden, Denmark, and Norway and also a substantial variation within each country. This paper examines whether quality differences can form part of the explanation and attempts to uncover quality-cost trade-offs. Data on costs and discharges in each diagnosis-related group for 160 acute hospitals in 2008-2009 were collected. Patient register-based measures of quality such as readmissions, mortality (in hospital or outside), and patient safety indices were developed and case-mix adjusted. Productivity is estimated using bootstrapped data envelopment analysis. Results indicate that case-mix adjustment is important, and there are significant differences in the case-mix adjusted performance measures as well as in productivity both at the national and hospital levels. For most quality indicators, the performance measures reveal room for improvement. There is a weak but statistical significant trade-off between productivity and inpatient readmissions within 30 days but a tendency that hospitals with high 30-day mortality also have higher costs. Hence, no clear cost-quality trade-off pattern was discovered. Patient registers can be used and developed to improve future quality and cost comparisons.
authors.affiliation: Frisch Centre, Oslo, Norway.
authors.forename: Sverre A C
authors.initials: SA
authors.lastname: Kittelsen
authors.affiliation: SINTEF Health Research and NTNU, Trondheim, Norway.
authors.forename: Kjartan S
authors.initials: KS
authors.lastname: Anthun
authors.affiliation: Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Fanny
authors.initials: F
authors.lastname: Goude
authors.affiliation: Frisch Centre, Oslo, Norway.
authors.forename: Ingrid M S
authors.initials: IM
authors.lastname: Huitfeldt
authors.affiliation: Centre for Health and Social Economics CHESS, National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Unto
authors.initials: U
authors.lastname: Häkkinen
authors.affiliation: COHERE, University of Southern Denmark, Odense, Denmark.
authors.forename: Marie
authors.initials: M
authors.lastname: Kruse
authors.affiliation: Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Emma
authors.initials: E
authors.lastname: Medin
authors.affiliation: Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Clas
authors.initials: C
authors.lastname: Rehnberg
authors.affiliation: Centre for Health and Social Economics CHESS, National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Hanna
authors.initials: H
authors.lastname: Rättö
mesh_terms: D000293:Adolescent; D000328:Adult; D019985:Benchmarking / Q000706:statistics & numerical data; D002648:Child; D003953:Diagnosis-Related Groups / Q000191:economics; D017598:Efficiency, Organizational / Q000191:economics; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D008297:Male; D019984:Quality Indicators, Health Care / Q000191:economics*; D020379:Risk Adjustment / Q000191:economics; D012537:Scandinavian and Nordic Countries
keywords: international comparisons; outcomes; performance; productivity; quality