Research in Progress (RIP): "Which Patients Receive Surgery in For-Profit and Non-Profit Hospitals in a Universal Health System?"



Geir Holom

Date and Time

May 18, 2016 4:00 PM - 5:00 PM

FSI Contact

Nicole Feldman

Please note: All research in progress seminars are off-the-record. Any information about methodology and/or results are embargoed until publication.


The Norwegian universal health care system is built on the fundamental principle of equal access to high quality health services regardless of socioeconomic status, ethnicity and geographical residence. Norway (approx. 5 Million people) is recognized for being an overall top performer among OECD countries on various health measures. However, the aging population has led to substantial cost increases as well as long waiting times for elective surgery, due to insufficient ability of hospitals to absorb patient inflows. These were some of the main motivations for Norway’s Hospital Reform and the implementation of the Free Choice System in the early years following the millennium. The responsibility for financing and providing specialized health services was transferred to four Regional Health Authorities (Central State), which in turn were given the right to contract (usually by tendering competition) with Private For-Profit Hospitals (PFPs). In the Free Choice System, patients holding a referral from their general practitioner (GP) can choose any hospital, both PFPs and Non-Profit Hospitals, for the same out of pocket cost. We have previously found that PFPs deliver the same procedures at a substantially lower cost (down to 50.6% of the National DRG-price). However, due to relatively large variations in waiting times between PFPs and Non-Profit Hospitals, we hypothesized that some groups may be better at navigating in this new system and achieve lower waiting times. We were particularly interested in whether the reform, aimed to contain costs and reduce waiting time for elective surgery, has compromised the fundamental principle equal access to care. Patients who underwent day surgery during the period 2009 – 2014 were identified through the Norwegian Patient Register and linked with socioeconomic data using the Norwegian Tax Register and the Norwegian Education Register. Preliminary findings suggest that otherwise similar younger patients, poorer patients, and those with more comorbidities are less likely to use PFPs, using Non-profit Hospitals instead. Higher educated patients go more frequently to PFPs and the difference between lower educated and higher educated patients is increasing with longer waiting times. We also find an overall increasing secular trend to use PFPs.


Geir H. Holom, MD, is a Visiting Scholar at Stanford School of Medicine (CHP/PCOR) from the University of Oslo. His research focuses on the expansion of private for-profit hospitals in the Nordic countries and its effect on prices, quality of care and selection of patients. He received a BSc in Economics and Business Administration from the Norwegian School of Economics and an MD from the University of Bergen. While in medical school, he conducted research on patients diagnosed with head and neck cancer who underwent head and neck reconstruction using microsurgery. Since receiving his MD, he has worked as a physician in both primary care and specialized health services. Prior to entering the field of medicine, he worked in the business and finance sector. Dr. Holom volunteers for the Children's Program at Oslo University Hospital.