Abstract

Background: Finland and Norway have health care systems with a varying degree of vertical integration. In Finland the financial responsibility for all patient treatment is placed at the municipal level, while in Norway the responsibility for patients is divided between the municipalities (primary and long-term care) and state-owned hospitals. From 2012, the Norwegian system became more vertically integrated.

Objectives: The aim of the paper is to analyse the effects of variations in integration on performance indicators.

Methods: The data included operated hip fracture patients from the years 2009-2014. Data from routinely collected national registers (which also included primary health and long-term care services) were linked. Performance indicators were compared at baseline, and trends were described and analysed by difference-in-difference methods.

Results: The baseline study (2009-2011) indicated that hip fracture patients in Oslo had longer stays in acute hospitals. They used less institutional care outside of the hospitals as well as more GP services and fewer other outpatient services. Mortality was lower, and the probability of being discharged to home after 90 days was higher than in Helsinki. The Coordination Reform shortened the length of the first acute stay in the hospitals, but it increased the length of the first institutional episode, demonstrating that the shorter hospital stays were more than compensated for by longer stays in long-term care institutions. The analyses of trends in short-term institutionalization and patients discharged to home after 90 days also showed less desired results, which were partly explained by better trends in these indicators in the Helsinki area. After the reform, the performance differences between the two regions had decreased.