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The Coordination Reform: "The quality of the services must be improved"

​Despite the fact that the municipalities receive sicker patients than previously following the Coordination Reform, they have done little to increase capacity or bolster skills. "The Ministry must follow developments closely, also in terms of the quality of services patients receive in the municipalities," says Auditor General Per-Kristian Foss.

Published 1/12/2016 1:00 PM

Document 3:5 (2015–2016) The Office of the Auditor General's investigation of resource utilisation and quality in the health service following the introduction of the Coordination Reform was submitted to the Storting on 12 January 2016.
Little growth in municipal capacity

The Coordination Reform was introduced in 2012 to provide better quality health services for patients. At the same time, the resources are to be better utilised by municipalities taking responsibility for a larger part of the health services.

The Office of the Auditor General (OAG)'s audit shows that the municipalities take over the care of patients from hospitals to a greater extent than previously, although both municipalities and GPs believe that many are discharged too early.

Although the municipalities receive sicker patients with greater needs for treatment and care than in the past, the municipalities have neither increased capacity nor improved the skills of employees appreciably after the introduction of the Coordination Reform. The audit also shows that a high percentage of the municipalities have not strengthened services to substance abuse and psychiatric patients.

"The Ministry must monitor whether the planned measures adequately strengthen skills in the municipal health services," says Foss.

Poor utilisation of resources

One of the measures introduced in connection with the Coordination Reform is the 24-hour Municipal Emergency Beds (MEB) service, which is meant to help reduce the number of hospital admissions. The audit shows that the MEB service is hardly used, and that several municipalities use it as part of the municipality's ordinary health and care service. This means that the instrument is not used as intended by the Storting. The number of patients treated in MEB units is not in reasonable proportion to public expenditure on the service.

"If the MEB service is to contribute to sound use of society's resources, it is important that the Ministry consider whether economic instruments can contribute to treating more patients locally in municipalities rather than at hospitals," says the Auditor General.

Do not receive important information

Many municipalities and health trusts believe that coordination and individual plans do not contribute enough towards meeting the needs of users who need long-term, coordinated services from municipalities and hospitals. Neither municipalities nor hospitals believe they receive the patient information they need to facilitate good treatment and follow-up.

"The quality of the information exchanged needs to improve. It is challenging to facilitate proper treatment when important information about the patient is missing or arrives late," says Foss.

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