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The Office of the Auditor General's investigation of resource utilisation and quality in the health service following the introduction of the Coordination Reform

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Summary

​Background and objective of the audit

The Coordination Reform was initiated on 1 January 2012 with the goal of securing sustainable, good quality health services. This goal will be achieved in part by municipal health services taking on a larger share of health care services to curb growth in the use of hospital services.

The aim of the audit was to assess whether the Coordination Reform has so far contributed to achieving overall health policy goals of better utilisation of resources and better quality services.

Findings and recommendations

Municipalities have taken over patients who previously had completed their treatment in hospitals, but there is little knowledge about the quality of services for these patients

The municipalities are now taking in sicker patients with a greater need for treatment than before. However, the Ministry of Health and Care Services and the Norwegian Directorate of Health have limited knowledge of how the quality of municipal health services has evolved after the reform.

The Office of the Auditor General (OAG) recommends that the Ministry of Health and Care Services increase its knowledge of the municipalities' health and care services, including by means of quality indicators.

The 24-hour municipal emergency beds (MEB) service is not used in a way and to an extent that is in line with the intention

The MEB service is a key instrument that will contribute to better use of resources by enabling municipalities to offer a good alternative to hospitalisation. In many municipalities, less than half of the admissions to municipal emergency beds (MEB) units replace hospitalisation. In addition, the occupancy rate at MEB units is low overall, and the health trusts believe that many patients admitted to hospitals should have been admitted to an MEB unit.

The OAG recommends that the Ministry of Health and Care Services

  • consider how use can evolve to become more in line with the intentions, both with regard to occupancy and target group
  • consider whether it has economic instruments that contribute to the utilisation of the MEB service in accordance with the intentions
  • further examine the quality of the service.

Coordination of care for patients who need services from both the primary and specialist health service is inadequate

The need to exchange information has increased after the introduction of Coordination Reform. More than half of the municipalities experience that they do not receive adequate information about patients' expected future development when they are discharged from the hospital for further treatment and care in the municipal health and care service. Many municipalities also find that they do not receive sufficient information about the patients' overall level of function. Conversely, many hospitals receive insufficient information about the patient's function level from the municipalities when patients are admitted to hospitals, and medication lists are often incomplete.

The OAG recommends that the Ministry of Health and Care Services consider measures to improve cooperation between the hospitals and municipalities, including the quality of information exchanged and the use of individual plans.

Municipal substance abuse and psychiatry services have not been strengthened in line with the downsizing of beds in the specialist health service

The number of inpatient beds for treatment of substance abuse and psychiatric care in the specialist health services has been cut by almost 10 per cent from 2010 to 2014. This reduction has not been compensated by a corresponding augmentation of municipal services.

The OAG recommends that the Ministry of Health and Care Services help strengthen the municipalities' work with patients undergoing treatment for psychiatric problems or substance abuse.

This includes assessing

  • measures to ensure that these patients receive appropriate services from municipal health services and specialist health services
  • whether the division of tasks and responsibilities between municipal health services and specialist health services is adequately prepared for this group of patients

Municipalities have marginally increased capacity and skills following the introduction of the Coordination Reform

  • Few municipalities have established augmented short-term places for discharge-ready patients, rehabilitation places, assisted living facilities or long-term beds in nursing homes after the introduction of the Coordination Reform.
  • A majority of municipalities have not significantly increased the number of FTEs in the home care service or in nursing homes.
  • Two of three municipalities have only made limited enhancements in the skills of nursing home and home care service employees in the form of in-service training or further education.

The OAG recommends that the Ministry of Health and Care Services follow up on whether planned measures adequately help to strengthen expertise in municipal health services.

Ministry/ministries:

Riksrevisjonen, Storgata 16, P.O. Box 8130 Dep, 0032 Oslo, Norway

Phone: +47 22 24 10 00

Org.nr: 974 760 843