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Nordic Economic Policy Review

Challenges in health care financing and provision

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The Nordic Economic Policy Review is published by the Nordic Council of Ministers and addresses policy issues in a way that is useful for in-formed non-specialists as well as for professional economists. All articles are commissioned from leading professional economists and are subject to peer review prior to publication. The review appears twice a year. Content: Challenges in health care financing and provision - Tor Iversen and Sverre A.C. Kittelsen Ageing populations: More care or just later care? - Terkel Christiansen, Jørgen Lauridsen and Mickael Bech Comment by Anna Lilja Gunnarsdottir Lifestyle, health and costs – what does available evidence suggest? - Kristian Bolin Comment by Tinna Laufey Ásgeirsdóttir The economics of long-term care: A survey - Helmuth Cremer, Pierre Pestieau and Gregory Ponthiere Comment by Þórólfur Matthíasson The role of primary health care in controlling the cost of specialist health care - Stephen Beales and Peter C. Smith Comment by Helgi Tómasson Payments in support of effective primary care for chronic conditions - Randall P. Ellis and Arlene S. Ash Comment by Jørgen T. Lauridsen An economic assessment of price rationing versus non-price rationing of health care - Luigi Siciliani Comment by Mickael Bech Should pharmaceutical costs be curbed? - Kurt R. Brekke, Dag Morten Dalen and Steinar Strøm Comment by Helgi Tómasson Productivity differences in Nordic hospitals: Can we learn from Finland? - Clas Rehnberg and Unto Häkkinen Comment by Thorvaldur Gylfason

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Comment on Ellis and Ash: Payment in support of effective primary care for chronic conditions

Commonly, the responsibilities and financing of health treatment are extremely fragmented. This is the essential point of departure of the study, and it is observed that such fragmentation leads to many undesirable shortcomings – inefficiency in the utilization of resources, quality loss, increased risks for patients and adverse effects just to mention a few. Per definition, this is the case in the US health care system, but it also holds true for Scandinavian countries due to a traditional practice of decentralization of many decisions regarding health care delivery as well as its financing. For standard (i.e. uniquely coded) diagnosis treatment, there is a long tradition for overcoming the aforementioned shortcomings during the implementation of concepts like shared care, integrated care etc. However, for non-standard diagnoses (i.e. diagnoses that cannot be uniquely coded), practice lags considerably behind. This does, in particular, cover many chronic conditions – type II diabetes just to mention one well-known example.

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