CAN A PUBLIC-HEALTH CARE SYSTEM ACHIEVE EQUITY - THE NORWEGIAN EXPERIENCE

Equity in health care provision is an important polity goal in Norway. This article addresses equality in the services provided by primary c are physicians. These services are the responsibility of local governm ent financed mainly through public funding. Patient fees are low The l ocal government system results in geographical variation in the number of physicians relative to local health demands. The authors present t he hypothesis that: this generates inequalities in health care utiliza tion. The system of government finance is based on the assumption that utilization of health services is independent of patient income. Ther efore, variation in income is expected to have only a small impact on utilization. The authors estimate a demand model by combining extensiv e micro data with aggregate data on municipal supply. There is very li ttle relationship between indicators of access and health care utiliza tion. The estimated income elasticities approximate zero, supporting t he argument that equality in utilization has been achieved. However, t he authors results also raise the question of whether equality has bee n achieved at the cost of limiting supply of services for people who c ould afford to consume more, or to pay for services of higher quality.