The research programme
Studies in Quality and Cost for the elderly aims at providing knowledge of issues highlighted in
Report no. 25 to the Storting (2005-2006): Long-term care – future challenges. Care plan 2015; about the future challenges in long-term care in Norway. The report states that more knowledge about governance, management and leadership is required. This research programme focuses on the associations between the different financial and management arrangements and the composition and quality of care for the elderly. The main project consists of two sub-projects:
A. Leadership in nursing homes – impact on quality of care, job satisfaction and costs
B. The impact of economic incentives on the composition of long-term care services
Sub-project A describes what kinds of leadership that exist in Norwegian nursing homes and evaluate quality, job satisfaction and cost per patient. Finally, the study carries out an aggregate analysis exploring the relationship between all four main variables: leadership, quality, job satisfaction and cost. Sub-project B highlights the system of transfers and user co-payments related to long-term care and aims at studying to what extent potential inefficiencies in assignment and composition of long-term care to the elderly can be traced in actual data.
Eika (2006) lists in the PhD dissertation; The difficult quality: Essays on human services with limited consumer sovereignty, some of the fundamental characteristics of long-term care from an economic perspective. First, the position of the recipient as a consumer is weak. In particular, She is often not able to enforce quality standards since she cannot make a credible threat of neither exit nor voice (Hirschman 1970). Second, information imperfections abound, especially as concerns quality. Third, quality requires social interaction between the service provider and the service recipient and perhaps her spokesperson, and fourth, the service quality has long-term effects. The missing reliable quality information led Hansmann (1980) in a classical article to suggest that for-profit organizations are unlikely to provide high quality products in this sector and that non-profit firms have an important role to play. It is also thought that the non-profit sector may generate positive spill-over effects to the for-profit sector (Grabowski and Hirth 2003).
Also non-profit ownership in the nursing home industry, in Norway particularly public ownership, is challenging. While units in the private sector are primarily evaluated in the light of the profit generated and future dividend, it is challenging to identify indicators which measure successful public provision. In addition, due to limited consumer sovereignty and quality problems, insufficient incentives to optimal operations may occur, as well as work environment problems, lack of relevant learning and decreased productivity. These threats make management and leadership in publicly owned nursing homes challenging (Anthony and Young 2003). This is the topic of sub-project A.
In Norway, the financing of primary health care and long-term care is split between the state (the National Insurance Scheme) and the municipalities. The mixed system may create insufficient quality and inefficiencies in the composition of long-term care. These inefficiencies are further explored in sub-project B.
The programme is a collaboration between several research institutions:
