I spenningsfeltet mellom økonomi og etikk : en kvalitativ studie av hvordan leger forholder seg til DRG-systemet

Abstract

As part of changing the financial system of Norwegian hospitals in 1997, the DiagnosisRelated Group (DRG) system was introduced as a performance measurement. The DRGsystem was applied to all somatic hospital care, meaning that it affected the overwhelming majority of Norwegian specialist medical professionals. To better understand the consequences of this system, and the responses of medical professionals to its implementation, I conducted and analysed six interviews with doctors working at different medical departments in public Norwegian hospitals. This study focuses on how doctors relate to the system, what critics they have and if the economic incentives of the system affects them, and in what ways. My findings indicate that there are some risks by combining the DRG-system with professional ethics. But I also found that these professionals' ways of relating to the system seldom can be ascribed to financial motives alone. The doctors' critics and experiences showed that there are three different ways of relating to the system. Firstly, they can relate to it as disciplined DRG-encoders, willingly abiding the rules without questioning, where combining economic and ethics works well. If the professionals are aware of how the system works and use the system correct based on these grounds, it works as well. Secondly, the professionals can let the economy outweigh the ethics, and make financially driven decisions and actions. The third way of relating to the system is by strongly reject the economic incentives and stand firm by the ethic. The study also indicated that there are differences between younger doctors, who are to be disciplined, and the older ones working in management positions. The younger group is easier to abide to the system, while the older ones are more critical and rejects the system. Various medical disciplines may explain some of the differences between the doctors, since some disciplines seemed to be better adapted to the system. There is a need for more research about these generation distinguishes and what happens when the new generation takes over.