Quality or equality? The Norwegian experience with medical monopolies
Abstract
Background: In order to maintain both quality and efficiency of health services in a small country
with a scattered population, Norway established a monopoly system for 38 highly specialized
medical services. The geographical distributions of these services, which are provided by one or
two university hospitals only, were analysed.
Methods: The counties of residence for 2 711 patients admitted for the first time in 2001 to these
31 monopolies and 7 duopolies were identified.
Results: The general tendency observed was that with increasing distance from residential home
to monopoly hospitals there was a declining coverage of these health services. The same pattern
was found even with regard to explicit diagnoses or treatments such as organ transplantations
(except renal transplantations). Duopolies seemed to yield a more even geographical distribution
of the services.
Conclusion: Monopolies may serve as a useful means for maintaining quality in highly specialized
medical services, but seem to have an inherent tendency to do this at the expense of geographical
equality.