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Is the centralisation of hospitals inevitable?

Lasse Ruud-Hansen and Anette Ravlo

Dagens Medisin

28 August 2014 

To read the Norwegian article in full, click here.


PA’s Lasse Ruud-Hansen and Anette Ravlo, experts in healthcare, have had a byline article published in Dagens Medisin.

The piece details the need to develop specialised services, together with a wider range local health offerings, to improve the quality of Norwegian healthcare.

The article draws on the recent debate of hospital closures to discuss the optimal structure for the Norwegian health system. It states that the clinical outcomes which would be affected by restructuring, the effects that the structure would have on patients and their families, and the total cost picture must all be taken into account.

Lasse and Anette highlight how several analyses demonstrate that treatment by specialised units provide a better quality of care for patients. Health authorities in London, for example, have saved 400 stroke patients' lives during a three year period by reducing the number of accident and emergencies from 12 to three – despite the fact that patients have to travel up to 45 minutes extra.

They also declare that centralisation should be supported by coordinated actions to avoid unnecessary travel and admissions. A study of patients in Ireland revealed 50% of those admitted into hospitals could have been treated in primary care, while another analysis found that one in three patients who visited an emergency room in London could have received adequate assistance from their GP, NHS Direct (a non-emergency telephone service) or a pharmacist.

For the chronically ill, and elderly with weak health, Lasse and Anette state that there should be more investment in local services. Photographs and samples may be taken locally, for instance, but analysed centrally. Better availability of local solutions for those with less critical conditions, and the establishment of a national ‘question and answer phone service’ could be important tools.

Lasse and Anette conclude: “We believe the answer lies in well-coordinated solutions across local hospitals, social services, home care, nursing homes, GPs and central specialised units. There are significant opportunities for improvement by adopting new measures of effective communication and knowledge exchange between all stakeholders, including patients and their families.

“We must therefore develop specialised services, together with local health services, to improve the quality of Norwegian healthcare and achieve better resource utilisation.”

Lasse Ruud-Hansen and Anette Ravlo are healthcare experts at PA Consulting Group


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