Nordic Hospital Comparison Study Group (NHCSG)

The Nordic Hospital Comparison Study Group (NHCSG) is a Nordic network (NHCSG) for collaboration of measuring and analyzing the costs, performance, productivity and quality of acute hospitals. The collaboration includes the Frisch Center in Oslo, the Institute for Health and Welfare in Helsinki, the University of Southern Denmark in Odense and Karolinska Institutet.

Aim of the project

The aim of the project is to compare costs, productivity and quality between the acute hospitals in the Nordic countries. One purpose is also to standardize the comparisons and to investigate the possibilities of using register data for benchmarking between hospitals.

Results in brief

A number of studies have been carried out analysing hospital performance in four of the Nordic countries; Denmark, Norway, Finland and Sweden that takes advantage of the similar structure in the Nordic countries of organizing health care and common standards for recording utilization and outcomes. The productivity differences across acute hospitals in the Nordic countries have been measured and compared and linked to explanatory factors.

The analyses cover all acute hospitals and regions in the four Nordic countries and show a stable pattern where Swedish hospitals show the lowest productivity. The studies are unique compared with previous studies of hospital productivity where services such as the number of admissions, bed-days, and visits were used, these studies are based on data on admissions and day-care treatment grouped according to comparable diagnostic groups according to the DRG system (Diagnostic Related Groups). The Nordic system of the North-DRG-system provides opportunities for more a fare comparison of performance between hospitals.

The results show that there are large variations both within and between the Nordic countries. However, the results are clear when it comes to ranking between countries. In all analyses, the Finnish hospitals show the highest productivity, followed by Denmark and Norway, at last the Swedish hospitals. The results apply to all acute hospitals as well as to a separate analysis of university hospitals. The Swedish university hospitals improve their productivity slightly if outputs in terms of education activities and research outputs were included in the analysis. But also for university hospitals, Sweden is ended up last if only treatments of patients were included in the analysis.

Från DN Debatt 7 juli, 2015 - Svenska akutsjukhus har lägst produktivitet i Norden.

Continued work

The intention is to continue the collaboration between the Nordic research groups to develop and improve comparisons between providers.

Reports and publications

Maintaining fiscal sustainability in the Nordic countries.
Rehnberg C, Luoma K, Magnussen J.
In: Magnussen J, Vrangbaek K, Saltman R.
Nordic Health Care Systems: Recent reform and Current Policy Changes, Open University press/McGraw Hill, London, 2009.

Measuring cost efficiency in the Nordic hospitals--a cross-sectional comparison of public hospitals in 2002.
Linna M, Häkkinen U, Peltola M, Magnussen J, Anthun KS, Kittelsen S, et al
Health Care Manag Sci 2010 Dec;13(4):346-57

Cost efficiency of university hospitals in the Nordic countries: a cross-country analysis.
Medin E, Anthun KS, Häkkinen U, Kittelsen SA, Linna M, Magnussen J, et al
Eur J Health Econ 2011 Dec;12(6):509-19

Productivity differences in Nordic hospitals: Can we learn from Finland?
Rehnberg C & Häkkinen U.
Nordic Economic Policy review, No.2, 2012.

Cross-country comparisons of health-care costs: the case of cancer treatment in the Nordic countries.
Kalseth J, Halvorsen T, Kalseth B, Sarheim Anthun K, Peltola M, Kautiainen K, et al
Health Policy 2014 Apr;115(2-3):172-9

Decomposing the productivity differences between hospitals in the Nordic countries.
Kittelsen SA, Winsnes BA, Anthun KS, Goude, F, Hope Ø, Häkkinen U, Kalseth B, Kilsmark J, Medin E, Rehnberg C & Rättö H.
Journal of Productivity Analysis 2015. Vol. 43(3), s 281- 293 .

Contact person

Fanny Goude