Background: This article examines the issues of whether decentralisation of specialised healthcare is socially and economically beneficial, who benefit from it, and who carry the costs.
Material and method: Data for this study was drawn from an out-patient clinic in the town of Alta in northern Norway. A cost analysis was done based on 5026 consultations in an out-patient clinic over a six-month period in 2002.
Results: We estimated the additional costs of running the out-patient clinic at NOK 4.5 m. The alternative provision of these services implies that the patient would have had to travel to hospital for medical treatment, with costs estimated at NOK 14.1 m. The estimated cost savings over the period were accordingly NOK 9.6 m. Three parties benefit from decentralisation: patients and those who would have had to come to a hospital with them, the National Insurance System, and employers. Finnmark Health Enterprise carried the additional costs of running the out-patient facility. The estimated public-sector cost savings from decentralisation over this six-month period were, at a minimum, NOK 0.8 m.
Interpretation: The analysis reveals shortcomings in the system for financing specialised healthcare. As long as National Insurance System covers travelling expenses, the health enterprise does not stand to save money from decentralisation, though it is socially and economically efficient when all factors are taken into account.