Reablement - reducing need for health services
“The findings suggest that this service [home-based reablement] reduces the overall health system costs. The largest decrease is in the use of specialised services, while home-based reablement is carried out by primary care services. Thus, the main benefit is seen in a different service than the one implementing the intervention.”
Tore Bersvendsen
PhD candidate and research adviser
Tore Bersvendsen defended his doctoral dissertation "Effects of home-based reablement: A micro-econometric approach" on 26 June 2020.
He followed the PhD programme at the School of Business and Law at UiA.
Tore Bersvendsen’s doctorate received funding through the Public Sector PhD scheme, which is a collaboration between the higher education sector and the public sector. This is the first PhD collaboration of its kind in the municipality of Kristiansand.
Summary of the thesis by Tore Bersvendsen:
Reablement - reducing need for health services
Healthcare services today are not necessarily suited to be the solutions of the future, and in recent years a number of new interventions have emerged.
Home-based reablement
A model that most municipalities have introduced is home-based reablement, which aims to increase or restore a patient's functional level while exercising in a home environment. Consequently, the patient becomes more independent and hopefully has less need of healthcare services.
Through four sub-studies, the dissertation examines home-based reablement from different perspectives.
Previous studies
The first part presents a systematic review of literature. What emerges is that findings from current empirical assessments of home-based reablement are not uniform.
Several studies report significant positive effect, whereas others do not.
There is no indication that the programme has had any negative effect.
It also turns out that all the studies examined lack important information about the data collection and application of statistical methods.
The first sub-study concludes that multidisciplinary research teams would be useful in future research on home-based reablement.
Key personnel
Many Norwegian municipalities use an administrative office for the allocation of services.
The second sub-study studies the effect of changes in administrative workers sick leave at such an office.
It turns out that with increased absenteeism, the number of approved homecare nurse hours also increases.
The study also shows that the introduction of home-based reablement reduces the number of hours of homecare nursing.
The study uses applied econometric methods and shows how detailed knowledge of organisational matters is essential in the choice of method.
Data access
The key to good empirical research is good access to data. Newer methods in quantitative research require access to large data sets.
The third sub-study describes how a unique data set is created by merging data from several national health registers.
Ethical dilemmas and alternative costs are discussed.
At the same time, the chapter demonstrates how to use modern imputation strategies to compensate for missing data.
Reduced health costs - individual variations
The fourth sub-study, the longest chapter of the dissertation, uses the data set presented in the previous sub-study to estimate the health cost effect of home-based reablement.
The findings suggest that this service reduces the overall health system costs. The largest decrease is in the use of specialised services, while home-based reablement is carried out by primary care services.
Thus, the main benefit is seen in a different service than the one implementing the intervention.
The findings also show that all effects of home-based reablement can be attributed to females, and that there are large individual variations in the estimated effect.
Further research into what causes these differences will be a task for future research.
Disputation facts:
The Candidate: Tore Bersvendsen (1984, Lenvik). BA in Public Administration, UiA (2006), Masters degree in Public Administration, UiA (2008) Master thesis: «On the analytical complexity of the likelihood for a simple DSGE model». One year studies i christianity and religion, Ansgar college (2009).
Bersvendsen was a trainee at Trainee Sør (3x6 months) at Sørlandet Hospital, Kristiansand municipality and Haydom Lutheran Hospital, Tanzania (2009 – 2011). Present position: Kristiansand kommune ( from 2011), at first as an adviser, now research adviser.
The trial lecture and the public defence will take place online, via the Zoom conferencing app (link below)
Dean Kristin Wallevik, School of Business and Law, UiA will chair the disputation.
The trial lecture at 10:15 hours
Public defence at 12:00 hours
Given topic for trial lecture: "The resources available to the health and care sector are limited. Some think the resources should be utilised to maximise the health gains of the services the sector provides. What opportunities and challenges do health economic evaluation methods bring to priority setting discussions?"
Thesis Title: “Effects of home-based reablement: A micro-econometric approach”
Search for the thesis in AURA - Agder University Research Archive, a digital archive of scientific papers, theses and dissertations from the academic staff and students at the University of Agder.
Opponents:
First opponent: Associate Professor PhD Mette Gørtz, University of Copenhagen, Denmark
Second opponent: Professor Egil Kjerstad, Research Director at NORCE and Professor II University of Bergen
Professor Sigbjørn Sødal, School of Business and Law, University of Agder, is appointed as the administrator for the assessment commitee.
Supervisors were Professor Jochen Jungeilges, UiA (main supervisor) and Head of research, PhD Eirik Abildsnes, Kristiansand municipality (co-supervisor)