[Medical monopolies--a choice between quality and equality?]

The highly specialised medical services in Norway consist of 33 monopolies and 8 bipolies, involving both a duty of referral and a duty of admittance for defined patient groups. All the specialised services are located to large hospitals in southern Norway.

In conjunction with a thorough review of the specialised services, the geographical distribution of the 2711 patients treated in 2001 was analysed.

The geographical distribution was highly skewed, with a decreasing coverage with increasing distances from the monopoly centres. The ratio between the county with the most and the one with the least use of the services was 2.3. Northern Norway had a significantly lower usage.

Monopolies seem to have an inherent tendency to give poor distribution of health care. Medical monopolies seem to have many of the negative effects associated with economic monopolies. A cautious attitude towards new and a rigid control of old monopolies is recommended. Equality of access to services should be maintained as a primary goal in public health care systems.