Health Policy 69 (2004) 317–327 Trading patients Lessons from Scandinavia Grete Botten, Sverre Grepperud 1 , Sölve Mikal Nerland * Centre for Health Administration, University of Oslo, Rikshospitalet, NO-0027 Oslo, Norway Received 2 July 2003; accepted 30 December 2003 Abstract The next few decades will bring about more trade in services, among them health care. This paper describes a recent project on cross-border trading of patients initiated by the Norwegian parliament (The Patient Bridge). This health policy reform met some resistance among hospital physicians. However, patients were willing to participate if being properly informed and supported by local health care workers. The Patient Bridge turned out to be a relatively expensive project partly because of the transaction costs involved (transportation and escort) and partly because of high treatment costs. Excessive treatment costs were a result of insufficient cost-consciousness in the purchasing organization. The Patient Bridge revealed large price differentials not only between Norwegian and foreign hospitals, but also between hospitals abroad, even within the same country. This finding points to the possibilities of reaching mutual gains from trading patients across borders. © 2004 Elsevier Ireland Ltd. All rights reserved. Keywords: Cross-border trade; Patient export; Health economics; Demand-side reform 1. Introduction As a result of a rapid globalization and region- alization in the last decades countries have become more integrated both economically and politically. Institutions such as The European Union (EU) and The World Trade Organization (WTO) have expanded their fields of activity, and the number of multilateral and bilateral agreements in various areas is increas- ing. As concerns cross-border trade, both the volume and the scope of goods and services being traded have * Corresponding author. Tel.: +47-23075311; fax: +47-23075310. 1 E-mail address: sverre.grepperud@samfunnsmed.uio.no (S. Grepperud). increased. Services that previously were offered only domestically are now to an increasing extent being traded across borders. The health care sectors of most European coun- tries have been exposed to several reforms in the last decades. These reforms, although implemented at dif- ferent dates and with country-specific characteristics and causes, have obvious similarities. Reform patterns observed in many countries are; (1) the split of pur- chasers from providers, (2) the organization of hos- pitals as enterprises or trusts, (3) performance-based payment systems, (4) freedom for patients to choose among hospitals, and (5) the introduction of other patient rights that underpin the new role of pa- tients as consumers, such as upper limits on waiting time. 0168-8510/$ – see front matter © 2004 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.healthpol.2003.12.014