Healthcare in Norway
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In Norway, municipalities are in charge of providing basic healthcare. Since the money given to municipalities is not set aside for any particular purpose, each municipality is free to determine its own health budget. Municipalities coordinate primary healthcare services through agreements with independent physicians. In Norway, private healthcare providers are not compensated unless they have a contract with the public health service. All public hospitals in
Norway Norway, officially the Kingdom of Norway, is a Nordic country in Northern Europe, the mainland territory of which comprises the western and northernmost portion of the Scandinavian Peninsula. The remote Arctic island of Jan Mayen and t ...
are run by four Regional Health Authorities (RHA) overseen by the
Ministry of Health and Care Services The Royal Norwegian Ministry of Health and Care Services (''Helse- og omsorgsdepartementet'') is a Norwegian government ministry in charge of health policy, public health, health care services, and health legislation in Norway. It is led by the Mini ...
. In addition to these public hospitals, there are a small number of privately owned health clinics currently operating.


Statistics

With a
population Population typically refers to the number of people in a single area, whether it be a city or town, region, country, continent, or the world. Governments typically quantify the size of the resident population within their jurisdiction using a ...
of 5 391 369 as of the first quarter of 2021, and a
gross national income The gross national income (GNI), previously known as gross national product (GNP), is the total domestic and foreign output claimed by residents of a country, consisting of gross domestic product (GDP), plus factor incomes earned by foreign ...
per capita of 70 800 (PPP, current
international dollar The international dollar (int'l dollar or intl dollar, symbols Int'l$., Intl$., Int$), also known as Geary–Khamis dollar (symbols G-K$ or GK$), is a hypothetical unit of currency that has the same purchasing power parity that the U.S. dollar ...
) in 2019, Norway has a
life expectancy at birth Life is a quality that distinguishes matter that has biological processes, such as signaling and self-sustaining processes, from that which does not, and is defined by the capacity for growth, reaction to stimuli, metabolism, energy t ...
of 84 years for women and 81 years for men as of 2016. As of 2019, there are 2.5 deaths for children under 5 years of age per 1000 live births.


Availability and cost

Expenditure on healthcare is about 7 727 USD per person per year in 2020, among the highest in the world.http://www.commonwealthfund.org/~/media/files/publications/fund-report/2010/jun/1417_squires_intl_profiles_622.pdf It has the highest proportion of nurses and midwives per person in Europe: 1 744 per 100 000 people in 2015. While the availability of public healthcare is universal in Norway, there are certain payment stipulations. Children aged sixteen or younger, and several other groups (such as nursing women and retirees) are given free healthcare regardless of the coverage they may have had in previous situations. All other citizens are responsible for paying a certain amount in user fees. If they reach a certain amount of money paid
out-of-pocket An out-of-pocket expense (or out-of-pocket cost, OOP) is the direct payment of money that may or may not be later reimbursed from a third-party source. For example, when operating a vehicle, gasoline, parking fees and tolls are considered out-of ...
, they receive an exemption card (''frikort for helsetjenester'' in Norwegian) for public health services, and they no longer have to pay user fees for the remainder of the calendar year. The amount is 2460
NOK Nok is a village in Jaba Local Government Area of Kaduna State, Nigeria. The village is an archeological site. Archaeology The discovery of terracotta figurines at this location caused its name to be used for the Nok culture, of which these ...
in 2021, or about 264 USD. Everything above this amount is given for free for the rest of that year. The exemption card covers family doctors,
psychologist A psychologist is a professional who practices psychology and studies mental states, perceptual, cognitive, emotional, and social processes and behavior. Their work often involves the experimentation, observation, and interpretation of how indi ...
s,
outpatient clinics A clinic (or outpatient clinic or ambulatory care clinic) is a health facility that is primarily focused on the care of outpatients. Clinics can be privately operated or publicly managed and funded. They typically cover the primary care needs ...
, radiology services,
laboratory tests A laboratory (; ; colloquially lab) is a facility that provides controlled conditions in which scientific or technological research, experiments, and measurement may be performed. Laboratory services are provided in a variety of settings: physici ...
, patient travel,
medicines A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy (pharmacotherapy) is an important part of the medical field and rel ...
and
equipment Equipment most commonly refers to a set of tools or other objects commonly used to achieve a particular objective. Different job Work or labor (or labour in British English) is intentional activity people perform to support the needs and ...
falling under the "blue prescription" system,
physiotherapy Physical therapy (PT), also known as physiotherapy, is one of the allied health professions. It is provided by physical therapists who promote, maintain, or restore health through physical examination, diagnosis, management, prognosis, patient ...
, dental diseases and abnormalities,
periodontitis Periodontal disease, also known as gum disease, is a set of inflammatory conditions affecting the tissues surrounding the teeth. In its early stage, called gingivitis, the gums become swollen and red and may bleed. It is considered the main cau ...
,
rehabilitation Rehabilitation or Rehab may refer to: Health * Rehabilitation (neuropsychology), therapy to regain or improve neurocognitive function that has been lost or diminished * Rehabilitation (wildlife), treatment of injured wildlife so they can be retur ...
, and travel for treatment abroad arranged by the Oslo University Hospital - Rikshospitalet HF. Dentists and dental hygienists are not included, but hospitalisation and everything related to being hospitalised in Norway is free for any citizen regardless of income or deductible status. In terms of emergency room admission, all immediate healthcare costs are covered.


Health expenses and governmental funding

Norway Norway, officially the Kingdom of Norway, is a Nordic country in Northern Europe, the mainland territory of which comprises the western and northernmost portion of the Scandinavian Peninsula. The remote Arctic island of Jan Mayen and t ...
scores overall very high on different rankings in health care performances worldwide. Unique for the Norwegian health care system is that the state funds almost all expenses a patient would have. Patients with extra high expenses due to a permanent illness receive a tax deduction. In 2020, 11.3% of the country’s
GDP Gross domestic product (GDP) is a monetary measure of the market value of all the final goods and services produced and sold (not resold) in a specific time period by countries. Due to its complex and subjective nature this measure is ofte ...
went to health spending, and only about 14% of that was private spending (out-of-pocket payments), reflecting moderate cost-sharing requirements. The public share of health spending as a proportion of total government expenditure is only around 17%. The government creates an annual health
budget A budget is a calculation play, usually but not always financial, for a defined period, often one year or a month. A budget may include anticipated sales volumes and revenues, resource quantities including time, costs and expenses, environmenta ...
for the following year, every year in December. This budget includes all expenses within the health branch of Norway. The parliament has only on some occasions voted for additional funds later in the year, primarily for hospitals. The
welfare Welfare, or commonly social welfare, is a type of government support intended to ensure that members of a society can meet basic human needs such as food and shelter. Social security may either be synonymous with welfare, or refer specificall ...
state costs a lot to maintain and to improve after the standard and inflation of the year. Pension, regulated after age, is the largest expense in the budget section covering health and welfare. The government has changed in the year of 2018 the management of expenses and funding to the health sector, with the goal to shorten the length of waiting lines and improve health services. Funds for hospital care are allocated to the regional health authorities after the budget is passed for the coming year. They are responsible to distribute the financial funding to hospitals and other health services locally.


History and development

After the
Second World War World War II or the Second World War, often abbreviated as WWII or WW2, was a world war that lasted from 1939 to 1945. It involved the vast majority of the world's countries—including all of the great powers—forming two opposin ...
the government of Norway decided to include
national health care National health insurance (NHI), sometimes called statutory health insurance (SHI), is a system of health insurance that insures a national population against the costs of health care. It may be administered by the public sector, the private sect ...
as one of their main focuses in the development of the welfare state. The state is responsible for providing good and necessary health services for everyone. This responsibility is divided between three levels of government: the state government, county, and local council. The government is responsible for developing laws and passing bills, but the Department of Health and Care has the main responsibility for the daily running and operations of health politics and health services in Norway. In 2001 every citizen gained the right to have a permanent doctor in the area they live in. The city council in every county is responsible for this right, and they also initiate agreements and cooperation with the doctors. This improvement is one of several in healthcare that Norway has to offer. The various reforms share the common thread that they all came as a reaction to inefficient systems that did not take full advantage of all available resources. Another major reform that came in the beginning of the 21st century, was the health reform of 2002.


Hospital reform of 2002

In 2002 the government took over the responsibility of running the hospitals in the country.
Kjell Magne Bondevik Kjell Magne Bondevik (; born 3 September 1947) is a Norway, Norwegian Lutheranism, Lutheran Religious minister, minister and Politics of Norway, politician. As leader of the Christian Democratic Party (Norway), Christian Democratic Party, he serv ...
was the prime minister at the time. He was the leader of the KrF party and was head of the coalition government (alongside the
Høyre The Conservative Party or The Right ( nb, Høyre, nn, Høgre, , H; se, Olgešbellodat) is a liberal-conservative political party in Norway. It is the major party of the Norwegian centre-right, and was the leading party in government as part of ...
and Venstre parties). Up until then, hospitals in Norway were operated by the county and the city council. The goal of the reforms was to improve the quality of medical treatment, to run the hospitals more efficiently than previously and to make medical treatment equally available to everyone in the country. The reform was inspired by the
New Public Management New Public Management (NPM) is an approach to running public service organizations that is used in government and public service institutions and agencies, at both sub-national and national levels. The term was first introduced by academics in the ...
movement, and major changes were realized in accordance with these principles. Hospitals and services were organised in to five regional health-companies. These are independent legal entities organised and operated like corporations, with a few differences: the health companies are only owned by the government, they cannot go bankrupt and are guaranteed by the government. The government also loans and gives them financing from state funding. The reform was to some extent successful. Patient waiting lists before treatment were reduced with almost 20 thousand patients. However, the spending on healthcare in Norway increased, and after a year the financial deficit reached almost 3.1 billion. Also, efficiency improvements in treatments have impacted patient experience as they have less time with the doctor and sometimes must check out of the hospital on the same day as they were admitted.


Pharmaceuticals

Norway does not produce the bulk of pharmaceuticals consumed domestically, and imports the majority that are used in its health system. This has resulted in most residents having to pay full price for any prescription. Pharmaceutical exporting is overseen by the Ministry of Health and Care Services. Insurance coverage for medicine imported from outside the country is managed through the Norwegian Health Economics Administration (HELFO).


Administration

Norway has four designated Regional Health Authorities. They are:
Northern Norway Regional Health Authority Northern Norway Regional Health Authority ( no, Helse Nord) is one of four regional health authorities in Norway. It covers the counties of Finnmark, Nordland and Troms. The authority owns five health trusts that operate the hospitals as well a ...
, Central Norway Regional Health Authority, Western Norway Regional Health Authority, and
Southern and Eastern Norway Regional Health Authority Southern and Eastern Norway Regional Health Authority ( no, Helse Sør-Øst RHF) is the largest of the four Regional health authorities in Norway. It covers the counties of Viken, Oslo, Innlandet, Vestfold og Telemark, and Agder, with 57% of the ...
. According to the Patients' Rights Act, all eligible persons have the right to a choice in hospitals when receiving treatment.


Performance

The Norwegian Health Care System was ranked number 11 in overall performance by the
World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...
in a 2000 report evaluating the
health care system Health, according to the World Health Organization, is "a state of complete physical, Mental health, mental and social well-being and not merely the absence of disease and infirmity".World Health Organization. (2006)''Constitution of the World H ...
s of each of the 191
United Nations The United Nations (UN) is an intergovernmental organization whose stated purposes are to maintain international peace and international security, security, develop friendly relations among nations, achieve international cooperation, and be ...
member nations. According to the Euro health consumer index, in 2015 the Norwegian health system was ranked third in Europe but had inexplicably long waiting lists as 270,000 Norwegians were waiting for medical treatment in 2012-13. In the
OECD The Organisation for Economic Co-operation and Development (OECD; french: Organisation de coopération et de développement économiques, ''OCDE'') is an intergovernmental organisation with 38 member countries, founded in 1961 to stimulate e ...
publication ''Health at a Glance 2011'', Norway had among the longest wait times for elective surgery and specialist appointments among eleven countries surveyed. However, the Norwegian government has been successful in reducing the average wait times for hospital care in recent years.


Health topics


Burden of diseases


Norwegian disease burden report launched. Published 21.03.16


Public Health Report - Short Version: Health Condition in Norway 2018 (Report 05/2018)


Pregnancy and maternity care

All pregnant women in Norway are entitled to maternity care from a midwife at a Maternity and Child Health Care Centre or from their General Practitioner. There are usually eight antenatal appointments including one ultrasound screening during pregnancy. The consultations are free of charge, and pregnant employees have the right to paid time off work for antenatal appointments. There were 56,600 children born in 2017, 2,300 fewer than the previous year. This gave a total fertility rate of 1.62 children per woman - the lowest measured in Norway ever. 139 children were registered as stillborn in 2017. This corresponds to 2.4 deaths per 1,000 born and is the lowest number ever recorded. In Norway 2015: Nursing and midwifery personnel density (per 1000 population).Value: 17.824. That includes practising midwives and practising nurses. Data Source: OECD Health Data, accessed October 2017. WHO region: Europe Effective. date: 2018-02-26


Infectious diseases

Global incidence of many infectious diseases has declined. Higher standards of living and improved hygienic conditions are a major cause, as well as the prevalence of vaccines. Nonetheless, increased international travel and import of food is causing an increase in some infectious diseases in Norway such as some foodborne infections and infections by antibiotic-resistant bacteria. Patients are exempt from cost-sharing for visits, tests, and treatments for all infectious diseases deemed to pose a threat to public health.


Tuberculosis

Tuberculosis is the most infectious disease worldwide, and is a major challenge in global health care. However, in Norway, the decline in the number of tuberculosis cases continues. By 2017, a total of 261 patients with tuberculosis were reported to the Institute of Public Health. This is a decline from previous years. During the last twenty years, the highest number of patients with tuberculosis was 392 in 2013. It makes Norway one of the countries with the lowest tuberculosis incidence in the world. Differences in the global disease burden of tuberculosis are also reflected in the disparities of infection rates within Norway, where major inequalities based on people's country of origin can be observed. Only 11 percent of the patients who were reported with tuberculosis disease in 2017 were born in Norway, and only half of them had Norwegian-born parents.


MDR-TB

The number of multiresistant tuberculosis cases is between four and 11 cases per year. By 2017, nine patients were diagnosed with multiresistant tuberculosis. None of these had developed resistance during treatment in Norway.


Preventive treatment, latent tuberculosis

Most cases of tuberculosis disease in Norway are detected early and therefore are not transmitted, i.e. they are considered latent. An important part of the tuberculosis work in Norway is ensuring that people with an increased risk of post-infection disease development are offered preventative treatment. In addition to those who are thought to be newly infected, high risk groups include children and persons with impaired immune system. The number of people receiving preventative treatment is still too low, according to the Institute of Public Health. The number of preventative treatments is expected to be greater than the number treated for tuberculosis disease, but in several counties these groups are about the same.


HIV/AIDS

HIV infection is present in all countries of the world. UNAIDS estimates that by the end of 2016 approximately 36.7 million people living with HIV infection, approximately 17 million of these have access to antiviral treatment. Since the start of the HIV epidemic, it is estimated that approx. 78 million people have been infected with HIV and approximately 35 million people have died of AIDS-related illnesses. Globally, women account for 52% of the HIV-infected persons. About 69% of the HIV-infected live in sub-Saharan Africa. In 2016, around 1.8 million individuals acquired HIV. This is the lowest number of newly diagnosed since the mid 1990s. In Norway, HIV infection and AIDS have also been present and since 1983 the Institute of Public Health in Oslo has been observing and performing statistical analysis, showing overall low incidence. In 2017, there were 18 individuals diagnosed with AIDS and 213 individuals diagnosed with HIV. People who test HIV positive are referred to a doctor with a good knowledge of HIV. Treatment for HIV infection is usually handled by a specialist health service in the hospital. For people who live far from a hospital, the local doctor can collaborate with the specialists to give the best possible local support.


United Nations: Sustainable development goals, SDGs 2016-2030

Norway regards the 2030 Agenda with its 17
Sustainable Development Goals The Sustainable Development Goals (SDGs) or Global Goals are a collection of 17 interlinked objectives designed to serve as a "shared blueprint for peace and prosperity for people and the planet, now and into the future".United Nations (2017) R ...
(SDGs) as a transformative global roadmap for both national and international efforts aimed at eradicating extreme poverty, while protecting planetary boundaries and promoting prosperity, peace and justice. Norway was also a part of the 2016 voluntary national review of the high level political forum on Sustainable development. UN reports and various international indexes show that Norway ranks high in terms of global implementation of the SDGs. At the same time, it is evident that implementing the 2030 Agenda will be demanding for Norway, too. The Government has identified a number of targets that pose particular challenges for domestic follow-up in Norway. These challenges relate to several of the SDGs and all three dimensions of sustainable development – social, economic, and environmental. Targets that are likely to remain the focus of political attention and policy development are those relating to sustainable consumption and production, health and education, equality, employment, and migration. The Government is giving priority to ensuring quality education and employment, especially for young people and those at risk of marginalisation. This is an important contribution to realising the 2030 Agenda vision of leaving no one behind. Challenges that have been identified at the national level: * Reducing non-communicable diseases and promoting mental health * Increasing high-school completion rates * Eliminating all forms of violence against women and girls * Reducing the proportion of young people not in employment, education or training * Ensuring sustainable infrastructure * Sustaining income growth of the bottom 40% of the population at a rate higher than the national average * Improving urban air quality * Halving
food waste Food loss and waste is food that is not eaten. The causes of food waste or loss are numerous and occur throughout the food system, during production, processing, distribution, retail and food service sales, and consumption. Overall, about o ...
and reducing waste generation * Reducing the impact of invasive alien species * Reducing all forms of violence and related death rates and combating organised crime.


See also

* Health in Norway


References

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