Health Policies: Norway (2016)

Introduction

The Norwegian healthcare system is founded on the principles of universal access, decentralisation, and free choice of provider (The Norwegian Medicine Agency 2015). The health system is nationally managed and financed, and is built on the principle that all citizens have equal access regardless of socioeconomic status, country of origin, and area of residence. The healthcare system is financed by taxation, together with income-related employee and employer contributions. All residents are covered by the National Insurance Scheme (NIS) managed by the Norwegian Health Economics Administration (HELFO) and all Norwegian citizens are invited to choose their general practitioner (The Norwegian Medicine Agency 2015).

The hospital reform of 2001/2002 transferred the ownership of all public hospitals, psychiatric institutions, ambulance services, and substance abuse treatment centres from the municipality to the state. While healthcare policies are controlled centrally, the responsibility for its provision is decentralised.

In 2012, the Coordination Reform was launched. The reform aims to create a more cohesive and coordinated approach to healthcare services, a greater proportion of such services are to be provided in the local communities, better preventive measures, and improving public health (The Coordination Reform 2015).

Although the Norwegian healthcare system functions well in many areas, changing demographics are putting pressure on health services.The overall picture is that the oldest age groups will increase the most between 2006 and 2030. During this period, the age group 67-79 is expected to increase by nearly 70 %. The demographic challenge for the municipal nursing and care services will be particularly great towards the end of the period, when the size of the population over 80 will increase between 40 and 50 % from 2006 to 2030 [1].

With the 2012 Coordination Reform Norway puts in place measures to meet such challenges, its effects still remain to be seen. As OECD (2014: 3) states in their review of the Norwegian healthcare system: “Norway’s ambitious reform agenda must be balanced by structured efforts on the field”. An example of how these new structures work on the field was put forward by the Norwegian Cancer Society. In 2012, they started financing cancer coordinators in order to tackle the complex needs of cancer patients. The coordinator helps guide, coordinate, and align resources in different phases of the treatment. Also, in 2001, the new policy of ‘free choice of treatments’ was implemented. Its goal is to shorten the queue for treatments and is led by the Minister of Health (Ministry of Health and Care Services, 2014).

Long-term Care

The municipalities are responsible for providing long-term care. Institutions that provide long-term care include nursing homes, long-term psychiatric homes, and shelter homes for severely disabled children and youth. Cost-sharing for institutionalised care is income-based and is set between 75 and 85 %, means-adjusted. Patients’ assets are not subject to assessment in setting cost-sharing requirements and do not need to be liquidated to cover cost-sharing (it is based on income only). This is also known as the “Scandinavian Model”, because the organisations, financing, and functioning of the health and social services is similar in Norway, Denmark, and Sweden. The orientation towards public welfare solutions has long historical traditions. It can be traced back to late Middle Ages, was renewed through the revised Poor Law legislation at the turn of 19th century, and was modernised through the development of the public welfare programmes after the Second World War (Reisegg et al. 2014). These programmes were built up under the leadership of continuous social democratic governments up to 1965, and were supported in all basic issues by the other major political parties (Van Nostrand et al. 1995). The full responsibility for providing long-term care was given to the municipalities in 1988 (Braut 2014).

Further, home nursing is also provided by the municipalities for free, if feasible and needed. After a home visit and discussions with the patient and family, the municipality makes a determination on the level of care that will be provided, which most often takes into account an evaluation by the patient’s general practitioners or by the hospital upon discharge; decisions about providing care in a nursing home are not excluded. A few nursing homes are privately run, but their services are provided under contract with the municipalities. Very few patients pay individually for full-time nursing home care. Municipalities may also provide for end-of-life care for terminal patients in nursing homes, but many nursing homes lack palliative units. Patients may pay for their care but only with private funds. There is also a system in place for informal carers to apply for financial support from the municipalities (Van Nostrand et al. 1995).

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