Healthcare in Norway

In Norway, all hospitals are funded by the public as part of the national budget.[1] However, while medical treatment is free of charge for any person younger than the age of sixteen, residents who have reached adulthood must pay a deductible each year before becoming eligible for an exemption card. The card entitles one to free healthcare for the remainder of that year.[2]

A nurse at a nursing home in Nord-Trøndelag, Norway

All public hospitals in Norway are run by four Regional Health Authorities (RHA) overseen by the Ministry of Health and Care Services. In addition to these public hospitals, there are a small number of privately owned health clinics currently operating.

Statistics:[3]

Total population (2018, 2.quarters)[3]	5,312,343
Gross national income per capita (PPP international $, 2016)[4]	55,700
Life expectancy at birth m/f (years, 2016)	81/84
Probability of dying under five (per 1,000 live births, 2016)[5]	2.7
Probability of dying between 15 and 60 years m/f (per 1,000 population, 2016)	66/42
Total expenditure on health per capita (Intl $, 2014)	6,347
Total expenditure on health as % of GDP (2017)	10.4
Latest data available from the Global Health Observatory and SSB, NO Statistical agency [6]

Availability and cost

Expenditure on healthcare is about USD $6,647 per head per year (2016), among the highest in the world.[1] It has the highest proportion of nurses and midwives per head in Europe - 1,744 per 100,000 in 2015.[7]

While the availability of public healthcare is universal in Norway, there are certain payment stipulations.

Children aged sixteen or younger, and pregnant and/or nursing women are given free healthcare regardless of the coverage they may have had in previous situations. All citizens are otherwise responsible for the annual deductible - which averages around 2040 Norwegian krone (about $246.00 USD.) Norway’s health system also does not cover specialized care for those above 16 years of age, and anyone needing treatment such as specialized physiotherapy is required to pay an additional deductible. While health appointments themselves are encompassed by the deductible, extra materials and medical equipment are often covered by the patient.[2]

In terms of emergency room admission, all immediate healthcare costs are covered. In the case that hospitals in Norway are unable to treat a patient, then treatment abroad is arranged free of charge.[8]

Health expenses and governmental funding

Norway 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.[9] In 2010, 9.4% of the country’s GDP went to health spending, and only about 1.4% of that was private spending.[10]

In 2017, 10.4% of the country's GDP went to health spending.[11] Norway has one of the lowest private healthcare spending rates in the world. In 2007, out-of-pocket payments made up 15% of total health expenditure, in 2010 private (out-of-pocket) money payments are up to 15.3%,[12] reflecting moderate cost-sharing requirements.[13] The government creates an annual health budget 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 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 in the year of 2018 increased expenses and funding to the health sector with 2% compared to last year, with the goal to shorten the length of waiting lines and improve health services.[14] 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 the government of Norway decided to include national health care as one of their main focuses in the development of the welfare state. The state is responsible to provide good and necessary health services for everyone.[15] The responsibility is divided between three levels of governmental responsibility. First the state government, second the county and lastly the 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 regarding health politics and health services in Norway.[16] An arraignment was developed in 2001 that gave each citizen the right to have a permanent doctor in the area they lived in. The city council in every county is responsible for this right, and they also initiate agreements and cooperation with the doctors.[17] This improvement is one of several in the healthcare that Norway have to offer. The different reforms has in common that they all came as a reaction to an inefficient system 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 was the prime minister at this time. He was the leader of the party KrF and he was head of a government in coalition with two other parties, Høyre and Venstre. Up until this date the hospitals in Norway were operated by the county and the city council. The goal was to improve the quality of medical treatment, to run the hospitals more efficiently than earlier and to make medical treatment equally available to everyone in the country.[17] The reform was inspired by thoughts from the New Public Management movement, and major changes was realized after these principles. Hospitals and services was organized in to five regional health-companies. They are independent legal entities organized after the same principles as a corporation, with a few exceptions. The health companies are only owned by the government, they cannot go bankrupt and is guaranteed by the government. The government also loans and gives them financing from state funding.[18] The reform was to some extent successful. Patient waiting lists before treatment were reduced with almost 20 thousand patients. But the spending on healthcare in Norway increased, and after a year the financial deficit reached almost 3.1 billion.[19] Also, efficiency improvements in treatments can be noticed by patients when they have less time with the doctor and sometimes must check out of the hospital the same day.

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).[20] −gl6j

Administration

Norway has four designated Regional Health Authorities. They are: Northern Norway Regional Health Authority, Central Norway Regional Health Authority, Western Norway Regional Health Authority, and Southern and Eastern Norway Regional Health Authority.[21][21] According to the Patients' Rights Act,[22] all eligible persons have the right to a choice in hospitals when receiving treatment.[23]

Performance

The Norwegian Health Care System was ranked number 11 in overall performance by the World Health Organization[24] in a 2000 report evaluating the health care systems of each of the 191 United Nations 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.[25] 270,000 Norwegians were waiting for medical treatment in 2012-13.[26][27][28] In the OECD publication Health at a Glance 2011, Norway had among the longest wait times for elective surgery and specialist appointments among eleven countries surveyed.[29] However, the Solberg Cabinet has been successful in reducing the average wait times for hospital care.[30][31][32][33]

Health topics

Burden of diseases [34]

Norwegian disease burden report launched. Published 21.03.16 [35]

Public Health Report - Short Version: Health Condition in Norway 2018 (Report 05/2018)[36]

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.[37]

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.[38]

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.

Mortality rate, under 5- and under 1-age.
Observed deaths per 1000 live	1990	2016
Under 5 years	8.6	2.7
Under 1 year	7.0	2.2

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 [39]

Infectious diseases

Many infectious diseases have declined globally. Higher standards of living and improved hygienic conditions are a major cause, as well as the use of vaccines. Increased international travel and import of food is causing an increase in some infectious diseases in Norway. These include some foodborne infections and infections by antibiotic-resistant bacteria.[40] Patients are exempt from cost-sharing for visits, tests, and treatments for all infectious diseases deemed to pose a threat to public health.[41]

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 disease were reported to the Public Health Institute. This is a decline from the 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 presence in the world. Differences in the global disease burden of tuberculosis are also reflected in the occurrence in the country itself, 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.[42]

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.[42]

Preventive treatment Latent Tuberculosis

Most cases of tuberculosis disease in Norway are detected early and therefore do not lead to disease of others I.E. they are considered latent.

An important part of the tuberculosis work in this country is precisely to ensure that people with an increased risk of post-infection disease development are offered preventive 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 preventive treatment is still too low, according to the Institute of Public Health. The number of preventive treatments is expected to be greater than the number treated for tuberculosis disease, but in several counties these groups are about the same.[42]

HIV/AIDS

HIV infection has been proven 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 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. About 1.8 million are now infected globally annually with HIV (2016). This is the lowest number of newly diagnosed since the mid 1990s.[43]

In Norway, HIV infection and AIDS has also been proven, and from 1983, the Public Health Institute in Oslo, has been doing the statistics, showing overall low incidence. In 2017, there were 18 cases diagnosed with AIDS and 213 cases diagnosed with HIV.[44]

People who test HIV positive will be 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.[45]

DALYs in Norway 1990–2016

The Disability Adjusted Life Years per percent is dominated by Non-Communicable Diseases, NCDs. Low back and neck pain has the highest share, 8.08% of total DALYs, but it is slightly decreasing. Ischemic heart disease is second largest with 7.42% of total DALYs, COPD is increasing and has 3.09% of total DALYs.[46]

Injuries, including violence and self harm, have a smaller share of total DALYs. Falls have the largest share within this area with 2.93% of total DALYs and is increasing the most. Self harm is second largest with 2%, and road injuries has 1.44% of total DALYs, both decreasing.[46]

Communicable, neonatal, maternal and nutritional diseases has the smallest share of the total DALYs. The largest share within this area is: Lower respiratory diseases with 1.22% of total DALYs. Diarrheal diseases are increasing and has got 0.34% of total DALYs. HIV/AIDS is small and decreasing and has got 0.087% of total DALYs. Tuberculosis is even smaller and decreasing, with 0.045% of total DALYs.[46]

United Nations: Sustainable development goals, SDGs 2016-2030

Norway regards the 2030 Agenda with its 17 Sustainable Development Goals (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.[47]

Norway was also a part of the 2016 voluntary national review of the high level political forum on Sustainable development.[48]

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.[48]

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 and reducing waste generation
Reducing the impact of invasive alien species
Reducing all forms of violence and related death rates and combating organised crime.[47]

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