Lu asked me to post about the Norwegian healthcare
system. Ha…now you can be sorry!
The sources I used to make this post are OECD (ORGANISATION FOR ECONOMIC CO-OPERATION AND DEVELOPMENT), The World Health Report 2002, which was officially launched October 30th last year and the Norwegian Ministry of Healthcare. Besides I was on the team of lawyers working for 3 years on the last Norwegian law about National Insurance. A job I did in addition to my ordinary job.
The report from WHO represents one of the largest research projects ever undertaken by the World Health Organization. I will be using the expression GDP a lot, which means “the gross domestic product”.
I want to stress that no country has a perfect health care system as far as I know. Some systems may however operate significantly better than others. Although one system working good in one country, might not work as well in another country , due to differense in size, population and economy.
The Norwegian health care system is characterised by extensive coverage, high quality and proven medical competence. Total health care coverage is 100 % of the population (compared to the US is 45% of population).
Over the past fifteen years, health care expenditure as a ratio of trend GDP in Norway has grown by a moderate 1 percentage point, which is below the (unweighted) OECD average and considerably less than in the United States, France, Canada, Spain and Switzerland.
Norway has traditionally endorsed a principle of equal rights to satisfactory health services, to be funded by the National Insurance Fund. In Norway, a complex system financing health services and social services has evolved over time. Moreover, it is continually developing and changing; only the main lines will be presented here.
The health care system in Norway has both public and private medical services and facilities. Public health expenditures constitute now about 12% of total public expenditure, against 1.5% for private health care expenditures. The largest part of these expenditures is the cost of salaries. (To compare the US Public health expenditures in 1998 was 12,9% and the Norwegian health expenditures the same year was 8,6%.)
Every person living in Norway today has the right to social security benefits. All citizens have access to care; no one may be denied services on the basis of income, age, or health status. Coverage is "portable," meaning residents retain their health benefits wherever they move. Health care has no relationship to employment. Benefits are the same for all citizens. (This is the same as in Canada I believe.)
The national health insurance system ensures, among others, the right to:
free hospital care when needed,
free medical assistance during pregnancy and delivery,
economic compensation for employed persons during illness,
maternity leave with 100% salary for one year (available to either of the parents in the latter part of the period),
subsidised medical consultations in the event of illness,
subsidies for necessary medication in connection with chronic diseases,
disability pension for formerly employed persons in the event of chronic disability,
unemployment benefits,
a general pension after 67 years of age.
As you know there is no such thing as “free healthcare”. Extencive healtcare is expencive and somebody has to pay….. Just like in the US the payroll taxes (financing the Social Security and Medicare in the US) are levied at a flat rate and has not been changed: 6.7% of gross income or 3% if you are retired or on disability. So it is not like we have an endless taxburden to pay for the People’s healthcare.
The main sources of financing of health services at local level are:
tax at local level,
transfer of funds from the central Government,
the National Insurance Fund,
obligatory user fee from patients for medical consultations.
Organisation of health services at local level
The decision about how much of the local funds are to be spent on the health
Central government funding of local health services is meant to secure that all parts of the population have access to services of equal quality, independently of the local budget. The size of governmental transfers depends among others on geography, population size and demographic structure. In reality it is not possible to compensate for all differences, and to provide total equality in the national health system.
Users of the curative services pay a user fee. This fee is identical all over the country, and constitutes about NOK 90 (approx. US$15) for an ordinary medical consultation, somewhat higher for home visits, on public holidays, during the night and for specialist services. For some conditions no user fee is charged (for example antenatal health checks). The fee in reality covers only a fraction of the local authorities health expenditures.
What is covered by the National Insurance Fund?
The costs of drugs are largely covered by the individual patient. Exceptions are those medicines used by patients suffering from certain chronic diseases; these are subsidised from the National Insurance Fund.
A disease will in principle lead to considerable costs for the stricken person, so in order to reduce this burden, a ceiling of almost NOK 1300 (approx. US$200) per person per year (or per parent and children) is set as a limit to what individual patients are expected to pay for their medication and medical services (1996). Costs exceeding this level are covered by the National Insurance Fund.
Oral health services are free for children and adolescents up to 18 years of age. Other oral health services are - with a few exceptions - private, and have to be paid for in total by the individual. The same is true for cost of opticians services, glasses and contact lenses - these are to be covered in their entirety by patients.
Only 2% of private consumption expenditure is on health care. Of this expenditure again 40% is on dental services.
In the bigger cities there are some physicians who work on an entirely private basis, outside the publicly funded system. They are free to set the prices of their own services as long as they adhere to the standards set by the Norwegian Medical Association. Their number is not large, and there has never been a large market for this type of health care services in Norway.
One of the system's weaknesses has earlier been long waiting lists for hospital admission, but that has now changed. A series of recent reforms, most importantly a change to activity-based funding of hospitals, raised efficiency a lot. After the reforms you can now pick the hosptital you want in the country. You can look up all the hospitals on the Internet and choose the one that fit your needs the best.
The Norwegian health care system is not funded by private insurance at all. This approach contrasts with the dominant model in many OECD countries, whereby privately provided health services are being funded by a mix of social and private insurance.
Our health care weaknesses compared with the US:
Our health care lack the high-quality services that are available for those with good insurance in the US. Neither do we have the large numbers of physicians, clinics or hospitals, and especially not the specialists that the US has in certain parts of the country. Also the US is at the forefront of clinical research and are doing major technological breakthroughs in treating numerous diseases. But all of these weaknesses are of course also related to Norway being a very small nation.
Note about OECD: An international organisation helping governments tackle the economic, social and governance challenges of a globalised economy. The OECD groups 30 member countries sharing a commitment to democratic government and the market economy. With active relationships with some 70 other countries, NGOs and civil society, it has a global reach. Best known for its publications and its statistics, its work covers economic and social issues from macroeconomics, to trade, education, development and science and innovation.
The sources I used to make this post are OECD (ORGANISATION FOR ECONOMIC CO-OPERATION AND DEVELOPMENT), The World Health Report 2002, which was officially launched October 30th last year and the Norwegian Ministry of Healthcare. Besides I was on the team of lawyers working for 3 years on the last Norwegian law about National Insurance. A job I did in addition to my ordinary job.
The report from WHO represents one of the largest research projects ever undertaken by the World Health Organization. I will be using the expression GDP a lot, which means “the gross domestic product”.
I want to stress that no country has a perfect health care system as far as I know. Some systems may however operate significantly better than others. Although one system working good in one country, might not work as well in another country , due to differense in size, population and economy.
The Norwegian health care system is characterised by extensive coverage, high quality and proven medical competence. Total health care coverage is 100 % of the population (compared to the US is 45% of population).
Over the past fifteen years, health care expenditure as a ratio of trend GDP in Norway has grown by a moderate 1 percentage point, which is below the (unweighted) OECD average and considerably less than in the United States, France, Canada, Spain and Switzerland.
Norway has traditionally endorsed a principle of equal rights to satisfactory health services, to be funded by the National Insurance Fund. In Norway, a complex system financing health services and social services has evolved over time. Moreover, it is continually developing and changing; only the main lines will be presented here.
The health care system in Norway has both public and private medical services and facilities. Public health expenditures constitute now about 12% of total public expenditure, against 1.5% for private health care expenditures. The largest part of these expenditures is the cost of salaries. (To compare the US Public health expenditures in 1998 was 12,9% and the Norwegian health expenditures the same year was 8,6%.)
Every person living in Norway today has the right to social security benefits. All citizens have access to care; no one may be denied services on the basis of income, age, or health status. Coverage is "portable," meaning residents retain their health benefits wherever they move. Health care has no relationship to employment. Benefits are the same for all citizens. (This is the same as in Canada I believe.)
The national health insurance system ensures, among others, the right to:
free hospital care when needed,
free medical assistance during pregnancy and delivery,
economic compensation for employed persons during illness,
maternity leave with 100% salary for one year (available to either of the parents in the latter part of the period),
subsidised medical consultations in the event of illness,
subsidies for necessary medication in connection with chronic diseases,
disability pension for formerly employed persons in the event of chronic disability,
unemployment benefits,
a general pension after 67 years of age.
As you know there is no such thing as “free healthcare”. Extencive healtcare is expencive and somebody has to pay….. Just like in the US the payroll taxes (financing the Social Security and Medicare in the US) are levied at a flat rate and has not been changed: 6.7% of gross income or 3% if you are retired or on disability. So it is not like we have an endless taxburden to pay for the People’s healthcare.
The main sources of financing of health services at local level are:
tax at local level,
transfer of funds from the central Government,
the National Insurance Fund,
obligatory user fee from patients for medical consultations.
Organisation of health services at local level
The decision about how much of the local funds are to be spent on the health
Central government funding of local health services is meant to secure that all parts of the population have access to services of equal quality, independently of the local budget. The size of governmental transfers depends among others on geography, population size and demographic structure. In reality it is not possible to compensate for all differences, and to provide total equality in the national health system.
Users of the curative services pay a user fee. This fee is identical all over the country, and constitutes about NOK 90 (approx. US$15) for an ordinary medical consultation, somewhat higher for home visits, on public holidays, during the night and for specialist services. For some conditions no user fee is charged (for example antenatal health checks). The fee in reality covers only a fraction of the local authorities health expenditures.
What is covered by the National Insurance Fund?
The costs of drugs are largely covered by the individual patient. Exceptions are those medicines used by patients suffering from certain chronic diseases; these are subsidised from the National Insurance Fund.
A disease will in principle lead to considerable costs for the stricken person, so in order to reduce this burden, a ceiling of almost NOK 1300 (approx. US$200) per person per year (or per parent and children) is set as a limit to what individual patients are expected to pay for their medication and medical services (1996). Costs exceeding this level are covered by the National Insurance Fund.
Oral health services are free for children and adolescents up to 18 years of age. Other oral health services are - with a few exceptions - private, and have to be paid for in total by the individual. The same is true for cost of opticians services, glasses and contact lenses - these are to be covered in their entirety by patients.
Only 2% of private consumption expenditure is on health care. Of this expenditure again 40% is on dental services.
In the bigger cities there are some physicians who work on an entirely private basis, outside the publicly funded system. They are free to set the prices of their own services as long as they adhere to the standards set by the Norwegian Medical Association. Their number is not large, and there has never been a large market for this type of health care services in Norway.
One of the system's weaknesses has earlier been long waiting lists for hospital admission, but that has now changed. A series of recent reforms, most importantly a change to activity-based funding of hospitals, raised efficiency a lot. After the reforms you can now pick the hosptital you want in the country. You can look up all the hospitals on the Internet and choose the one that fit your needs the best.
The Norwegian health care system is not funded by private insurance at all. This approach contrasts with the dominant model in many OECD countries, whereby privately provided health services are being funded by a mix of social and private insurance.
Our health care weaknesses compared with the US:
Our health care lack the high-quality services that are available for those with good insurance in the US. Neither do we have the large numbers of physicians, clinics or hospitals, and especially not the specialists that the US has in certain parts of the country. Also the US is at the forefront of clinical research and are doing major technological breakthroughs in treating numerous diseases. But all of these weaknesses are of course also related to Norway being a very small nation.
Note about OECD: An international organisation helping governments tackle the economic, social and governance challenges of a globalised economy. The OECD groups 30 member countries sharing a commitment to democratic government and the market economy. With active relationships with some 70 other countries, NGOs and civil society, it has a global reach. Best known for its publications and its statistics, its work covers economic and social issues from macroeconomics, to trade, education, development and science and innovation.
USA
