Norway

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Background

Population: 5,033,675 Population: 314,838,000 GDP (PPP): $53,470 GDP (PPP): $48,386 per capita (4th) per capita (6th) Gini: 25.8 (5th) Gini: 45.0 (6th) HDI: 0.943 (1st) HDI: 0.910 (5th) 2/12/13 Life Expectancy: 80.2 Life Expectancy: 78.2

About Norway

Constitutional Monarchy: head of state (King Harald) and prime minister (Jens Stoltenberg) oversee government. Extensive reserves of petroleum, natural gas, minerals, lumber, seafood, fresh water, and hydropower. World's largest producer of oil and natural gas outside the Middle East. (~25% of countries GDP) Nordic welfare model: universal health 2/12/13 care, subsidized higher education, and

Structure & Flow

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Municipalities

The 431 municipalities in Norway are responsible for provisions and funding of the primary health care and social services. Receive funding from the General Purpose Grant Scheme, who decides how to distribute funds to municipalities based on many factors.

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General Practitioners

There are approx. 4000 General Practitioners (GPs) in Norway. Patients select a GP , a max of two separate ones a year, and see them if they need medical advice.
If

further care is needed (specialty care) the GP has to refer their patient to the specific specialist needed.

95% of the population is registered to GPs.

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Private Health Care Sector

There is a small section of people who choose to be in private health care. (5%)
Both

profit and not-for-profit exists

Several specialty care services are mostly private.

Pharmacy,

radiology, lab tests, etc

Though these are mostly private, the GP are usually the ones suggesting and referring patients there.
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Hospitals

Owned by the state, but formally are registered as legal entities with an executive board.
Financed

through capitation, activity based payments and out-of-pocket payments.

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General Flow
Illness GP

Specialist

Hospital

Long Term Care

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Norway and The USA

Number of Physicians per 1,000 population:

Norway: USA:

4.0

2.4

Acute Care Hospital Beds per 1,000 population:

Norway: USA:

2.4

2.7

Avg. length of stay in Acute Care 2/12/13

What We Can Learn

By having the patients see their GP first, there is more efficient treatment at the appropriate care facility (less waiting time) By having to see your GP first, there is a longer time to get treated, because of the need of a referral from your GP. But public hospitals, compared to notfor-profit ones, dont have the space to keep people if needed.
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Finances & Cost Management

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Who is Covered?

All citizens or residents who live or work in Norway. All residents on permanent work in the Norwegian shelf. Any students residing for more than 1 year*.

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Funding for the Healthcare

Taxes collected by:

Central

Government 83% 3% 14%

Counties

Municipalities

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Benefits of the Healthcare

Free Benefits:

Emergency Transportation Inpatient Hospital Care

Subsidized Benefits: (Co-Pays) Outpatient Care

Specialists All other Prescriptions*

Prescription Radiology Medication for Lab Tests serious illnesses Non-funded Healthcare: Non-prescription Drugs Some Adult Some out of country Most adult dental care Dental Care* treatments (only if treatments not included Any Private sector 2/12/13 in insurance. unable to be

Out-of-Pocket Payments (Cost-Sharing)

Visit to a Specialist:
Co-pay

= NKr307 (=$56 US) = NKr180 (=$33 US)

Visit to a General Practitioner:

Co-pay

Prescription Medication:
Co-pay

= 36% of expenses of the medicines

Maximum

co-pay = NKr 520 (=$95 US)

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Co-Pay Ceiling

Annual Maximum limit for out-of-pocket costs. In 2010, Ceiling was set at 1880NKr ($339 US)

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National Insurance
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Who is Insured?

Norway 100% of residents are insured

USA- nearly 20% lacks insurance

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Problems With Health Insurance

Spend a lot time on paperwork or disputes over medical bills NOR 8% US 17%

Insurance denied payment or did not pay as much as expected

2%

25%

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2009 Survey: Doctors say Insurance Restrictions on Care Are a Major Time Concern

NOR 17%

US 48%

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Quality & Access to benefits

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Norways Objectives for Quality and Equality to Access

All residents in Norway are publicly insured. No major health risk is excluded from the public insurance scheme An equal use of health care services for individuals with equal needs regardless of income, age, education, gender, ethnic background and place of residence.
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Bottlenecks in the Hospital Sector

The 1998 OECD Economic Survey of Norway identified major challenges for the Norwegian health care sector because of capacity shortages as suggested by long waiting lists The number of nurses has risen faster than that of physicians The level of per capita acute beds remains below the OECD median That putting too much emphasis on 2/12/13 activity-based financing takes away

Bottlenecks in the Hospital Sector

Official reports suggesting that the reallocation of health care resources from lower to higher priority areas has proved difficult to implement In 1990 with the introduction of a legal waiting time guarantee, stipulating a maximum waiting period of six months for non-emergency patients
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Positive Qualities of the Healthcare System

The number of nurses has rise to become one of the highest in the OECD per capita. long-term care beds per capita are among the highest in the OECD

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Norway Equal Access and High Quality

In a recent official opinion poll (NOU 1997), about 95 per cent of the respondents expressed satisfaction with the professional skills of their physicians 80 per cent gave a positive appraisal of the results of treatment and the service attitude of medical staff. The life expectancy at birth, at 74.2 years for men and 80.3 years for women
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Norway Equal Access and High Quality

The number of avoidable years of life lost under age 70 per 1 000 at around 5 for males and 3 for females In 2003, the US had an infant mortality rate of 6.8 deaths per 1,000 live births. Norways rate was 3.5 per 1,000 The Act on Patient Rights introduced free choice of all public hospitals by the patients. The level of fairness in financing is a measure of equality. Norway2/12/13 8 to ranks

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Increase of Access

Both supply of services and responsiveness have improved Activity of both hospitals and private physicians has increased. The technical efficiency of public hospitals seems to have improved. Waiting times have been reduced both in primary and specialized care
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Increase of Access

More pharmacies are available in urban areas without impairing supply in remote areas, and they stay open longer hours In June 2001, the government introduced major changes in primary care through the so-called patient-list system As a result of the patient-list reform, 98% of the population is now registered with a GP. Patients find that accessibility has 2/12/13 improved, while GPs consider it more

Healthcare Problems & Reforms in Norway

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Typical Problem Areas

Long admission wait lists, lack of medical staff

This

is the biggest problem in Norway Healthcare

Lack of coordination between hospitals and municipalities Cost efficiency Limited choice in providers
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Delay and Waitlist Problems

Moral Hazard of free healthcare ~280,000 Norwegians estimated to be waiting for care on a given day
Hip

replacement wait time: 4 months 3 months 2 months

Prostectomy:

Hysterectomy:

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Other Problems

Management and Coordination

Efficiency

problems

Increasing potential tax burden

40-45% 10%

tax rate

of GDP expended on Health Care (Rank 7th)

Limited choice of health providers for people

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Reforms

Management Reform attempts 1990 Patients Right Act

Unsuccessful Patients

government attempt to solve waiting list problem with a condition that could cause catastrophic or very serious consequences have right to a treatment within 6 months

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America vs. Norway

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USA vs. Norway: Prisons

Incarceration Rate: 730/100,000 (1st) Tough punishments for tough crimes; lockdown in jail, close quarters, life sentences, Private prisons, many inmates per cell,

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USA vs. Norway: Prisons

Incarceration Rate: 73/100,000 (173rd) Rehabilitate inmates .. Recidivism rate: 20% No bars, no electric fences, maximum sentence of 21 years, guards do not carry weapons Kitchens, suite bedroom/bathrooms, organized athletics, full medical/dental/optical care
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USA vs. Norway: Prisons

Bastoy Prison, Norway

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