With growing calls in the United States for nationwide Medicare for all, many people are looking toward the often-praised health care models of Scandinavian countries, such as Norway, which is ranked 7th in the world for health care by The Commonwealth Fund Survey (2014).
So what exactly does health care look like in Norway, and how does it compare to that of the United States?
Velcommen til Norge!
(Welcome to Norway!)
Population: 5,255,000 (2016)
Average income: $66,000 (2013)
Life expectancy at birth: 81/84 (m/f)
Cost of health care per capita: $6,347 (2014)
Infant mortality rate: 2.08 (per 1,000) (2015)
Norway Health care system.
Norway is touted as having one of the greatest health care systems in the world due to its accessibility to all people, which provides equal rights and opportunities to citizens of all socioeconomic classes. Norway earned the designation by The United Nations Development Program (UNDP) as the best Scandinavian country to live in. The life expectancy in Norway is higher than ever before, which is attributed to excellent public health and a high-quality welfare program (InterNations).
How is the heath care system structured?
Public vs. Private
Public health care … How does it work?
Government-funded public health care is accessible to anyone who is a legal resident of Norway. This includes people with a visa who plan to stay for at least 12 months, as well as anyone with legal employment in the country. The principle of public health care is based on the premise that people of all socioeconomic classes have identical access to the same standards of care. In the early 1900s, the public welfare fund for health care took shape and emerged into folketrygden, which translates to National Insurance Fund in English, or better known in Norway as the Norwegian National Insurance Scheme.
Public health care ... How does it work?
The system is entirely controlled by the government and financed in several ways:
Taxes: People pay approximately 7.9% of their total gross income into the National Insurance Scheme each year.
Social Security benefits: People must pay into the system in Norway. If you move to Norway and pay into another country’s SS benefits, you are not eligible for public insurance
Out-of-pocket co-pays: These are highly subsidized by the government. There is a yearly cap on out-of-pocket spending; meaning people pay until they meet a certain monetary amount, usually less than $252 total U.S. dollars or 2,000 kroner.
Private Health Care
Residents of Norway can participate in the National Insurance Scheme and/or purchase their own private health insurance. It is possible that a person chooses to have both public and private health care to insure broader access to specialists and the freedom to choose their general practitioner. As a result, private insurance costs more than government-funded access.
How does one choose a primary care provider or see a specialist in Norway?
Once someone is enrolled into the National Insurance Scheme and registered in the National Population Register, they will receive a Norwegian identification number. This number is essential to the use of the public health care fund; without it a person cannot use the system. A general practitioner (GP) is automatically assigned by the Norwegian Health Economics Administration (HELFO) to each person enrolled in the system. A GP may be switched up to two times per year. If a person uses the public health care system, they have to be referred to a specialist by their primary care provider, which can result in a waitlist of up to 3-4 months to see the specialist. If a person chooses to skip the referral process, they can pay for private services and see a specialist of their choice and often sooner.
Primary Care and Specialists
Most of the hospitals in Norway are public hospitals and owned by the government. There are a small number of private institutions, though they are still funded by the public.
Hospital and primary care physicians are generally reimbursed via a salary.
Physician reimbursement comes directly from the government and is based on a fixed schedule. The provider is not permitted to charge higher reimbursement rates than what is already set.
Who owns the hospital and pays the docotor?
Population: 322 million (2016)
Average income: $53,000 (2013)
Health care spending: $9,403 per capita (2014)
Infant mortality rate: 5.6 deaths per 1,000 (2016)
Life expectancy: 76/81 (m/f) (2016)
How does the U.S. Compare ?
According to the Commonwealth Fund Survey (2014), the U.S. ranks 11th in the world for health care.
What types of coverage exist in the U.S.?
Through employers or private insurance companies
Through government programs: Medicare and Medicaid
How do the U.S. and Norway Compare?
Public insurance (Medicare/Medicaid) only available to certain groups of people
Private insurance is expensive but often partially funded by employers
Employer participation in offering insurance is voluntary
Higher infant mortality rate
Spend more money per capita on health care
Lower life expectancy
Multi-payer reinbursement, leading to cost variations for same services
Higher incidence of health disparities
Public insurance available to everyone
Spend less money per capita on health care
Better health outcomes for chronic diseases
Lower infant mortality rate
Longer wait times to see specalists
Option to purchase private insurance
What are your thoughts on a single payer health care system in the U.S.?
How do you think this would effect our practice as APRNs?
Medicare for All...
All photos retrieved from Unsplash via VisMe.
Davis, K., Stremikis, K., Squires, D., & Schoen, C. (2014). Mirror, Mirror On The Wall. How the Performance of the U.S. Health Care System Compares Internationally. The Commonwealth Fund. Retrieved from: https://www.commonwealthfund.org/sites/default/files/documents/___media_files_publications_fund_report_2014_jun_1755_davis_mirror_mirror_2014.pdf
Expat Arrivals. (2018). HealthCare in Norway. Retrieved from: http://www.expatarrivals.com/europe/norway/healthcare-norwayInterNations.
Connecting Global Minds. (n.d.). Healthcare in Norway. Retrieved from: https://www.internations.org/norway-expats/guide/living-in-norway-15585/healthcare-in-norway-2
The Local (2018). An expat’s introduction to healthcare in Norway. Cigna Global. Retrieved from: https://www.thelocal.no/20180110/an-expats-introduction-to-healthcare-in-norway-cignaglobal-tlccu
The World Health Organization (2018). United States. Retrieved from: www.who.int/countries/usa/en/
The World Health Organization (2018). Norway. Retrieved from: http://www.who.int/countries/nor/en/
(2017). Norwegian doctors explain why Norway ranks so much higher than the U.S. on health outcomes. YouTube Video. Retrieved from: https://www.youtube.com/watch?v=NUtQAnxcS0Y