Health Care Around the World International Health Care Systems

Health Care Around the World: Norway

All Norwegians are insured by the National Insurance Scheme. This is a universal, tax-funded, single-payer health system. Compared to France, Italy, Spain and Japan, Norway has the most centralized system.

Percent Insured. 100%. All Norwegian citizens and residents are covered.

Funding. The National Insurance Scheme is funded by general tax revenues. There is no earmarked tax for health care. The Norwegian tax burden is 45% of GDP. The government sets a global budget limiting overall health expenditures and capital investment.

Private Insurance. Norwegians can opt out of the the government system and pay out-of-pocket. Many pay out-of-pocket and travel to a foreign country for medical care when waiting lists are long.

Physician Compensation. Hospital and nonhospital physicians generally are paid on a salaried basis. Some specialists can receive an annual grant and fee-for-service payments. Reimbursement rates, however, are set by the government and, unlike in France, the physician can not charge higher rates than the centrally-set reimbursement rate.

Physician Choice. Patients choose general practitioners (GPs) from a government list. These GPs then act as gatekeepers for specialist services. Patients can only switch GPs twice per year and only if there is no waiting list for the requested GP.

Copayment/Deductibles. There are no copayments for hospitals stays or drugs. There are small copayments for outpatient treatment.

Waiting Times. There are significant waiting times for many procedures. Many Norwegians go abroad for medical treatments. The average weight for a hip replacement is more than 4 months. “Approximately 23 percent of all patients referred for hospital admission have to wait longer than three months for admission.” Also, care can be denied if it is not deemed to be cost-effective.

Benefits. Very generous. The program also provides sick pay.” ¬†As Michael Moore has noted, the Norwegian system will even pay for ‘spa treatments’ in some cases.”

45 Comments

  1. I have been studying different health systems as a part of my education in health administration. I came across this article and I wanted comment on it. I researched multiple systems extensively. I have to say that social contracts in health systems where you have proper partnership between the government and the private sector is the best. Relying on private payers is a risk, paying for some aged group and not others wouldn’t benefit the system as a whole. The government is needed to control the system from regulation, cost, and budget stand points. Private sector is needed to provide alternative solutions to citizens who choose to get care faster and avoid waiting list or opt out. In healthcare, you have got to control cost, use of technology, and salarie along with expectations. Companies such as drugs and advanced technologies can adjust their business model in a way to maintain their presence and competitive edge. However regular citizens wont be able to adjust their basic healthcare needs. It is better to have a basic system that covers all population with some contribution from the private sector. Such model won’t exist in the US for the following reasons; corporation, lobbyiests, strong AMA and desired high clinical professionals compensation, shortage of healthcare providers, the highest expenditures on the US economy on other sectors such as defense, litigious society, and the individualistic cultural values of americans. To sum up, In the US it will continue to be harder to challenge the current system and impose proper reform.

  2. Folks, Norway was a population of 4.9M people. That’s the size of Alabama, the 22nd largest state and only one million more people than Puerto Rico. Wake up people. That single payer government model would be a massive nightmare in a country of 310M people. it’s just not feasible…heck, even Medicaid and Medicare are a mess, rife with Billions of fraud and waste.

    What’s needed is tort reform, less defensive medicine, cross state portability like the very competitive auto insurance industry. I don’t want the govt touching my healthcare or getting between me and my doctor. 5M citizens in Norway vs. 310M….night and day folks, one size or approach does not fit all.

  3. Tedlink,

    The billions of fraud and waste are perpetrated by the health care providers (i.e.) the private sector, not the gov’t.

    Beyond that, I doubt one could find any research that support your comments regarding tort reform, etc.

    Right now, your insurance company is getting between you and your doctor… at least that is the way it is on this planet.

    Doesn’t medicare and the VA have cross state portability…

    Why not explain massive nightmare…actually, the opposite is the truth, price drop with scale…that’s why the push (by the current administration) is to automate.

    Think you have been listening to Rush.

    Rick

  4. Rick: two words: Medicare fraud. Google the story of Medicare fraud linked to Cuba. Tedlink’s comments are spot on especially as regards purchasing insurance across state lines. Health insurance can be obtained in Alabama for $1500 per year while it cost thousands and thousands more in northeastern states.

  5. It appears everyone is missing a critical point.

    “What is the quality of health care that you are receiving?”

    My wife is Norwegian and the pregnancy care (diagnostic) is awful in Norway compared to a regular clinic in the US which will cost about $3,000 per pregnancy and/or covered by insurance.

    Furthermore, we read stories in Norwegian publications a) Norwegian doctors have little liability, they malpractice, get a warning and then back to business, b) you cannot choose your doctor, c) you have to wait and wait for any specialist, d) several deaths each year due to patients waiting cancer treatment, e) horror stories about misdiagnosis after misdiagnosis, f) no information about your doctor anywhere (what the education, how many warnings etc.) g) families have no rights! you ask for a doctor in the hospital and you are reprimanded by the nurse, i) personal experience you have no privacy – our first ultrasound was in Norway and the room had two doctors (while we were having the ultrasound.) m) Also personal experience what the doctors missed in Norway, doctors “immediately” caught in USA (our baby had heart surgery.)

    So, anyone who thinks that governmental health care is a substitute for private health care (incuding myself in my younger days) is a “fool.” Governemtal health care is a “minimum.”

    I am sorry for the Norwegians in general. You live in the richest country in the world yet you have no idea what “good health care” could be like. Simiar to Eastern German driving their trabbants, they had no idea how well a Mercedes was like. It was surreal.

    This is my analogy – yes, USA has a maor health (expense) crisis but at least I have the option a) to choose what I want and can pay for and b) I can rate my doctors, I can sue them and most importantly I AM IN CHARGE OF MY HEALTH… I do not trust any doctor blindly yet in Norway – Doctors are Gods. In the US, they are here to serve me.

    Yet, I agree that a health issue should not cause financial disaster to an uninsured family in the US. Perhaps the new Health Care law in the USA will improve it.

    I work and pay about 1/4th of my income to health care – I do this because my insurance plan allows me to see any specialist that I like. I can lower it or pay even more for additional coverages.

    In summary – Having free healthcare means nothing as long as the quality is bad.

    US could certainly afford to set up a free/tax payer based healthcare system equal to Norway’s – which would mean “no decent care for elderly, ” “wait and wait and wait diagnosis”, “no liability in case there is mistreatment, misjudgement”, “overbooked rooms,” and “a few decent regional hospitals” in the all the country.

    Let’s get real – Norway healthcare is a “GOOD IDEA” but it is “BAD PRACTICE.”

    US healthcare is “EXPENSIVE” but “EXCELLENT.”

    Ultimately you always get what you pay for… Dreams are free!

    Thank you

  6. Hello,
    I am currently writing from this from Telemark, Norway. Here’s just a few things people are overlooking:
    1. Norway has insanely high taxes on everything mainly to help pay for thier healthcare.
    2. Thier ain’t no such thing as a free lunch. When I ask Norwegians who is paying for thier healthcare, they always say other people, rich people, greedy companies, the government but in essense they are stealing from one group to pay for another. (That only lasts so long.)
    3. They recently have found huge amounts of oil and have been using those profits to further subsidize healthcare. Although costs are starting to greatly increase rapidly.
    4. They have extremely long waits for major surgeries which is why this article mentioned that so many of them leave Norway for the really important stuff and pay out of pocket.
    5. Most people who like these Government run systems are young and healthy and only need it for a cold, a broken leg, stitches… Since there is accounting board that ultimately controls how much can be spent you can be turned down for something potentially risky that may save your life.

    I just paid 650 KR for a stupid concert ticket and 100 KR for a beer last night. That’s almost $150 US Dollars which would of cost me about $30 tops back in Chicago. I just helped pay for someone’s “Medical Spa Treatment” that Michael Moore was bragging about above… Let them enjoy it for now cause it’s all gonna come crashing down soon. “Socialism is a great idea… until you run out of other people’s money.” – Margaret Thatcher

  7. Selcuk:
    It seem you are missing the point. Ofcourse amazing healthcare can be bought with lots of money. But on average the Norwegian healthcare system is better (according to all studies I’ve seen), cheaper and fair.
    In Norway litigations does not go against the doctor personally but rather the hospital. That does not mean the doctor cannot loose his/hers license if convicted of malpractise. But it does mean that they do not need the very expensive indemnity insurance which again drives up costs.

    Another point to make is that Norway wealth from oil is really beside the point as all other Scandinavian health care systems are similar, despite no oil revenue. As mentioned by others the centralized healthcare system is much, much cheaper than the American model anyway and would suit any country, rich or poor.

    There are so many reasons why costs are spiralling out of control in the US, eg doctors dole out unecessary tests, medications and procedures. And don’t be fooled into thinking that equates better healthcare. No medication is without side-effect and no procedure is risk-free. But the doctor will get more money (and less litigations) if being “generous” like this. As mentioned in the article the Doctors in Norway are usually on a set wage and will not rake in money by doing uneccessary tests etc.
    Also money is wasted by hospitals needing to cater for every doctor’s whim when it comes to brands (of medications and surgical equipment). That means lots of stuff sitting on the shelfs (and lining medical companies pockets). In Norway the hospital decides what is the best equipment and everyone will use this. Following the same therapeutic guideline might seem like less choice for the patient, but honestly what patient would be better qualified to choose anyway. It also make it easier to conduct proper research into what works best, and since everyone (including nurses) are familiar with the system, less mistakes are made.

  8. TommyHolly
    Pretty much every point you make seems utterly ignorant.
    1. The Norwegian tax is actually lower than many other European countries (like France or Italy). The taxes pay for free Healthcare, free Education, lots of subsidies etc. Which is why people are healthier, better educated and get better paying jobs, able to spend more time with children growing up, less crime, the list goes on and on. In pretty much every stat Norway is way up there despite the horrible weather. And please don’t bring the oil into this because Sweden is usally even better and have not one drop of oil.
    2. As other people have mentioned all healthcare systems depend on many paying for the few, that is the very essence of insurance of any kind. The difference is that Norway does not line the pockets of all the in-between people.
    3. Recently found oil? Costs greatly increase rapidly? Uhm no.
    4. 4 months wait for a hip replacement is actually pretty darn good. It’s usually for a long term condition anyway. Very, very few people go abroad for treatment and often that is cosmetic surgery anyway. If treatment is better vailable abroad then the government pays for that actually.
    5. That point made no sense what-so-ever. Why would this system be preferred by the young and healthy only, shouldn’t it be the old and sick? What life-saving treatment would be denied? All treatment is free, for everyone. Isn’t it poor people in the US that are denied treatments?

    Not sure why a concert ticket should cost that much less in Chicago, but I can assure you that the money you wasted would only sponsor the “spa treatment” for the band you watched.

    If the whole population runs out of money then no model of healthcare would be able to function, but at least the Norwegian one would last longer since it is ultimately cheaper than the American model.

  9. With the upcoming election here in the US, I always find myself drawn to the hot button topics such as Medicare, “Obamacare” and the likes. I found the post by John J on July 29, 2011 at 7:37 pm to be extremely enlightening, and I am left dumbfounded by the push back that so many Americans (I’m sure many of whom are Republicans) have in adopting a Universal Healthcare System.

    I was at the local playground with my children just the other day, and my children had brought toys with them to the playground. There were other children there and one of them asked to play with one of the toys. Did I tell the child to go get their own toys because what’s mine is mine and what’s yours is yours? NO!!! Most parents encourage their children to share with other kids, but when we’re older we are suppose to now turn our backs on each other? Not exactly sending the right message now is it?

    That’s what I liken the attitudes of the opponents of Universal Healthcare in the US to. Look, our healthcare system is broken, and instead of trying to re-invent the wheel, we need to research and adopt the healthcare systems of countries such as Norway, Finland, France, etc. Sure, their models may have some flaws, but which one doesn’t? Waiting periods for particular procedures to be performed are not only present in “other” countries, we have those same wait times right here in the good ole’ US of A. The quality of healthcare isn’t the same? How many of our doctors are hit with malpractice suits each year? Approximately 1 in 14. How many of the drugs that the FDA deemed as safe and helpful have killed people or worsened their condition? Rezulin (troglitazone) and Vioxx (rofecoxib) just to name two. Again, I’m sure similar stories are told in other countries because you can’t remove the human element from them, and humans are fallible.

    5 weeks of paid vacation each year? I would have to work over 20 years at the same job before I would qualify for 5 weeks of vacation. One year of maternity leave—-paid? When my wife had our two children, she had to use up all of her vacation time (about two weeks) and FMLA for the duration of her maternity leave. While FMLA protects your job while you are off work, that’s about all it is good for. It is unpaid, job-protected leave. Not every employer is covered by it, and you have to meet certain eligibility requirements. Minimum of 12 months at your employer. You must have worked at least 1250 hours in the 12 months prior to taking FMLA. You must work for an employer who has at least 50 employees within 75 miles of your worksite. Oh, and I had to keep paying her insurance premiums while she was out, too. With a Universal Healthcare system, that would be a non-issue.

    The truth of the matter is, what most other countries have in place doesn’t just stop at a Universal Healthcare system– it extends out to the family dynamic, the education system, and the individual citizens. I could go on and on, but I’ll leave you with this:

    Norwegians, Finns, the French, etc., are more united as a people than the United State of America…..and I think that is sad.

  10. I didn’t know there was an average “weight” for hip replacements! How much does the article state that they weigh, now… ? 4 months? And, how much does a month weigh? Probably around 30 days.

  11. Just a couple of points:

    Waiting times in Norway are generally shorter than in the US. As is the case for most developed nations, except Canada. For example, for a hip replacement, you go to http://www.frittsykehusvalg.no/start/ and just pick the hospital with the sortest witing list. And for a hip replacement, that is less than 4 weeks.

    Hip replacements tend not to be used in serious comparisons of waiting times anyway, because hip replacements wear out at very predictable rates. So an organized health care system will know when it starts to become neccessary, and book you in up to years in advance. A chaotic one will be surprised every time someone needs a new hip.

    By far greatest reasons for Norwegians to get medical care abroad is plastic surgery, liposuction etc, which are not covered by the health care system. The second reson is getting treatments wich are paid for by the Norwegian system, but not performed in Norway.

    The Tanner report is not an acceptable source, it is an argument and generally not factual. It is not research.

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  13. Don’t get too excited about the Norwegian health care The older you get the longer the waiting list you’ll get put on. At least in the states if I need cataract surgery and I am 90 I’ll get it — maybe in just a week. My Uncle waited five years for it in Norway. Think all your shots are free? No. Want to go to Thailand and need special shots? Nearly $200 a person…not covered. Don’t even begin to think your dental is covered. Also, your local hospital, in most cases, can’t handle everything you need. You’ll probably have to leave your home and go hundreds of miles away by plan to get treatment. My girlfriend has two disabled kids and no one in northern Norway can help them. They have to go to Oslo. It may as well be Rome from where they live. Another friend needed a quadruple bypass. Was told that because of his age he’d have to go on a waiting list. He would have died if he hadn’t gone to Germany and had it done. Do you mind sleeping in the hallway in a hospital or staying in a ward with many folks after having a baby? Or waiting for hours in a doctor’s office just to see the doctor? It’s hardly perfect.

  14. To Telcontir,

    I don’t think I am missing a point because illness is a very personal experience. When you or someone in your family is sick you don’t seek fairness – you seek “best” treatment that you can get.

    The problem in Norway is that you don’t have options. The “state system” overrules over the individual rights to achieve somewhat collectively agreed definition of fairness.

    But what is fair? If the argument is fairness you include ideals to a pragmatic matter – that is health, and my health.

    In my earlier days, I would have accepted these ideals but when life tests you with real diseases and with real health challenges, trust me, you will not worry about social definitions.

    What is “unnecessary” becomes “unnecessary” if it cannot detect anything, but if your doctor is suspecting a rare case of say 1% type of cancer and orders several tests, trust me the piece of my mind of knowing you are cancer free or knowing that it can be detected early is worth the extra cost that insurance companies pass on to people.

    Where as in Norway, if you are reading the news you will hear stories of elderly men begging their ONLY family doctors to test them for years, women losing their lives due to breast cancer spreading due to tests not conducted on time.

    I am not a social planner and at this stage in my life clearly see that health is a personal issue. Just like any government should not tell me how many children I should or should not have, or what I should eat or not eat, no government should be able to overwrite my freedom to choose a doctor of my choice.

    In Norway this choice simply is taken away from you. I have been in hospitals in Norway and USA. I have been in clinics in Norway and USA. I have seen both sides and while I realize openly both systems shortcomings – I am not willing to return to Norway mainly because the health care system is not anywhere close to what I am accustomed in US.

    It is yes a good system (in Norway) compared to having nothing but if you can afford (and you really don’t have to be rich and there are amazing programs in the US as well that cost you much less than the national insurance contributions) the US healthcare OPTIONS is incredibly advanced and remains the best in the world.

    On a final note – when you go to your doctor in Norway, can you even see where they graduated from? if they had any warnings? if they had any good or bad reviews? I can simply do this in the USA by googling the net and checking sites that review doctors.

    In the US one can breathe knowing that you will get the best care – even if that means you may have to pay for it or get into debt… But can you really put a price on health? Can you put a price on human life? Do you want your doctor to treat you and test you with all available methods or do you want your doctor to think if the cost is justified first? I want the best treatment rather than the doctor worrying about saving money when it comes to my health. Let me worry about saving money but let my doctor worry about being the best doctor they can be.

    The healthcare in Norway, as much as you want to be proud of it, is unfortunately not adequate especially on complex issues. It needs a serious reform. Healthy people are not aware if it until disease hits their families and nothing and nothing compares the freedom to seek the best therapies rather than worrying about whether your family doctor will refer you to a specialist and how long you have to wait for a specialist and then how long it will take for your treatment.

    Last month a friend of mine’s wife went to a routine check-up and was diagnosed with breast cancer. From diagnosis to treatment = 1 week! In Norway, she would be probably not diagnosed, and be dead.

    In summary – it is not FAIR that some Norwegians have to die waiting but it may be FAIR that all Norwegians get the equal amount of rationed health care. It is not FAIR that some American’s who cannot afford INSURANCE will not get the same level of treatment of those who can but at least they still have the option to use the Emergency Room.

    By the way, I am not a nationalist and believed with all my heart Norway was an extremely well managed country. I wanted to live in Norway and now while I could technically move to Norway anyday, including my Norwegian wife after experiencing the freedom in USA, is realizing that life in Norway is very socialistic, suppressed and individual rights are usually not as well protected, respected as they are in the US. Just challenge your doctors in Norway next time and see what happens!

  15. I am an Oz ex-pat who lives in Norway and has experience with the healthcare system. I have had serious illness treated there and due misdiagnosis, failed treatments and general abject ignorance I chose to seek treatment in Oz. The standards were night and day.

    From my perspective I would prefer choice, service, malpractice recourse, quality and technical competence over self-regulated general provision of mandatory healthcare. And for those deniers in Norway your health care is far from free, you pay for it…

    I live here, I earn 120KUSD a year, pay 50KUSD in direct tax, 25% sales tax on everything I buy, 100%+ import tax on cars, up to 500% import tax on food items, Fuel tax, road tax, road tolls, tv licences, tax tax tax… at the very least 75% of my income goes in tax of one form or another.

    I would far and away prefer to pay 28% income tax + 10% GST and then choose where the remainder of my hard earned income is spent than bolster the coffers of an ineffective socialistic bureaucracy that answers to no-one.

    The best way to ensure quality and service is through private healthcare, the best way to ensure coverage is through socialism. Blend the two and we will see a better system for all emerge.

    The role of the government being a regulator – to regulate treatment regimes and standardize healthcare insurance packages (low, medium and high coverage). To place a tax on income to allow minimum coverage for all (3-5%). To allow for higher levels of coverage for higher premiums paid. To enforce patient rights – any patient, any Dr, any hospital, any time.

  16. The tax burden is closer to 30%. it depends how much you earn. but around 30% is the most common amount. if you are really rich you can get up to 50%.

  17. This site is a refreshing take on the healthcare issue. Being in the US I am trying to get an unbiased perspective about the healthcare issue and I appreciate the honest comments here as they are rare. I have read every comment here and I am coming to the conclusion that a centralized system like Norway’s has some good aspects and from some of the opinions here bad things too. I believe every person should have access to affordable health care and it appears the way to do that is probably somewhere in the middle between a totally socialized system like Norway and a private system. Costs must be affordable, and with a private system that is driven by keeping shareholder profits up quarter to quarter I don’t see that keeping costs down will ever occur.

  18. I wrote you my story, my bad experience with Norwegian health care ,how unfair they treat me, I am a Norwegian citizen, But i see you do not publish my comment when is a true story.

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