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.”


  1. From Geir Vollsaeter via email:

    “The reference is from 2000 stats and the result of a short term fix in the past to some hospitals and national capacity problems but that turned permanent for good reasons. The option for treatment abroad is for people with psoriasis, skin problems, severe asthma and lung disease etc which is mostly related to Norway’s climate where temperature, humidity and lack of sun is a challenge for those patients during most of the year. So it is entirely useless as an argument for a failure of a national healthcare system. Its a calculated an human response for patients in need of help where natural conditions in Norway, beyond human control, leads to a economically efficient and rational response with patients in mind.”

  2. but the thing is, it isn’t free, you’ll be paying for your hip replacement through your taxes. Heck, you’ll be helping to pay for someone else’s hip replacement too!

  3. Bill: I would rather pay a fixed tax rate towards my hip replacement AND any other medical problem I may have than pay whatever my insurance company needs me to pay to keep their shareholders happy. If I have to count on the insurance company to pay for my knee surgery, then it is very easy for them to take advantage of their position and find ways to cut costs (deductibles, no accepting already diagnosed medical conditions) in order to continue making a profit. Yes, it’s a free market, and I could change my insurance company to one with competitive rates; but there are so few insurance companies to choose from, and no company wants to lower their rates to the point where they end up having to drop out of the market once it reaches saturation point. No growth, and shareholders stop investing in you. So you will always end up having to pay higher and higher costs. It never ends. Suddenly, if the company you work for decides it can’t make enough of a profit unless it ships your industry overseas, soon you can’t afford your insurance. It’s in your interest to pay into a government health plan that provides a COMPETITIVE level of care; otherwise, the insurance industry will have no reason to stop raising costs.

  4. Bill
    Norwegians pay 3 % flat on their income to national health care coverage. Benchmark that against middle Americas health care costs. The overwhelming majority gladly pays for someones else’s hip replacement to get the individual back in the workforce to ensure more people are paying into the collective good. Its cheap, fair and works well for 4.7 million Norwegians whom don’t complain much about the system.

  5. I as an American have a lot of respect for the Norway people and their health care system. It sounds to me it is designed more for the overall good of the Norway people and Norway, and not with the main focus on helping insurance companies make lots of money along with health providers and ect. I’m sure it has faults but those faults when compared to the good would be as many of us here in America would say—-“whoopedee-do”

    G. Long

  6. I am from Norway and except for studying in America the last two years I have lived in Norway my entire life. Yes we do pay a lot of taxes, but there is well worth it knowing that no one needs to die when not necessary. I have ones helped a friend to an emergency room here in America and the information about her insurance/insurance company was much more important than her… I also had a Norwegian friend become very ill and needed surgery while living here, and the Norwegian government did pay for her surgery which was lifesaving for her at that time. I would say it is worth paying extra tax and rather have a healthy population!

  7. I agree that the Norwegian centralized health care system is best. One should not have to worry about having health coverage, enough $ for deductibles or medication. Medication can be very expensive, especially for ones on limited incomes such as senior citizens.

  8. I live in the USA and was placed on a SIX month waiting period for my hip replacement surgery. Okay, I could have gone to a BAD surgeon and waited only a month, but I was willing to wait six months for the best surgeon who was experienced in the best approach for this surgery. I have health insurance but still had to pay thousands of dollars afterwards 1) to the hospital 2) to the home health company 3) to the surgeon 4) to the anesthesiologist. Give us single payer so we can stop subsidizing the rich who can afford to pay out of pocket but don’t because they generally have access to the best group health insurance plans

  9. @Bill: You already ARE paying for someone else’s hip replacement. You are subsidizing everyone who has on a group health insurance plan and your taxes are paying for everyone who cannot afford any health insurance. And who do you think pays for all the people that the health insurance companies refuse to cover? That’s right, the federal government sends money to hospitals to pay for treatments for the uninsured. If we Americans stop being so selfish and started thinking about helping one another, we could reduce costs for everyone.

  10. “The Norwegian tax burden is 45% of GDP.”

    Norwegian healthcare is actually 40% ‘cheaper’ than comparable US healthcare, and mistakes and complications are fewer. It also isn’t really fair to give people the impression that the government takes half your money while giving little or nothing back as in the US. The 45% ‘tax burden’ is the ‘total tax pressure’, and if you include all the relevant posts you would have to pay out of pocket in the US to enjoy the same security and standard of living, you would be looking at a similar figure.

    “These GPs then act as gatekeepers for specialist services.”

    I have never been denied the services of a specialist. Nor do I know anyone who has. The GP merely determines if the condition warrants seeing a specialist. It has to do with cost effectiveness. Anyone is free to see a specialist at any time if they pay for it – and even then it’s cheaper than in the US.

    “There are significant waiting times for many procedures.”

    The thing about treating so many people is that priorities have to be made. Things like hip replacements and tonsillectomies can usually wait. The waiting list for a tonsillectomy is also 3-4 months, however I had an acute bout of tonsillitis and was operated that same day by a surgical tonsil specialist.

  11. I was just figuring the other day that, as the primary earner in my household and source of employer based health insurance…I pay about 25% of my income SOLELY for health care…insurance premiums, copays, deductibles for medical, dental and eye care.
    about 20 more out of my check for taxes…and I earn just over the 2X poverty level for my household size (thus do not qualify for help).
    I also work at a pharmacy and see the ridiculous amount of money for high end drugs (paid by ALL plans, not just gov’t or private)…when no one has even tried the cheaper alternatives….so it is not a matter of just swapping out public for private care, there is a whole overhaul that is needed.
    The basics should be covered. The documented illnesses above and beyond that should be covered. We should accept a small amount of bureaucracy in insisting that cheaper alternatives be tried first. Then we would be one step towards a much saner solution….
    I came here to see how one of the economies doing best during these hard times handles their health care. I was not surprised at the answer….

  12. To Bill, who commented about paying for someone else’s hip replacement: Sir, do you not realize you already pay for someone else’s hip replacement, oxygen treatments (because he/she has emphysema from years of insisting upon their “right” to smoke); or the native american woman who would rather run her children through ER (because that is covered on the reservation for free) than take them to the local town clinic, which would be out-of-pocket; or the man on a CPAP machine and diabetes medicines because of his perceived right to over eat and make poor choices in his dietary habits for years. All these things are already being covered by you, in part, through the ever-increasing health insurances premiums offered to you (at gun point) by your employers. No matter how you slice, most everyone helps to fund most everyone else’s health care.
    Remember, the original plan was a “government For the People, By the People.” We all benefit with a national health care system in place – exercising as an extension of the government – for the good of the people. A healthy citizenry assists is creating a a healthy economy and a healthy world presence.

  13. I am a Norwegian, and I work as a computer and copier technician – making an average industrial workers wage (about 70 000 us dollars). That’s not much – at least since my wife does not work.
    That’s about 5833 us dollars a month before tax. After tax I’m left with about 3650 us dollars.

    I have 3 children and a wife that’s home with the children.
    I get 200 dollars for every child a month from the state. My wife get about 1000 dollars for staying home with the children (but will be reduced if I have the children in a kindergarten, because the government subsidizes kindergartens in Norway.
    So I (we) get 1600 dollars back from the government.
    I have then 5250 dollars a month.. they take some and give some back 🙂

    Anyway.. my children gets free dental care until they are 18 years old. Then they have to pay 25% of the costs until they are 20 and 50% until they are 25. They are now expected to have a job so they can pay the full price – OR be a student (at a free) university. Many universities have free dental included or have reduced prices.

    They get 100% free medical care until they are 18 years old. When they turn 18 they have to pay about 15 dollars for every visit to the doctor or hospital. I make 34 dollars an hour. I work 37,5 hours a week.. more and less.
    I get a 5 week holiday with pay every year.
    A pregnant woman gets at least 1 year maternity leave with full pay after the child is born and a few month before birth. She also gets 100% free medical care in this period.
    If you are ill a lot, or have a permanent decease – there is a limit on how much you will be charged, including the 15 dollar fees. I think it’s about 3-400 dollars. After that everything is free. Medicine included of course.
    The 15 dollar is for every doctors visit, and includes the meds. It does not matter if you get 10 pills, 500 pills or you need heart surgery. It is 15 dollars anyway.
    It you are retired, on welfare and stuff like that – you don’t pay at all.
    The government will also refund your traveling expenses too – so the 15 dollars is usually something you get back – unless you are next door neighbor with the hospital.

    We get subsidized price for the kindergarten and for SFO (you can deliver the school children earlier at school and pick them up later – and the school will the the “babysitter” and help them with homework or let them play or both)
    My daughter was born with a heart defect (hole in the heart) that needed surgery. There is basically no waiting time for this kind of surgery. Buy we had to travel 250km to another hospital that have specialized themselves in heart surgery on small children. The trip is free. They fixed the heart via a blood vessel in the thigh. Now I can not even see a scar.
    A few years later they discovered she had diabetes. We can choose to use shots/pens or a pump. Everything is free. Also when she gets an adult.
    We also get another 150 dollars a month because of the potential inconvenience the disease could be to us.

    The other children have also been to the hospital a few times. No waiting time.

    If you are older and need a new hip joint for example – you may have to wait for a while.
    It is not the cost of the surgery but there is a limit on how many doctors/surgeons the government can have on each hospital. They need to be effective and they have to include a lot of technology to reduce the number of man hours. So hospitals are now very automated :
    They can use a lot of money on systems like this – and it will still be profitable because we are a high cost country.
    If you are working for a company, and they know you have to wait 4 month for a surgery – they can opt to pay for it, so you can come back to work much faster.
    There are also some deceases or surgeries that we don’t have enough experience to fix, or foreign hospitals can do better. That is special instances. Then the government buys these services from another hospital in Germany, the UK or somewhere else.
    There are talks now about sending more patients abroad to reduce the load on the hospitals in Norway for a while. There are talks about using some international hospitals in Thailand: which would be cheaper for Norway, because people get back to work faster and can start to make money again – and pay taxes 🙂

    They are also talking about offering free dental care for everybody. It will cost, but I think it is worth it. It is cheaper to fix the teeth early, before the patient get serious problems. Just like medical care, some people smoke, eat fatty food, don’t exercise and don’t brush their teeth. But the cost is divided among so many people that it is doable.

    As you can see from my tax level and what I get back – I really get more back then I pay. If you are really rich, you pay more – but you have more money to begin with. With a healthy educated population there are less risk of being robbed or mugged too.
    So in the end I think everybody wins with this kind of health care.

    But with a system like this, it is important that the government use the money wisely. People have to take a responsibility to stay healthy and exercise. There are always some people that will take advantage of this system.

  14. I have enjoyed the discourse, above, especially the details provided from our Norwegian allies.

    I agree that Norway has since about 1970 enjoyed a very high standard of living. It is a standard of living coveted by the citizens of many nations.

    I feel that it is important, however, to state several facts to place the details in proper perspective. Since the 1970’s Norway has established itself as one of the World’s leading oil exporters. Norway receives more oil export-generated tax relief per capita than perhaps any nation on earth. This tremendous source of federal government funding has permitted Norway to provide many social programs which are simply not possible for other countries. Certainly, the U.S. does not have the capability to match Norway’s oil exports per capita. Moreover, Norway has a total population of only 5 million people. The U.S. has a population of 307 million people. Norway can certainly afford to provide strong government-assisted care for its people for the short term because of the per-capita oil export revenue currently provided. It is noteworthy that one of Norway’s current concerns is how they can provide for the future when the oil revenues subside.

    Again, I believe that it is foolishness to make generalizations regarding the economic situation in the U.S. (or any other country for that matter) to Norway in regard to standard of living or governmental programs. Norway is a fine country blessed by an abundance of natural resources per capita, but is very small in comparison to many other countries in the world in population, GNP, and economic complexity. What works for them is not likely going to work for larger nations with vastly more complex economies.

  15. I just have to comment to gungaden above here about a few points.
    In Norway, we do not spend all our oil money to keep our “social programs” running. We have a whooping 3000 billion kroner (600 billion USD) fund, where we invest the money to gain revenue and keep the norwegian market stable, as well as saving it for future generations.
    And your argument for having 307 million people vs 5 million people can be used just as well against you, as you would have taxes from 307 million people as we have from 5.

    Norway rules, and I truly LOVE taxes, would gladly pay more of them!

  16. In the US, all states have free Kindergarten. FYI. We have for more than 30 years.

    Median household disposable income in Norway and the US is virtually identical, adjusted for PPP. If you adjust our non-European-descent numbers to match yours, US median disposable income becomes higher, even accounting for health care expenses. And that’s without crazy amounts of oil money going into the public coffers.

    Most people have dental insurance already–many more than those who should, really, since it’s just not worth it financially for many.

    Most of our high medical costs come from “unnecessary testing,” but it’s that “unnecessary testing” that gives us the highest cancer and heart attack survival rates in the world. It’s really expensive, per person saved, but most Americans feel it’s worth it if they have a chance of not dying. Acute care in Norway is pretty awesome, and Norway has managed to instill a better sense of responsibility in its citizens when it comes to diabetes and asthma management (these ARE diagnosed in good numbers in the US, and they DO have access to medication and doctors, but lower SES groups refuse to manage the diseases properly). But the government control of cost-effective medicine means that, yes, more people really do die of preventable things.

    Americans also choose to have more surgeries than Norwegians for the same conditions. We are on more medicines, as well.

    Please note that the poor in the US do have a number of subsidies, including a full food subsidy, a pension system, disability benefits similar to that of Norway, free medical care, and the like. The debate is about the people who have the disposable income for some health insurance but choose not to buy it–whether they should be forced to buy insurance or whether the government should put everyone on the same plan. Right now, the government pays so little for its medical plans that the insured and out-of-pocket subsidize the government system by paying more.

    Poverty rates are set at levels that are also a bit ridiculous in the US because of extreme differences in the cost of living in different areas. Three-bedroom, two-bath houses can be had in mixed blue-and white-collar neighborhoods in some areas for well under $100,000. In a lower wealth area, still without high crime, houses can go for $60-80,000. In comparison, houses in some areas start at $500,000 and more for structures that aren’t as nice as the $60-80k houses. Rent where I came from started at about $450/month in areas that were low crime. Here, they start at $1300 a month. So a family has to make more than $10k more here to even start at the same place!

    Yet there is a single government poverty rate for most of the US. In many areas, the cost of living is low enough that people below the “poverty” line are doing very well. The median household below the poverty line has a 40% chance of living in a house that they own, and living spaces are notably larger than Western Europe’s averages. The structural condition of the median dwelling below the poverty line is good, and the number of appliances is comparable to the average European house. Food prices, too, vary drastically from area to area and can easily be 150-200% higher in some areas. So in some areas, people at the poverty line are truly struggling–impossibly so, in some places. In most, they really aren’t.

    I’d rather have more control of my spending and be more rewarded if I work hard and achieve, thanks all the same.

  17. Well yes, Norway exports a lot of oil and the U.S. imports a lot, but that difference is not the reason that Norway can afford universal health care and the other benefits it accords its citizens. The reason is that Norway OWNS the oil company doing all the drilling–yes, I know that there is that nasty socialism–and the profits go directly into the government coffers just as our income taxes do.

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