Scandinavian standards of Norway Health System
Scandinavian standards of Norway Health System
The Kingdom of Norway is a state in Northern Europe, which occupies the Western and Northern part of the Scandinavian Peninsula and part of the Arctic Spitsbergen Archipelago. Norway is a country that can serve as a reference reasonable in all policies.
The quality and availability of medical services in Scandinavia, and in Norway in particular, are known all over the world. Scandinavian countries are often a joke called the "countries of the winning socialism", and in this joke there is a share of truth. Indeed, the basic principle of Norwegian medicine is to provide medical care for all residents of the country, regardless of their social status and purse thickness.
The Norwegian health system is constantly developing and reformed. The first state medical institutions were founded here in the XVIII century, and specialized clinics and psychiatric hospitals appeared only by the end of the XIX century. Today, 420 thousand people operate in Norwegian health care, the average salary in the industry is about 3.5 thousand euros per month. For a long time and firmly rooted local government continues to develop: regional and local governments are more and more functions of the central authorities.
Management and system structure
In the health structure of Norway, there are three main levels that correspond to three levels of power: the central, regional (19 Fühlka) and local (435 municipalities). To avoid duplication of medical services, a Swedish-Finnish system of providing inpatient care was canceled in the country, at which it was carried out by regional authorities. The country was divided into five medical and territorial districts, which are managed by Fühlka. Local authorities are responsible for the organization of medical care; At the central level, only rationing and supervision is carried out. All permanent residents of Norway are covered by state insurance. At the same time, health care in Norway is funded by the state. The government pays most of the cost of medical services – approximately 95%. When pregnancy and childbirth, assistance is free.
Central level. The central health authorities include the Ministry of Health and Social Security, the State Institute of Public Health and the State Healthcare Board. The ministry is responsible for the development of health policy, its legislative base and the main directions of development, budget preparation, planning, organization of the information network.The state coordinates the activities of the Institute of Public Health and some other scientific and preventive institutions. The State Council for Health – an independent professional organization, which, together with the Health Services, is supervised and provides compliance with the health care provisions and laws. At the national level, highly specialized assistance is provided (for example, treatment of rare diseases, organ transplantation).
Regional level. At this level, hospital and advisory assistance is provided. In polyclinic departments, consultations of specialists for patients with directions from a general practice doctor are held and specialized hospital assistance is provided in hospitals. In order for highly specialized medical care to be effective and profitable, since 1974, the country was divided into five medical and territorial districts, in each of which the district committee of health care was established. In the early 1990s The state decided to expand their responsibilities: Starting from 2000, each district is obliged to provide its long-term health plan to the Ministry of Health in accordance with the main areas of state policy in this area.
Local level. At 435 countries municipalities are entrusted with funding and organizing primary medical care and medical and social services.
Usually there are three departments in the municipality: medical care, patronage and home care, social security. In order for medical and social services to meet the needs of the population, in 1986 the municipalities were granted the right to determine the priority directions in their financing and organization.
This level includes all varieties of primary medical care to general practitioners. This includes a medical center, a house for patients and a house for older people who need care. The medical center contains 1-2 therapist, physiotherapist, nurses and midwives. In case of primary treatment, the patient advises a general practice doctor. It is monitored by patients with a period of trickling patients with physiotherapist. The medical center is monitored by children, pregnant, vaccination. If necessary, the patient is sent to the regional medical institution.
Features of medicine financing
Distinctive features of Norwegian health care – funding mainly at the expense of taxes, which are the highest in the world and make up about 50% of the incomes of the population, the predominance of the public sector and a small proportion of paid medical services. Medical help provided all permanent residents of Norway. The state pays for them and therapeutic trips to any resort.Financing is provided by central, regional and local authorities (municipalities have the right to impose local taxes in addition to national ones), as well as the state insurance system.
Local governments receive government funding in proportion to their population. Local health services receive funds from the state budget (general and targeted subsidies), the state insurance system (insurance compensation) and from the population (paid services). Although the state does not directly influence the distribution of funds, in practice the autonomy of local governments is limited by the standards and financial policies they set.
In 1997, the county's share of health care funding declined to less than 30%, while the share of government spending by the end of the 1990s. increased up to 50%. Since many patients are treated outside their own county, there is a cross payment system: the county where the patient lives reimburses the costs to the county in which this patient was treated. The state insurance system finances healthcare by about 17.9% (covers the cost of medicines and transportation of patients, pays for the services of contracted doctors in private practice). Doctors receive a salary from the municipality, as well as payment from patients, which can be up to 70% of the family doctor's income. If necessary, the family doctor refers the patient to a specialist. In this case, payment is made at the expense of the health insurance fund.
Introduced in 1980, global budget funding forced some counties and hospitals to narrow their scope due to budget constraints. Long waiting lists for hospitalization led to the adoption in 1997 of the current funding scheme, which takes into account the volume of services provided by the hospital. The main goal of the innovation is to increase the efficiency and profitability of hospitals. Although the introduction of the new funding system was voluntary, by 1999 all counties had switched to it, with the exception of one.
Voluntary insurance in Norway is poorly developed. The main source of additional financial income is paid medical services. A visit to a specialist in the outpatient department of a hospital costs at least 19 euros. In addition, in such departments, patients pay part of the cost of laboratory and x-ray studies, some medicines. Co-payments apply for treatment by general practitioners, out-of-hospital specialists and psychotherapists, certain medications, and travel costs associated with examinations and treatments. The co-payment for medical services is about 10% of healthcare costs. In the early 1980s the maximum level of expenses of citizens for paid medical services, including medicines, primary and outpatient medical care, has been introduced.Separate groups of the population and patients with some diseases are exempt from surcharge.
Medical Help Levels
Primary medical care. Municipalities are responsible for primary health care, including prevention and health promotion, diagnostic and medical interventions, rehabilitation and long-term care. The municipal council approves the Health Development Plan in accordance with the needs of the population living on its territory. The volume of health financing. Local authorities themselves define themselves, and the list of medical services they are obliged to have, established by the Law on Health and Powers of Local Authorities. Each Fulka has an overseas officer for these services. There are also seven specialized medical and administrative institutions subordinate to the Ministry of Health, which provide expert opinions. State prophylactic programs, such as early detection of breast cancer and cervical cancer, are implemented under the guidance of relevant specialized institutions. The leading role in primary medical care is played by general practitioners, mostly combined in groups of 2-6 people with assistants, the number of which depends on the funds allocated by the municipality. As a rule, general practitioners specialize in the field of general or family medicine. Most general practitioners are municipal employees or private doctors working under a contract with municipalities.
In the choice of general practitioner, patients are not limited to anything. The patient has the right twice a year to choose a doctor. It is possible to be treated in physiotherapists and manual therapists without sending a doctor, but such treatment will cost more since it is not covered by state insurance. Specialist doctors receive a fee for services from state insurance only if the patient sent a general practice to them. Recently, the requirements for general practitioners have increased. First, the number of hospital beds has decreased and the duration of staying in the hospital. Based on this, the improvement of work of general practitioners has become one of the priorities. To this end, in 1997, the official registration of patients adopted by the patient entered the entire country, and its income began to depend not only on the number of serviced population, but also from medical services rendered.
Specialized medical care. Since 1969, for planning, financing and organizing specialized medical care (general hospital, psychiatric clinics, laboratory and other specialized medical services, dental clinics for adults) respond to Fühlka.In the organization and management of stationary help, Fühlka is quite independent. In each of the five medical and territorial districts of Norway there is a circumferential hospital providing highly specialized medical care. All district hospitals serve as training bases; Four of them belong to Fühlka, the fifth – national. Several hospitals belong to voluntary organizations, but the status of these hospitals is practically no different from the status of state. Private practice segment is insignificant. Norwegian laws strictly limit the activities of private hospitals in which most laboratory and radiological research is carried out. There are also about 30 private laboratories and other institutions involved in diagnostic research. Private institutions are funded by state insurance.
Due to the strengthening of the role of outpatient care and the development of day hospitals, the average duration of hospitalization is reduced. The average employment bed in Norway is higher than in many other European countries, while the level of using inpatient treatment is relatively low. In the last decade, the most urgent task in the health sector was queues for inpatient treatment. This task was tried to solve in different ways. Now the situation has improved somewhat.
Part of Norway, especially the north and islands located in the North Sea, highlighted in the fifth region, have a very low population density and relatively weak transport infrastructure. Special attention is paid to the development of telemedicine in this region, that is, remote methods for counseling and diagnosing using the most modern telecommunications technologies, in particular video conferencing. People need to be transported to the place of medical care on helicopters or aircraft.
Medico-social service. Social services in Norway are provided in accordance with the decentralized model. The state is responsible for the formation of policies, personnel training and the formation of a legislative base, and municipalities for the provision of services. The latter mainly receive funds for services through state subsidies. For some areas that pay special attention to, the municipalities receive "targeted" grants. This, for example, services for the elderly or measures aimed at ensuring that people with mental disorders can live in their own homes with adaptation of services, as well as participate in the work and organization of leisure.
Examples of social services:
– practical assistance to people who need it due to disability, elderly, etc.;
– Emergency assistance to people and families who have comprehensive care needs;
– support for people who need help in organizing leisure activities and establishing contacts with other people;
– Shelter services.
Alcohol and drug treatment services are an integral part of health services.
In addition, municipalities are responsible for preventing social problems. Mostly they provide all social services themselves, however, in some cases, municipalities buy services from private organizations, in particular from many humanitarian and religious organizations regarding the organization of the provision of services for the elderly, disabled, people dependent on alcohol and drugs. In addition, over the past few years, many commercial organizations have begun to offer services such as care for the elderly and disabled, as well as full-time care or day care for people who have complex health care needs.
Timeline of reforms
Reforms in the 1990s were mainly aimed at improving the efficiency and availability of medical care and reducing the queues for hospitalization. In 1993, a list of basic prices for medicines was established (and expanded in 1998). In the late 1990s the financing scheme of hospitals and the conditions for remuneration of private practitioners have changed. In 1998-1999 a number of laws have been adopted, some of them deserve special attention. First, the district health committees were given the responsibility of planning the development of health care in their district. Secondly, under the Law on Specialized Health Care, psychiatric services were merged with other medical services, and the organization of long-term care for patients with mental disorders was entrusted to the municipalities. Thirdly, such patients' rights were legalized, such as the right to choose a hospital, to provide specialist advice no later than 30 working days after receiving a referral from a general practitioner, to consult another doctor. Patients who require long-term complex treatment are entitled to an individual health care plan that allows them to coordinate the actions of different services. In the spring of 2000, a system for registering patients in primary care facilities was introduced. Among other things, this system allowed citizens to change their personal doctor and, if desired, receive advice from another general practitioner. The recent reform entailed the unification of the national insurance system and the national employment service – NAV. This reform involves the creation of municipal departments responsible for the provision of public services related to national insurance and employment. In the future, it is planned to remove restrictions from the pharmacy network in order to increase competition in the retail trade in medicines; to give hospitals more autonomy in matters of organization and management.
Problems and prospects
To the negative time of the Norwegian health system, it is too large for the hospital capacity, which does not contribute to the best conditions for patients in them. In general, the health care of Norway has achieved great success since the beginning of its reform, but in the future he has to solve new tasks. For example, combine health decentralization with state regulation, guaranteeing the public accessibility. To solve this problem, the following reform directions are chosen: reduction of queues to hospitalization, especially for some categories of patients; strengthening planning at the level of medical and territorial districts; Supervision of the official registration of patients in the primary health care system. In addition, in the future it is planned to introduce new methods of managing hospitals and new forms of ownership of them, to provide medical personnel all areas of the country, clearly divide the functions of the central authorities and Fühlka in the financing of hospitals.