Health Systems in Transition, Norway, 2006
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Vol. 8 No. 1 2006 European on Health Systems and Policies Jan Roth Johnsen Norway Editor: Vaida Bankauskaite Health Systems in Transition Written by Jan Roth Johnsen Edited by Vaida Bankauskaite Norway 2006 The European Observatory on Health Systems and Policies is a partnership between the World Health Organization Regional Office for Europe, the Governments of Belgium, Finland, Greece, Norway, Spain and Sweden, the Veneto Region of Italy, the European Investment Bank, the Open Society Institute, the World Bank, CRP-Santé Luxembourg, the London School of Economics and Political Science, and the London School of Hygiene & Tropical Medicine. Keywords: DELIVERY OF HEALTH CARE EVALUATION STUDIES FINANCING, HEALTH HEALTH CARE REFORM HEALTH SYSTEM PLANS – organization and administration NORWAY © World Health Organization 2006, on behalf of the European Observatory on Health Systems and Policies All rights reserved. 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ISSN 1817-6127 Vol. 8 No. 1 Health systems in transition Norway Contents Preface .................................................................................................... v Acknowledgements ...................................................................................... vii List of abbreviations...................................................................................... ix List of tables and figures ............................................................................... xi Executive summary ..................................................................................... xiii 1. Introduction ................................................................................................ 1 1.1. Overview of the health system ................................................... 1 1.2. Geography and sociodemography .............................................. 1 1.3. Economic context ....................................................................... 4 1.4. Political context ......................................................................... 6 1.5. Health status ............................................................................... 8 2. Organizational structure ........................................................................... 13 2.1. Historical background .............................................................. 13 2.2. Organizational overview .......................................................... 16 2.3. Decentralization and centralization .......................................... 21 2.4. Patient empowerment ............................................................... 22 3. Financing ................................................................................................. 31 3.1. Health expenditure ................................................................... 31 3.2. Population coverage and basis for entitlement ........................ 34 3.3. Revenue collection/sources of funds ........................................ 41 3.4. Pooling of funds ....................................................................... 47 3.5. Purchasing and purchaser–provider relations .......................... 49 3.6. Payment mechanisms ............................................................... 51 4. Planning and regulation ........................................................................... 57 4.1. Regulation ................................................................................ 58 4.2. Planning and health information management ........................ 62 5. Physical and human resources ................................................................. 69 5.1. Physical resources .................................................................... 69 5.2. Human resources ...................................................................... 77 iii Health systems in transition Norway 6. Provision of services ................................................................................ 89 6.1. Public health ............................................................................. 89 6.2. Patient pathways ....................................................................... 91 6.3. Primary/ambulatory care .......................................................... 92 6.4. Specialist ambulatory care/inpatient care ................................. 94 6.5. Emergency care ........................................................................ 99 6.6. Pharmaceutical care ................................................................ 102 6.7. Rehabilitation/intermediate care ............................................ 106 6.8. Long term care ....................................................................... 108 6.9. Services for informal carers ................................................... 111 6.10. Palliative care .......................................................................... 112 6.11. Mental health care .................................................................. 114 6.12. Dental health care ................................................................... 119 6.13. Alternative medicine/complementary medicine ..................... 120 6.14. Health care for specific populations ....................................... 122 7. Principal health care reforms ................................................................. 123 7.1. Analysis of recent reforms ..................................................... 124 7.2. Future developments .............................................................. 139 8. Assessment of the health system ............................................................ 143 8.1. The stated objectives of the health system ............................. 143 8.2. The distribution of the health system’s costs and benefits across the population .............................................................. 144 8.3. Efficiency of resource allocation in health care ..................... 148 8.4. Technical efficiency in the production of health care ............. 149 8.5. Accountability of payers and providers.................................. 151 8.6. The contribution of the health system to health improvement 153 9. Conclusions ............................................................................................ 155 10. Appendices ........................................................................................... 159 10.1 References .............................................................................. 159 10.2 Useful web sites ..................................................................... 165 10.3 A selected list of laws ............................................................. 167 iv Health systems in transition Norway Preface he Health Systems in Transition profiles are country-based reports that provide a detailed description of a health system and of reform and policy Tinitiatives in progress or under development in a specific country. Each profile is produced by country experts in collaboration with the Observatory’s research directors and staff. In order to facilitate comparisons between countries, the profiles are based on a template, which is revised periodically. The template provides detailed guidelines and specific questions, definitions and examples needed to compile a profile. Health Systems in Transition profiles seek to provide relevant information to support policy-makers and analysts in the development of health systems in Europe.