Date post: | 06-Apr-2018 |
Category: |
Documents |
Upload: | saritha-vislavath |
View: | 216 times |
Download: | 0 times |
of 48
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
1/48
Health Research 1
The Norwegian Health care
System
By
Maggi Brigham
SINTEF Health Research
Dep. of Health Services Research
Trondheim
Norway
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
2/48
Health Research 2
Facts about Norway
4.6 million inhabitants
Population density 14.2 (population per km2)
Urban population 77 %
Population > 65 years old 15 %
Fertility rate 1.8 births per woman
Deaths per 1000 inhabitants/year 9.0
Infant deaths per 1000 live births 3.2
Life expectancy 82.3 years
GDP per capita 59 000 USD (PPP 39000) Gini coefficient of income 0.243
3rd largest oil exporter in the world
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
3/48
Health Research 3
Total health care expenditure in Norway
Primary and secondary (2004)
26 billion USD
Primary 18.5 billion; 4000 USD per person
secondary 7.5 billion USD; 1700 per person 5700 USD per person, PPP 3907 USD per person
9.9 % of GDP Johnsen p. 32
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
4/48
Health Research 4
Norway health care administration
Social security The Ministry ofSocial Affairs
The National
Insurance Administration
The Directorate for
Health and Social Affairs
Health Enterprises
Hospitals
The Norwegian
Board of Health
The Norwegian Institute
of Public Health
The Norwegian
Radiation ProtectionAuthority
The Norwegian
Medicines Agency
The Ministry of Health Ownership
The municipalities
The Municipal Health ServiceCare - care and rehabilitationSocial Services
County municipalities
The general public
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
5/48
Health Research 5
Ministry of Health and Care Services role
and responsibility
Legislation (preparation) and overall planning regarding primary health care
specialized health care/hospitals
public health
mental health medical rehabilitation
dental services
pharmacies and pharmaceuticals
emergency planning and coordination
policies on molecular biology and biotechnology food safety
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
6/48
Health Research 6
The Directorate of Health and Social
affairs role
Is a professional body (not political) that the Ministry of
Health and Care has delegated authority and
responsibility for
the surveillance of health and social services
Administration of health and social legislation
Implementation of policy
Both primary and secondary health care
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
7/48
Health Research 7
The Norwegian Medicines Agency
Is the national, regulatory authority for new and existing
medicines and the supply chain.
Is responsible for supervising the production, trials and
marketing of medicines.
It approves medicines and monitors their use, and
ensures cost-efficient, effective and well-documented use
of medicines.
Prevention of over use.
NOMA also regulate prices and trade conditions for
pharmacies
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
8/48
Health Research 8
Organisation and financing of hospital
services (secondary care) in Norway
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
9/48
Health Research 9
Organisation and financing of hospital
services (secondary care) in Norway
In Norway, the financing and provision of hospital services
is mainly the responsibility of the national government,
financed by income and wealth taxation.
But one can also find a growing private contribution in terms of
both financing and provision
The political responsibility and control of hospital services
lies with the Ministry of Health and Care Services, i .e.
which is responsible for the overall financing, planning and
prioritizing of health services in the country Delegated authority to the Directorate of Health and Social Affairs
for implementation and surveillance
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
10/48
Health Research 10
Organisation and financing of hospital
services in Norway, contd.
The Counties used to own, run and finance hospitals
(secondary care)
Transferred to national ownership 2002
Coordination
Budget control
Equalize access
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
11/48
Health Research 11
The Regional Health Authorities
The responsibility of providing hospital services is delegated to five
geographically based Regional Health Authorities (RHA), which are
organized as national governmentally-owned enterprises.
The RHA exercises state ownership and has the responsibility for
providing services to the population in the health region, within the
framework stated by the overall health political goals.
The responsibilities also cover specialized mental-health services and
hospital services to persons with drug-related health problems.
The production of hospital services is performed mainly by local
Health Authorities (HA) owned by the RHAs or with private, non-profit,
hospitals that have a provisional agreement with the RHA. The localHA consists of one or more hospitals. The RHA supplements its own
production with purchases from private, for-profit, providers.
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
12/48
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
13/48
Health Research 13
Private supplement
In later years, the private supplement of hospital services
has become increasingly important.
The number of private, for-profit, providers has grown.
The range and scale of activities (out-patient and day surgery) has
increased.
The public providers are the major purchasers, but there is also
privately financed purchases and a private health-insurance
market is emerging.
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
14/48
Health Research 14
The Management System of
Primary Health Care in Norway
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
15/48
Health Research 15
1) What is primary health care in Norway
rough overview
a) General Practitioners (GPs)
b) Care for elderly and disabled
c) Health Stations
90 percent of patients are trea
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
16/48
Health Research 16
1 a) General Practitioners (GPs)
TASKS:
Diagnosis
Prescribe medication 90 % of patients treated here, 10 % referred to specialist/hospital
Referral to hospital = Gatekeepers
ORGANISATION
- private, financed by municipality through agreements
- Trondheim: 150000 inhabitants (175000 with students) 125 GPs.Average: 1.400 inhabitants per GP.
- Every inhabitant has one GP, by choice or given by authorities ifyou dont choose.
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
17/48
Health Research 17
1b) Care for elderly and disabled
TASKS:
- nursing homes
- home-based services
Large and growing task.
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
18/48
Health Research 18
1c) Health Stations
FOR WHOM:
- Children and youth age 0-20.
TASKS: - mother and child care/information
- vaccination programs
- sexual education for youth/ prevent pregnancies
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
19/48
Health Research 19
The municipalities are ordered by
national authorities to provide theseprimary health services to the
inhabitants.
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
20/48
Health Research 20
Main laws and directives regarding
primary health care
The most important law regulating the provision of primary
health care is the Municipal Health Services Act of 1986
Defines responsibilities for primary health services and patient
rights
Also a Directive on Regular General Practitioners
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
21/48
Health Research 21
The Municipalitys role and responsibility
Municipalities are responsible for
planning and developing primary health care services to meet the
needs of the residents
Planning primary health services provided by other providers
Agreements with regular General Practitioners (GPs) Framework agreement between Municipalities Central Association and
Medical Doctors association
Agreements with private nursing homes
Also responsible for emergency services
Municipalities decide the amount of local public funds tobe spent on primary health care
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
22/48
Health Research 22
Municipalitys health care organization
The chief administrative officer of the municipality is
responsible for primary health services
Municipalities are self-governed by local politicians incooperation with local civil servants and free to set their
own local management models
Ombudsman and the County doctor are institutions
where patients can file complaints about health services
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
23/48
Health Research 23
2) Who is paying for Primary Health Care?
About 80-90% from local and central taxes
10-20% percent fee for services
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
24/48
Health Research 24
2: About local and central taxes
All inhabitants must pay
Controlled by local tax-authorities through employers
Progressive system, high income - high taxes
Central taxes to the national health insurance system Local taxes to municipality government
Used for primary health among other things
Same access to services whether you pay low taxes or
high taxes Basic principle: Pay according to ability, receive care
according to need
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
25/48
Health Research 25
3a) GPs financed by:
i) Grant from local authorities depending on how many
inhabitants the GP serve (40-50%)
ii) Activity based fees from central health insuranceadministration (NIS). Based on number of consultations
and diagnostic tests. (30-40%)
iii) Out of pocket fee from inhabitants (10-20%)
- Children do not pay
- Upper limit for out of pocket payment (chronic diseases)
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
26/48
Health Research 26
User charges in primary health care in Europe
General practitioner______________________________________________________________________________________________________
Austria Free (80% of the population)
Belgium 8% - 30%
Denmark Free
Finland 16,8 Euro
France 30%
Greece Free in NHS (not in private)
Ireland Free for the poor, 19 Euro for the richItaly Free
Netherlands Free (not for the rich?)
Norway 16 - 25 Euros (with roof)
Portugal 1,5 Euros
Spain Free
Great Britain Free
Sweden 8 - 17 Euro
Germany Free (?)
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
27/48
Health Research 27
3b) Care for elderly and disabled
Nursing homes financed by:
- Grant from local authorities, negotiated every year (80-
90%)
- Out of pocket payment (10-20%)
Home based health services financed by:
- Grant from local authorities, negotiated every year.
- (No fee for service)
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
28/48
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
29/48
Health Research 29
Summary Primary and Secondary
(hospital) care
Two separate management and financing systems in health care
Primary health: (Local) Municipality planning, implementation and
financing (+ NIS)
Secondary health:
(National) state responsibility and financing
Health enterprises planning and implementing
Primary health care: small out-of-pocket payment (>12 y)
Consultations, procedures, medicines
roof
Secondary health care:
Inpatient totally free for everyone
Outpatient: small out-of-pocket payment
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
30/48
Health Research 30
The Norwegian National Insurance
Scheme with Focus on Health
Insurance
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
31/48
Health Research 31
The Norwegian National Insurance
Scheme (NIS)
The NIS is a public universal insurance scheme that
assures everybody social security and health insurance,
regardless of income
Introduced in 1967
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
32/48
Health Research 32
History
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
33/48
Health Research 33
Chronology
Public accident insurance introduced in 1894
Public unemployment insurance introduced in 1906
After many failed attempts since 1884, the law on
public health insurance was adopted by theparliament in 1909.
Implemented in 1911
Public old-age pension scheme introduced in 1936
The National Insurance Scheme (NIS) established in 1967
First social security
Health insurance incorporated into the NIS in 1971
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
34/48
Health Research 34
These public health insurances wereintroduced while Norway was a
relatively poor country
(before we found oil)
A political project of welfare distribution
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
35/48
Health Research 35
Health insurance membership
1911: Compulsory membership for workers
361 000 members in 1912
Workers and their family
Universal in 1956
Workers (as before)
Self employed
Farmers
Fishermen
Tradesmen
Unemployed
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
36/48
Health Research 36
Membership in public health insurance
% of workforce % of population
1915 38 15
1950 72 31
1970 178 72
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
37/48
Health Research 37
Health Insurance Coverage
Sick pay, doctor consultations and hospital treatment Not dental health (still)
Not medicine (now partly)
Midwives and maternity light in 1912
Now more comprehensive
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
38/48
Health Research 38
Cost sharing of health insurance
1911 1956 1972
Member 60 % 49.5 33.6 %
Employer 10 % 29.7 50.4 %
Local
Municipality
10% 10.9 9.1 %
National
Government
20 % 9.9 7.9 %
Total 100 % 100 % 100 %
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
39/48
Health Research 39
Revenue collection
First: premiums paid like normal insurance premiums
1971: incorporated into NIS, Premiums replaced by tax(see below)
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
40/48
Health Research 40
Today
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
41/48
Health Research 41
Membership today
All persons who are eitherresidents orworking as
employees in Norway MUST be insured under the
National Insurance Scheme.
Also certain categories of Norwegian citizens working abroad
Others can apply for voluntary membership
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
42/48
Health Research 42
Members of NIS are entitled to
Free stay and treatment in public hospitals
Partial coverage of treatments by
GPs
Out-patient specialists
Psychologist/psychiatrist
Certain drugs
Transportation to examination/treatment
Children under 12 are exempt from cost sharing (out of
pocket payments)
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
43/48
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
44/48
Health Research 44
Health care expenditure by NIS
NIS gross budget: USD 35 700 million
7.800 USD per inhabitant
Health care expenditure by NIS USD 3 125 million
Health care expenditure almost 10 % of total NIS
spending
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
45/48
Health Research 45
Financing of the NIS
Central income tax to the
Employees: rate varies, first 3.2 %, now 7.6 % of income
Employers
Self-employed people
Controlled by local tax-authorities through employers
Same access to services no matter how much tax you pay
Allocations from National Government Budget
In the beginning large proportion, as people got richer smallerproportion of total budget
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
46/48
Health Research 46
NIS funds partly finance these aspects of
Health Care:
Regular general practitioners (GPs)
Emergency ward
Private specialists/outpatient hospital services
Pharmaceuticals from pharmacies
Johnson p. 37
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
47/48
Health Research 47
The NIS is administered by
National Insurance Administration
Subordinate to Ministry ofLabor and Social Inclusion
Tax authorities
premium collection
Municipal welfare offices
Pays claims to individuals, GPs, Outpatient services
8/3/2019 {DABE09E5 DD86 45B5 891A 5607E1B2C1E1}_The Norwegian Health Care System
48/48
H lth R h
Summary
Norwegian Health care mainly publicly managed and
financed
Two separate management and financial systems for
primary care and hospitals
Primary care: municipality
Hospitals: national government
GPs gatekeepers to hospitals
National Insurance Scheme.
Tax from Employers, employees. Municipal and national govt grant
Basic principle: pay according to ability & receive care according to
need