JANUARY

NORWAY
Primary, preventive, and nursing care are organized at the local level by municipalities. The municipality, often
in cooperation with the county, decides on public health initiatives or campaigns to promote a healthy lifestyle
and reduce social health disparities. Preventive services for mental health are directed toward children and
adolescents through the school system. Psychological care for children under the age of 18 is fully covered.
Primary care for mental health is provided by general practitioners (GPs) and municipal psychologists. Longterm
care, including palliative end-of-life care, is provided on the basis of need, either at home or in nursing
homes. There are few designated hospice facilities. The substantial government funding for municipalities is
generally not earmarked, and budgets are set locally, but provision of some services is statutory, particularly
those related to pediatric and long-term care.
Cost-sharing: GP and specialist visits, including outpatient hospital care and same-day surgery, require
copayments (NOK141 [USD15] and NOK320 [USD34] per visit in 2015, respectively), as do physiotherapy visits
(in varying amounts), covered prescription drugs (up to NOK520 [USD55] per prescription), and radiology and
laboratory tests (NOK227 [USD24] and NOK50 [USD5]). Public providers cannot charge patients more than
these amounts, except for bandages and other supplies. Consultations for antenatal and postnatal follow-up,
for prevention and treatment of transmittable diseases for particularly vulnerable individuals, and treatment of
sexually transmitted diseases are also exempt from copayments. Hospital admissions and inpatient treatment
are free. Out-of-pocket payments finance about 14 percent of total expenditure.
Home-based and institutional care for older or disabled people require high cost-sharing (up to 85% of personal
income), but are means-tested.
Safety net: The major safety net mechanisms are annual caps for out-of-pocket expenditure set by Parliament,
above which fees are waived. For 2015, the cost-sharing ceiling for most services is NOK2,105 (USD223). A
second ceiling is set at NOK2,675 (USD283) for services such as physiotherapy and certain dental services.
Long-term care and prescription drugs outside the “blue list” do not apply toward these ceilings.
Children under the age of 16 receive free treatment and access to essential drugs on the blue list. Pregnant
women receive free medical examinations during and after pregnancy. Residents eligible for minimum
retirement pension or disability pensions, which amount to about NOK162,000 (USD17,134) per year, receive
free essential drugs and nursing care. Individuals with specified communicable diseases, including HIV/AIDS,
and patients with work-related injuries receive free medical treatment and medication. Taxpayers with high
expenses (above NOK5,880, or USD622) as a result of permanent illness receive a tax deduction. “Basic
benefits” (NOK653–NOK2,264, or USD69–USD239 per month) may be provided, upon application, to patients
who regularly incur additional expenses due to permanent illness, injury, or disability.
How is the delivery system organized and financed?
Primary care: Municipalities provide primary care in accordance with current legislation, government directives,
and quality requirements set by the Directorate for Health.
The “regular GP scheme,” whereby people register with one general practitioner (GP), covers 99.4 percent
of the population. There were an average of 1,132 patients per GP in 2014. Patients may change their GP twice
a year. GPs function as gatekeepers, as referral to specialist treatment by a GP is required for coverage.
There are 2.4 specialists in hospitals or ambulatory care for every practicing primary care physician (Den norske
legeforening, 2015). Financial incentives encourage physicians to certify as a specialized GP and to see many
patients per day.
Municipalities contract with individual GPs, who receive a combination of capitation from the municipalities
(35% of income), fee-for-service from the Norwegian Health Economics Administration (Helfo) (35%), and
out-of-pocket payments from patients (30%). GP financing is determined nationally by negotiation between
the Ministry of Health and the Norwegian Medical Association. In the fee-for-service scheme, there are fees
provided for taking part in coordination of care and individual planning, but they are relatively low. There
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The Commonwealth Fund