JANUARY

NORWAY
is also a financial incentive for medication reconciliation. Most GPs are self-employed, and 10 percent are
salaried municipal employees (Helsedirektoratet, 2014). The average salary is estimated to be NOK750,000
(USD79,325), but may be substantially higher for full-time practitioners. GP practices typically comprise two
to six physicians and employ nurses, lab technicians, and secretaries. Many municipalities have multidisciplinary
outreach teams for mental health, staffed by health care workers employed by the municipalities.
Specialist care: The four RHAs, which are state-owned corporations that report to the Ministry of Health, are
responsible for supervising specialist inpatient somatic and psychiatric care, as well as treatment for alcohol and
substance abuse. The ministry provides RHAs’ budgets, and issues an annual document instructing the RHAs
as to aims and priorities.
Outpatient specialist care is provided both by hospitals and by self-employed specialists. Hospital-based
specialists are salaried. Privately practicing specialists contracted by an RHA are paid a combination of annual
lump sums, based on the type of practice and number of patients on the list (about 35%); fee-for-service
payments (about 35%); and patients’ copayments (about 30%). The annual lump sum and the out-of-pocket fees
are set by government, and the fee-for-service payment scheme is negotiated between government and the
Norwegian Medical Association. In principle, patients have a choice of specialist, although in practice specialist
availability varies by geographic location. In the more densely populated areas, clinics with multidisciplinary
specialists have emerged during the last few years and seem to be increasing in number. Hospital-employed
specialists cannot see private patients at the hospital, but may practice privately after hours, on their own time.
Specialists with an RHA contract can charge patients only the specified out-of-pocket fee. Those who do not
receive public financing are neither regulated nor subject to the out-of-pocket expenditure caps.
Patient out-of-pocket payments: Patients pay their out-of-pocket fee directly to the provider. If they reach the
first safety net ceiling, it is automatically registered and copayments are made directly to the provider by Helfo.
For the second ceiling, patients need to submit an application with proof of payment of the out-of-pocket costs.
Once it is approved, patients receive a certificate and are not charged further copayments.
After-hours care: After-hours emergency primary care services are the responsibility of the municipalities,
whose contracts with GPs include after-hours emergency services on rotation. The municipalities provide offices,
equipment, and assistance, and pay the GPs a small fee. Other payments are provided by the national fee-forservice
system and out-of-pocket payments from patients. The organization of after-hours services varies
according to the size of the municipality. The more densely populated municipalities have walk-in centers where
nurses triage patients and answer calls, and several doctors see patients all through the day and night. In
smaller municipalities, patients call an after-hours phone number and speak with a nurse, who calls the GP if the
patient needs to be seen. As of September 2015, a common national phone number was launched for all of
these public primary care after-hours services (legevakt). In larger cities, as a supplement to the public services,
there are a few privately owned and run after-hours clinics where patients pay in full.
There is variation as to whether information from emergency visits is shared with patients’ regular GPs. There is
an emergency phone number patients can call for urgent ambulance services, but no national medical advice
line. Patient cost-sharing and provider fees are slightly higher for after-hours emergency services.
Acute-care hospital services are the responsibility of RHAs. Patients need an acute-care referral to these services
by a primary care physician or may, in particular cases (accidents, suspected heart attack, stroke, etc.) have
access directly via ambulance.
Hospitals: Public hospital trusts are state-owned, formally registered as legal entities with an executive board
(approved and partly appointed by the Ministry of Health), and governed as publicly owned corporations. A few
are privately owned, mostly by nonprofit humanitarian organizations, and mostly provide publicly funded
services as part of RHA plans for providing acute care. The for-profit hospital sector is small, providing less than
1 percent of specialist services in 2013 (Samdata, 2013). For-profit hospitals do not provide the full range of
services, and do not offer acute services. A part of their services may be publicly funded, but the proportion
varies, from almost none to 85 percent in 2013.
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