JANUARY

NORWAY
What are the major strategies to ensure quality of care?
The national strategy for quality improvement (2005–15) focuses on efficacy, safety, efficiency, patient-centered
care, care coordination, and continuity and equality in access to health care (Directorate for Health, 2005).
National evidence-based guidelines are being developed for a number of diseases. For cancer, there is a
disease management program, introducing defined “packages” to be delivered to patients. To improve patient
safety, there is a five-year national program (2014–18), as well as a national reporting and learning system for
adverse events. There are 47 national clinical registries for specific diseases, as well as 15 national health
registries. There is no registry for technical devices, but a statutory duty for hospitals to report adverse events,
including those involving technical equipment.
The Directorate for Health is in charge of the national program for health care quality indicators. The program
includes results from national patient experience surveys. No information is gathered or disseminated regarding
results or quality of individual health care professionals’ performance.
The Registration Authority for Health Personnel licenses and authorizes all health care professionals and can
grant full and permanent approval to those meeting educational and professional criteria. There is no system
for reevaluation or reauthorization. The authority issues certificates of specialization to medical doctors, in
accordance with specific and transparent requirements. Only the specialization for GPs requires recertification.
The Norwegian Board of Health carries out audits of all levels of the health system, including the health
care workforce.
RHAs, hospitals, municipal providers and private practitioners are responsible for ensuring the quality of their
services. There is no requirement for accreditation or re-accreditation, although some hospitals or hospital
departments are accredited.
A five-year developmental period (2013–17) is under way for quality-based financing of RHAs, based on
performance and improvement on a set of indicators—29 indicators in 2014, increased to 33 indicators in
2015—of which patient experiences constitute about 30 percent of the reporting. Quality-based financing
constitutes only about 0.5 percent of the total of the RHAs’ budgets.
The Norwegian Institute of Public Health uses the Norwegian Prescription Database to produce annual reports
on prescribing trends, giving national health authorities a statistical base for planning and monitoring the
prescribing and use of drugs. Personal information held by the registry is anonymized.
What is being done to reduce disparities?
Eliminating socioeconomic inequalities in health is a priority of the Directorate for Health. A national strategy for
addressing inequalities in health and health care includes various ways of increasing knowledge and awareness
(Ministry of Health and Care Services 2007). There have been some initiatives for children, including vaccination
programs, kindergarten and education; initiatives for people with disabilities to be included in the workplace;
price and tax policies; initiatives for care integration; general information campaigns regarding smoking
cessation, alcohol and diets; and specific initiatives for populations at risk.
There is increasing focus on immigrants’ health and underutilization of health care. Research on pregnancy has
been informative, as there are significantly more complications for newborns and mothers among immigrants
than among Norwegians (Ahlberg and Vangen, 2005). The need for adequate information to be provided in
immigrants’ native languages has been emphasized.
Health outcomes vary geographically, not only because of differences in the prevalence of diseases but also
as a result of variations in the availability and quality of health care. Recruitment of health personnel, notably
doctors and specialized nurses, is more difficult in rural areas.
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The Commonwealth Fund