JANUARY

What is being done to promote delivery system integration and
care coordination?
NORWAY
Care coordination has been pointed out as a weakness in the health care system. The coordination reform
of 2012 put more emphasis on municipalities’ responsibility for 24-hour and post-discharge care, including
individual treatment plans for patients with chronic diseases, but not for hospital treatment. Hospitals and
municipalities must establish formal agreements on the care of patients with complex needs (Ministry of Health
and Care Services 2009 and 2011). The number of integrated primary care practices is experiencing moderate
growth, with GPs establishing common practices with physiotherapists and specialists in orthopedics,
gynecology, ophthalmology, dentistry, and pediatrics.
For hospitals, incentives for care coordination are provided by mandatory agreements with municipalities.
Financing is still fragmented between the hospitals (state-funded) and primary care (municipality-funded), but
the municipalities pay substantial fines per day to hospitals if they are not able to accommodate patients ready
for discharge.
What is the status of electronic health records?
A national strategy for health information technology (HIT) is the responsibility of the Directorate for Health,
with implementation by a departmental steering committee. Every resident is allotted a unique personal
identification number, which is used in primary care and for hospitals’ medical records. Secure messaging is not
a part of that system, but several GPs use such messaging systems, for instance to request prescriptions. Some
GP and specialist outpatient offices have electronic booking, while most hospitals do not. All patients have the
right to see or get a copy of their complete record, including doctors’ notes, but there is not yet an electronic
solution for doing so. An ongoing project on patient access currently gives 2.3 million inhabitants access to their
core medical record, also allowing for correction of personal information.
The National Health Network is charged with providing efficient and secure electronic exchange of patient
information between all relevant parties within the health and social services sector. It provides secure
telecommunication for GPs, hospitals, nursing homes, pharmacists, dentists, and others.
HIT in primary care is fragmented, and some areas of service lack resources and equipment for its
implementation. Still, virtually all GPs use electronic patient records and transmit prescriptions electronically to
pharmacies. HIT is also used for referrals, communication with laboratories and radiology services, and sick
leave. Most GPs receive electronic discharge letters from hospitals. Where after-hours emergency care is
organized within the same patient record network, patient histories remain available and primary care providers
are able to access information regarding emergency visits. All hospitals use electronic records.
The lack of structured electronic records in primary and secondary care precludes automatic data extraction;
hence, there is still insufficient data for quality improvement at local and national levels.
How are costs contained?
Central government sets an overall health budget annually, and municipalities and RHAs are responsible for
maintaining their budgets. The drug pricing scheme aims to encourage use of generic drugs. Cost-effectiveness
is a criterion to get on the “blue list” of drugs eligible for reimbursement, and there is a defined maximum price
for drugs, linked to reference prices set at the average of the three lowest market prices for the drug in a defined
group of Scandinavian and Western European countries. The Drug Procurement Cooperation (LIS) has been
effective in negotiating drug purchases and delivery jointly for the four RHAs.
Costs are contained through GP gatekeeping for specialized services. There is very little competition regarding
pricing within the health services. A minute proportion of specialized care is offered to the private sector by RHAs
and contracted through tenders, for which price is one of several criteria.
International Profiles of Health Care Systems, 2015 139