In Norway, municipalities are in charge of providing basic healthcare, while specialised healthcare is provided by the state through public hospitals.
Since the money given to municipalities is not set aside for any particular purpose, each municipality is free to determine its own health budget. Municipalities coordinate primary healthcare services through agreements with independent physicians. In Norway, private healthcare providers are not compensated unless they have a contract with the public health service. [1]
All public hospitals in Norway are run as health trusts (helseforetak (HF)) incorporated into one of four regional health authorities (regionale helseforetak (RHF)) overseen by the Ministry of Health and Care Services. In addition to these public hospitals, there are a small number of privately owned health clinics currently operating.[ citation needed ]
With a population of 5 391 369 as of the first quarter of 2021, [2] and a gross national income per capita of 70 800 (PPP, current international dollar) in 2019, [3] Norway has a life expectancy at birth of 84 years for women and 81 years for men as of 2016. [4] As of 2019, there are 2.5 deaths for children under 5 years of age per 1000 live births. [5]
Probability of dying between 15 and 60 years m/f (per 1,000 population, 2016) | 66/42 |
Total expenditure on health per capita (Intl $, 2014) | 6,347 |
Total expenditure on health as a percentage of GDP (2017) | 10.4 |
Latest data available from the Global Health Observatory and SSB, NO Statistical agency [6] |
Expenditure on healthcare is about 7,727 USD per person per year in 2020, [7] among the highest in the world. [8] It has the highest proportion of nurses and midwives per person in Europe: 1,744 per 100,000 people in 2015. [9]
While the availability of public healthcare is universal in Norway, there are certain payment stipulations. Children aged sixteen or younger, and several other groups (such as nursing women and retirees) are given free healthcare regardless of the coverage they may have had in previous situations. All other citizens are responsible for paying a certain amount in user fees. If they reach a certain amount of money paid out-of-pocket, they receive an exemption card (frikort for helsetjenester in Norwegian) for public health services, and they no longer have to pay user fees for the remainder of the calendar year. The amount is 2,460 NOK in 2021, or about US$264. Everything above this amount is given for free for the rest of that year.
The exemption card covers family doctors, psychologists, outpatient clinics, radiology services, laboratory tests, patient travel, medicines and equipment falling under the "blue prescription" system, physiotherapy, dental diseases and abnormalities, periodontitis, rehabilitation, and travel for treatment abroad arranged by the National Hospital (Rikshospitalet). [10] Dentists and dental hygienists are not included, but hospitalisation and everything related to being hospitalised in Norway is free for any citizen regardless of income or deductible status. [11] In terms of emergency room admission, all immediate healthcare costs are covered. [12]
Norway scores overall very high on different rankings in health care performances worldwide. Unique for the Norwegian health care system is that the state funds almost all expenses a patient would have. Patients with extra high expenses due to a permanent illness receive a tax deduction. [13]
In 2020, 11.3% of the country's GDP went to health spending, and only about 14% of that was private spending (out-of-pocket payments), reflecting moderate cost-sharing requirements. [14] The public share of health spending as a proportion of total government expenditure is only around 17%. [7]
The government creates an annual health budget for the following year, every year in December. This budget includes all expenses within the health branch of Norway. The parliament has only on some occasions voted for additional funds later in the year, primarily for hospitals. The welfare state costs a lot to maintain and to improve after the standard and inflation of the year.
Pension, regulated after age, is the largest expense in the budget section covering health and welfare. The government has changed in the year of 2018 the management of expenses and funding to the health sector, with the goal to shorten the length of waiting lines and improve health services. [15]
Funds for hospital care are allocated to the regional health authorities after the budget is passed for the coming year. They are responsible to distribute the financial funding to hospitals and other health services locally.
After the Second World War the government of Norway decided to include national health care as one of their main focuses in the development of the welfare state. The state is responsible for providing good and necessary health services for everyone. [16] This responsibility is divided between three levels of government: the state, county, and municipality.
The government is responsible for developing laws and passing bills, but the Department of Health and Care has the main responsibility for the daily running and operations of health politics and health services in Norway. [17] In 2001 every citizen gained the right to have a permanent doctor in the area they live in. The city council in every county is responsible for this right, and they also initiate agreements and cooperation with the doctors. [18]
This improvement is one of several in healthcare that Norway has to offer. The various reforms share the common thread that they all came as a reaction to inefficient systems that did not take full advantage of all available resources. Another major reform that came in the beginning of the 21st century, was the health reform of 2002.
In 2002, the government took over the responsibility of running the hospitals in the country. Kjell Magne Bondevik was the prime minister at the time. He was the leader of the Christian Democratic Party and was head of the coalition government (alongside the Conservatives and Liberals). Up until then, hospitals in Norway were operated by the counties and city councils. The goal of the reforms was to improve the quality of medical treatment, to run the hospitals more efficiently than previously and to make medical treatment equally available to everyone in the country. [18]
The reform was inspired by the New Public Management movement, and major changes were realized in accordance with these principles. Hospitals and services were organised as health trusts into five regional health authorities. These are independent legal entities organised and operated like corporations, with a few differences: the health trusts and authorities are only owned by the government, they cannot go bankrupt and are guaranteed by the government. The government also give loans and gives them financing from state funding. [19]
The reform was to some extent successful. Patient waiting lists before treatment were reduced with almost 20 thousand patients. However, the spending on healthcare in Norway increased, and after a year the financial deficit reached almost 3.1 billion. [20] Also, efficiency improvements in treatments have impacted patient experience as they have less time with the doctor and sometimes must check out of the hospital on the same day as they were admitted.
Norway does not produce the bulk of pharmaceuticals consumed domestically, and imports the majority that are used in its health system. This has resulted in most residents having to pay full price for any prescription. Pharmaceutical exporting is overseen by the Ministry of Health and Care Services. Insurance coverage for medicine imported from outside the country is managed through the Norwegian Health Economics Administration (HELFO). [21]
Norway has four designated Regional Health Authorities. They are: Northern Norway Regional Health Authority, Central Norway Regional Health Authority, Western Norway Regional Health Authority, and Southern and Eastern Norway Regional Health Authority. [22] According to the Patients' Rights Act, [23] all eligible persons have the right to a choice in hospitals when receiving treatment. [24]
The Norwegian Health Care System was ranked number 11 in overall performance by the World Health Organization [25] in a 2000 report evaluating the health care systems of each of the 191 United Nations member nations. According to the Euro health consumer index, in 2015 the Norwegian health system was ranked third in Europe but had inexplicably long waiting lists [26] as 270,000 Norwegians were waiting for medical treatment in 2012–13. [27] [28] [29] In the OECD publication Health at a Glance 2011, Norway had among the longest wait times for elective surgery and specialist appointments among eleven countries surveyed. [30] However, the Norwegian government has been successful in reducing the average wait times for hospital care in recent years. [31] [32] [33] [34]
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All pregnant women in Norway are entitled to maternity care from a midwife at a Maternity and Child Health Care Centre or from their General Practitioner.
There are usually eight antenatal appointments including one ultrasound screening during pregnancy. The consultations are free of charge, and pregnant employees have the right to paid time off work for antenatal appointments. [38]
There were 56,600 children born in 2017, 2,300 fewer than the previous year. This gave a total fertility rate of 1.62 children per woman - the lowest measured in Norway ever. [39]
139 children were registered as stillborn in 2017. This corresponds to 2.4 deaths per 1,000 born and is the lowest number ever recorded.
Observed deaths per 1000 live | 1990 | 2016 |
---|---|---|
Under 5 years | 8.6 | 2.7 |
Under 1 year | 7.0 | 2.2 |
In Norway 2015: Nursing and midwifery personnel density (per 1000 population).Value: 17.824. That includes practising midwives and practising nurses. Data Source: OECD Health Data, accessed October 2017. WHO region: Europe Effective. date: 2018-02-26 [40]
Global incidence of many infectious diseases has declined. Higher standards of living and improved hygienic conditions are a major cause, as well as the prevalence of vaccines. Nonetheless, increased international travel and import of food is causing an increase in some infectious diseases in Norway such as some foodborne infections and infections by antibiotic-resistant bacteria. [41] Patients are exempt from cost-sharing for visits, tests, and treatments for all infectious diseases deemed to pose a threat to public health. [42]
Tuberculosis is the most infectious disease worldwide, and is a major challenge in global health care. However, in Norway, the decline in the number of tuberculosis cases continues.
By 2017, a total of 261 patients with tuberculosis were reported to the Institute of Public Health. This is a decline from previous years. During the last twenty years, the highest number of patients with tuberculosis was 392 in 2013. It makes Norway one of the countries with the lowest tuberculosis incidence in the world. Differences in the global disease burden of tuberculosis are also reflected in the disparities of infection rates within Norway, where major inequalities based on people's country of origin can be observed. Only 11 percent of the patients who were reported with tuberculosis disease in 2017 were born in Norway, and only half of them had Norwegian-born parents. [43]
The number of multiresistant tuberculosis cases is between four and 11 cases per year. By 2017, nine patients were diagnosed with multiresistant tuberculosis. None of these had developed resistance during treatment in Norway. [43]
Most cases of tuberculosis disease in Norway are detected early and therefore are not transmitted, i.e. they are considered latent.
An important part of the tuberculosis work in Norway is ensuring that people with an increased risk of post-infection disease development are offered preventative treatment. In addition to those who are thought to be newly infected, high risk groups include children and persons with impaired immune system.
The number of people receiving preventative treatment is still too low, according to the Institute of Public Health. The number of preventative treatments is expected to be greater than the number treated for tuberculosis disease, but in several counties these groups are about the same. [43]
HIV infection is present in all countries of the world. UNAIDS estimates that by the end of 2016 approximately 36.7 million people living with HIV infection, approximately 17 million of these have access to antiviral treatment. Since the start of the HIV epidemic, it is estimated that approx. 78 million people have been infected with HIV and approximately 35 million people have died of AIDS-related illnesses. Globally, women account for 52% of the HIV-infected persons. About 69% of the HIV-infected live in sub-Saharan Africa. In 2016, around 1.8 million individuals acquired HIV. This is the lowest number of newly diagnosed since the mid-1990s. [44]
In Norway, HIV infection and AIDS have also been present and since 1983 the Institute of Public Health in Oslo has been observing and performing statistical analysis, showing overall low incidence. In 2017, there were 18 individuals diagnosed with AIDS and 213 individuals diagnosed with HIV. [45]
People who test HIV positive are referred to a doctor with a good knowledge of HIV. Treatment for HIV infection is usually handled by a specialist health service in the hospital. For people who live far from a hospital, the local doctor can collaborate with the specialists to give the best possible local support. [46]
Norway regards the 2030 Agenda with its 17 Sustainable Development Goals (SDGs) as a transformative global roadmap for both national and international efforts aimed at eradicating extreme poverty, while protecting planetary boundaries and promoting prosperity, peace and justice. [47]
Norway was also a part of the 2016 voluntary national review of the high level political forum on Sustainable development. [48]
UN reports and various international indexes show that Norway ranks high in terms of global implementation of the SDGs. At the same time, it is evident that implementing the 2030 Agenda will be demanding for Norway, too. [48]
The Government has identified a number of targets that pose particular challenges for domestic follow-up in Norway. These challenges relate to several of the SDGs and all three dimensions of sustainable development – social, economic, and environmental. Targets that are likely to remain the focus of political attention and policy development are those relating to sustainable consumption and production, health and education, equality, employment, and migration. The Government is giving priority to ensuring quality education and employment, especially for young people and those at risk of marginalisation. This is an important contribution to realising the 2030 Agenda vision of leaving no one behind. Challenges that have been identified at the national level:
Tuberculosis (TB), also known colloquially as the "white death", or historically as consumption, is a contagious disease usually caused by Mycobacterium tuberculosis (MTB) bacteria. Tuberculosis generally affects the lungs, but it can also affect other parts of the body. Most infections show no symptoms, in which case it is known as latent tuberculosis. Around 10% of latent infections progress to active disease that, if left untreated, kill about half of those affected. Typical symptoms of active TB are chronic cough with blood-containing mucus, fever, night sweats, and weight loss. Infection of other organs can cause a wide range of symptoms.
The Healthcare in Kazakhstan is a post-Soviet healthcare system under reform. The World Health Organization (WHO), in 2000, ranked the Kazakhstan's healthcare system as the 64th in overall performance, and 135th by overall level of health.
Health care services in Nepal are provided by both public and private sectors and are generally regarded as failing to meet international standards.
Health in Vietnam encompasses general and specific concerns to the region, its history, and various socioeconomic status, such as dealing with malnutrition, effects of Agent Orange as well as psychological issues from the Vietnam War, tropical diseases, and other issues such as underdeveloped healthcare systems or inadequate ratio of healthcare or social workers to patients.
Healthcare in Finland consists of a highly decentralized three-level publicly funded healthcare system and a much smaller private sector. Although the Ministry of Social Affairs and Health has the highest decision-making authority, specific healthcare precincts are responsible for providing healthcare to their residents as of 2023.
With less than 1 percent of the population estimated to be HIV-positive, Egypt is a low-HIV-prevalence country. However, between the years 2006 and 2011, HIV prevalence rates in Egypt increased tenfold. Until 2011, the average number of new cases of HIV in Egypt was 400 per year, but in 2012 and 2013, it increased to about 600 new cases, and in 2014, it reached 880 new cases per year. According to 2016 statistics from UNAIDS, there are about 11,000 people currently living with HIV in Egypt. The Ministry of Health and Population reported in 2020 over 13,000 Egyptians are living with HIV/AIDS. However, unsafe behaviors among most-at-risk populations and limited condom usage among the general population place Egypt at risk of a broader epidemic.
In precolonial Ghana, infectious diseases were the main cause of morbidity and mortality. The modern history of health in Ghana was heavily influenced by international actors such as Christian missionaries, European colonists, the World Bank, and the International Monetary Fund. In addition, the democratic shift in Ghana spurred healthcare reforms in an attempt to address the presence of infectious and noncommunicable diseases eventually resulting in the formation of the National Health insurance Scheme in place today.
The current population of Myanmar is 54.05 million. It was 27.27 million in 1970. The general state of healthcare in Myanmar is poor. The military government of 1962-2011 spent anywhere from 0.5% to 3% of the country's GDP on healthcare. Healthcare in Myanmar is consistently ranked among the lowest in the world. In 2015, in congruence with a new democratic government, a series of healthcare reforms were enacted. In 2017, the reformed government spent 5.2% of GDP on healthcare expenditures. Health indicators have begun to improve as spending continues to increase. Patients continue to pay the majority of healthcare costs out of pocket. Although, out of pocket costs were reduced from 85% to 62% from 2014 to 2015. They continue to drop annually. The global average of healthcare costs paid out of pocket is 32%. Both public and private hospitals are understaffed due to a national shortage of doctors and nurses. Public hospitals lack many of the basic facilities and equipment. WHO consistently ranks Myanmar among the worst nations in healthcare.
Health care in Poland is insurance based, delivered through a publicly funded health care system called the National Health Fund, which is free for all the citizens of Poland provided they fall into the "insured" category. According to Article 68 of the Polish Constitution everyone has a right to have access to health care. Citizens are granted equal access to the publicly funded healthcare system. In particular, the government is obliged to provide free health care to young children, pregnant women, disabled people, and the elderly. However, private health care use is very extensive in Poland. Patients who are uninsured have to pay the full cost of medical services. According to a study conducted by CBOS in 2016, out of 84% patients taking part in the survey, 40% declared use of both private and public health services, 37% use only public health care, and 7% use only private health services. 77% of all responders declared using private health care is caused by long waiting for public health care services.
Botswana's healthcare system has been steadily improving and expanding its infrastructure to become more accessible. The country's position as an upper middle-income country has allowed them to make strides in universal healthcare access for much of Botswana's population. The majority of the Botswana's 2.3 million inhabitants now live within five kilometres of a healthcare facility. As a result, the infant mortality and maternal mortality rates have been on a steady decline. The country's improving healthcare infrastructure has also been reflected in an increase of the average life expectancy from birth, with nearly all births occurring in healthcare facilities.
A landlocked sub-Saharan country, Burkina Faso is among the poorest countries in the world—44 percent of its population lives below the international poverty line of US$1.90 per day —and it ranks 185th out of 188 countries on UNDP's 2016 Human Development Index. Rapid population growth, gender inequality, and low levels of educational attainment contribute to food insecurity and poverty in Burkina Faso. The total population is just over 20 million with the estimated population growth rate is 3.1 percent per year and seven out of 10 Burkinabe are younger than 30. Total health care expenditures were an estimated 5% of GDP. Total expenditure on health per capita is 82 in 2014.
Health in Chad is suffering due to the country's weak healthcare system. Access to medical services is very limited and the health system struggles with shortage of medical staff, medicines and equipment. In 2018, the UNHCR reported that Chad currently has 615,681 people of concern, including 446,091 refugees and asylum seekers. There is a physician density of 0.04 per 1,000 population and nurse and midwife density of 0.31 per 1,000 population. The life expectancy at birth for people born in Chad, is 53 years for men and 55 years for women (2016). In 2019 Chad ranked as 187 out of 189 countries on the human development index, which places the country as a low human development country.
North Korea has a life expectancy of 74 years as of 2022. While North Korea is classified as a low-income country, the structure of North Korea's causes of death (2013) is unlike that of other low-income countries. Rather, causes of death are closer to the worldwide averages, with non-communicable diseases – such as cardiovascular disease – accounting for two-thirds of the total deaths.
Discrimination against people with HIV/AIDS or serophobia is the prejudice, fear, rejection, and stigmatization of people with HIV/AIDS. Marginalized, at-risk groups such as members of the LGBTQ+ community, intravenous drug users, and sex workers are most vulnerable to facing HIV/AIDS discrimination. The consequences of societal stigma against PLHIV are quite severe, as HIV/AIDS discrimination actively hinders access to HIV/AIDS screening and care around the world. Moreover, these negative stigmas become used against members of the LGBTQ+ community in the form of stereotypes held by physicians.
Examples of health care systems of the world, sorted by continent, are as follows.
Lesotho's Human development index value for 2018 was 0.518—which put the country in the low human development category—positioning it at 164 out of 189 countries and territories. Health care services in Lesotho are delivered primarily by the government and the Christian Health Association of Lesotho. Access to health services is difficult for many people, especially in rural areas. The country's health system is challenged by the relentless increase of the burden of disease brought about by AIDS, and a lack of expertise and human resources. Serious emergencies are often referred to neighbouring South Africa. The largest contribution to mortality in Lesotho are communicable diseases, maternal, perinatal and nutritional conditions.
Tuberculosis in India is a major health problem, causing about 220,000 deaths every year. In 2020, the Indian government made statements to eliminate tuberculosis from the country by 2025 through its National TB Elimination Program. Interventions in this program include major investment in health care, providing supplemental nutrition credit through the Nikshay Poshan Yojana, organizing a national epidemiological survey for tuberculosis, and organizing a national campaign to tie together the Indian government and private health infrastructure for the goal of eliminating the disease.
The Indian hospitals were racially segregated hospitals, originally serving as tuberculosis sanatoria but later operating as general hospitals for indigenous peoples in Canada which operated during the 20th century. The hospitals were originally used to isolate Indigenous tuberculosis patients from the general population because of a fear among health officials that "Indian TB" posed a danger to the non-indigenous population. Many of these hospitals were located on Indian reserves, and might also be called reserve hospitals, while others were in nearby towns.
Infectious diseases within American correctional settings are a concern within the public health sector. The corrections population is susceptible to infectious diseases through exposure to blood and other bodily fluids, drug injection, poor health care, prison overcrowding, demographics, security issues, lack of community support for rehabilitation programs, and high-risk behaviors. The spread of infectious diseases, such as HIV and other sexually transmitted infections, hepatitis C (HCV), hepatitis B (HBV), and tuberculosis, result largely from needle-sharing, drug use, and consensual and non-consensual sex among prisoners. HIV and hepatitis C need specific attention because of the specific public health concerns and issues they raise.
Health in Norway, with its early history of poverty and infectious diseases along with famines and epidemics, was poor for most of the population at least into the 1800s. The country eventually changed from a peasant society to an industrial one and established a public health system in 1860. Due to the high life expectancy at birth, the low under five mortality rate and the fertility rate in Norway, it is fair to say that the overall health status in the country is generally good.
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