Many Americans’ idea of health care in Europe looks something like Norway. Its health system even has the imprimatur of Michael Moore, who says that although he filmed there as part of his movie Sicko, it did not end up in the final film lest it be found too unbelievable for American viewers.
The first thing is that health care in Norway isn’t cheap. Norway spends 8.7 percent of its GDP on health care, less than most of its European neighbors, but this is misleading because with outlays of $4,520 per capita, Norway was the most expensive in Europe on this measure, and the priciest in the OECD other than the US. This cost is funded by central government tax revenues, additional taxes charged by the municipalities, and some out of pocket costs to patients.
Contrary to popular belief, the government doesn’t carry out all of the day to day operation of the health care system. Rather, Norway has significant decentralization in providing care. Five regional health authorities oversee access to specialists, while primary care falls under local authorities and these authorities have considerable latitude in their operations.
General policy, reimbursement rates, and the annual budget are, however, still set on the federal level. Many doctors and health care workers are paid salaries by the state rather than being reimbursed for the care they provide and
The upside of the Norwegian system is that anyone who is a legal resident can participate in the government system. They are entitled to all “necessary health care,” often defined quite inclusively, and neither doctors nor health care officials can deny treatments that fall under this for any reason, even if it creates a financial strain on the system. Some patients are even entitled to spa treatments, paid for by the state.
But while being in the hospital costs Norwegians nothing, health care there is not totally free at the point of service. For services not fully covered, patients are charged copays up to an annual individual total, about 1615 kronor in 2006. As an example, a visit to a GP costs about 125 to 235 kronor. Children are not charged copays for all or some medical services, depending on age. Those who are retired or disabled are also exempted.
Once a person (or one parent plus children under 16) has reached this threshold, they get a special card and their care is then gratis for the rest of the year. Over 1 million Norwegians reached this point in 2005. For care in areas outside the health system, such as dental and rehabilitation or treatment outside Norway, there is a separate threshold of 2500 kronor, which works the same way.
Other costs to patients come from copays for medications, plus having to pay the difference if a patient wants a pricier drug than the system will reimburse for. Overall, around 15 percent of health care spending is out of pocket.
The other side of such generosity is that Norway is among the nations whose residents must contend with extensive waits for health care services and rationing of care. This means that it is common for Norwegians to go to other countries to receive care faster than at home. Norway has also fallen prey to the lure of cost-effectiveness, which often comes into conflict with the wide right of Norwegians to “necessary health care.”
People in Norway also have only a limited ability to decide which doctor they want to go to since only those listed with the government are acceptable and specialists can only be seen with a referral from the general practitioner. Norwegians can choose their hospital but cannot demand procedures that are not authorized by the doctor.
Despite the huge government system in Norway, those who prefer private care can spend their own money to get it. However, private facilities are relatively few and generally located in urban areas. Most Norwegians go private only for “substance abuse treatment, rehabilitation and dental care,” as well as many laboratory tests and scans. Pharmacies are also primarily private. Care outside the government system also is significantly more expensive and generally private policies are purchased to supplement public coverage, not replace it.
