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small number of private hospitals do exist out-

can continue to fund rising costs even as its

side the public system.

payroll base shrinks.

The government sets a global budget limit-

ing overall health expenditures, and setting

Norway

capital investment expenditures for hospitals.

Most general practitioners and physician spe-

cialists outside hospitals receive a fixed salary,

Norway has a universal, tax-funded, single-

although some specialists working on a con-

payer, national health system. All Norwegian cit-

tract basis receive both an annual grant and

izens, as well as anyone living or working in

fee-for-service payments. Reimbursement rates

Norway, are covered under the National Insur-

are set by the government and balance-billing

ance Scheme. Norwegians can, however, opt out

is prohibited. Most other health care personnel

of the government system by paying out of

are salaried government employees.159

pocket. In addition, many Norwegians go

abroad for treatment to avoid the waiting lists

Patient choice of physician is constrained.

endemic under the government program.151

All Norwegian citizens must choose a general

practitioner from a government list. The GP

The system is financed through general

acts as a gatekeeper for other services and

tax revenues, with no earmarked or dedicated

tax for health care.152 Thus, health care

providers. Patients may switch GPs, but no

more than twice per year and only if there is no

becomes one large contributor to a tax bur-

waiting list for the requested GP.160 Specialists

den that consumes 45 percent of GDP.

Among industrialized countries, only Sweden

may only be seen with a referral from the GP.

has a higher tax burden.154

The Norwegian health care system has expe-

rienced serious problems with long and growing

Benefits are extensive and include inpa-

waiting lists.161 Approximately 280,000 Nor-

tient and outpatient care, diagnostic services,

specialist care, maternity services, preventive

wegians are estimated to be waiting for care on

medicine, palliative care, and prescription

any given day (out of a population of just 4.6

million).162 The average wait for hip replace-

drugs. At public hospitals, there are no

charges for stays or treatment, including

ment surgery is more than four months; for a

drugs. However, small copayments may be

prostectomy, close to three months; and for a

hysterectomy, more than two months.163

charged for outpatient treatment and for

treatment by a general practitioner, psycholo-

Approximately 23 percent of all patients referred

gist, or psychiatrist. The program also pro-

for hospital admission have to wait longer than

vides "sick pay" and disability benefits.155 As

three months for admission.164

Michael Moore has noted, the Norwegian sys-

The Norwegian government has responded

tem will even pay for "spa treatments" in

by repeatedly and unsuccessfully attempting to

some cases.156

legislate waiting lists out of existence. For exam-

ple, under the 1990 Patients' Rights Act,

Although the central government retains

patients with a condition that would lead to

overall responsibility for and authority over the

"catastrophic or very serious consequences"

system, some management and funding

The Norwegian

have a right to treatment within six months, if the

responsibilities have devolved to regional and

health care

treatment is available.165 In 2001, after several

municipal governments. In general, municipal

system has

governments are responsible for primary

government reports had documented repeated

health care, while four regional health authori-

violations of this policy, the government passed

experienced

ties are responsible for specialist care.157 Prior

a new mandate requiring that a patient's med-

serious problems

ical condition be at least "assessed" within 30

to 2002, public hospitals were run by local or

days.166 Despite these paper guarantees, waiting

county governments. In the face of chronic

with long and

lists have not been substantially reduced.167

problems, notably long waiting lists and rising

growing waiting

costs, the central government took direct con-

Moreover, such delays may represent only

trol of all public hospitals in January 2002.158 A

lists.

the tip of the iceberg when it comes to

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