eco 411 final presentation - norway

7/29/2019 Eco 411 Final Presentation - Norway

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Norway



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Background

Population: 5,033,675

GDP (PPP): $53,470

per capita (4th) Gini: 25.8 (5th)

HDI: 0.943 (1st)

Life Expectancy: 80.2

Population:314,838,000

GDP (PPP): $48,386per capita (6th)

Gini: 45.0 (6th)

HDI: 0.910 (5th)

Life Expectancy: 78.2



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About Norway

Constitutional Monarchy: head of state(King Harald) and prime minister (JensStoltenberg) oversee government.

Extensive reserves of petroleum, naturalgas, minerals, lumber, seafood, freshwater, and hydropower.

World's largest producer of oil andnatural gas outside the Middle East.(~25% of countries GDP)

Nordic welfare model: universal healthcare subsidized hi her education and




Structure & Flow



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Municipalities

The 431 municipalities in Norway areresponsible for provisions and funding of the primary health care and social

services. Receive funding from the General

Purpose Grant Scheme, who decides

how to distribute funds to municipalitiesbased on many factors.



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General Practitioners

There are approx. 4000 GeneralPractitioners (GP’s) in Norway.

Patients select a GP , a max of two

separate ones a year, and see them if they need medical advice.

If further care is needed (specialty care) the

GP has to refer their patient to the specificspecialist needed.

95% of the population is registered toGP’s.



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Private Health Care Sector

There is a small section of people whochoose to be in private health care. (5%)

Both profit and not-for-profit exists

Several specialty care services aremostly private.

Pharmacy, radiology, lab tests, etc…

Though these are mostly private, the GPare usually the ones suggesting andreferring patients there.



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Hospitals

Owned by the state, but formally areregistered as legal entities with anexecutive board.

Financed through capitation, activity basedpayments and out-of-pocket payments.



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General Flow

GP

Hospital

Specialist

Long Term Care

Illness



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Norway and The USA

Number of Physicians per 1,000population:

Norway: 4.0

USA: 2.4

Acute Care Hospital Beds per 1,000population:

Norway: 2.4

USA: 2.7

Avg. length of stay in Acute Care



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What We Can Learn

By having the patients see their GP first,there is more efficient treatment at theappropriate care facility (less waiting

time) By having to see your GP first, there is a

longer time to get treated, because of the need of a referral from your GP.

But public hospitals, compared to not-for-profit ones, don’t have the space tokeep people if needed.


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Finances & CostManagement



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Who is Covered?

All citizens or residents who live or workin Norway.

All residents on permanent work in the

Norwegian shelf.

Any students residing for more than 1year*.



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Funding for the Healthcare

Taxes collected by:

Central Government – 83%

Counties – 3%

Municipalities – 14%



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Benefits of the Healthcare

Free Benefits: Emergency Transportation

Inpatient HospitalCare

Prescription

Medication forserious illnesses

Some out of countrytreatments (only if unable to be

SubsidizedBenefits: (Co-Pays)

Outpatient Care

Specialists

All otherPrescriptions*

Radiology

Lab Tests

Some AdultDental Care*

Non-funded Healthcare:• Non-prescription Drugs• Most adult dental care•

Any Private sector treatments not includedin insurance.



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Out-of-Pocket Payments(Cost-Sharing)

Visit to a Specialist:

Co-pay = NKr307 (=$56 US)

Visit to a General Practitioner:

Co-pay = NKr180 (=$33 US)

Prescription Medication:

Co-pay = 36% of expenses of themedicines

Maximum co-pay = NKr 520 (=$95 US)



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Co-Pay Ceiling

Annual Maximum limit for out-of-pocketcosts.

In 2010, Ceiling was set at 1880NKr

($339 US)




National Insurance



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Who is Insured?

Norway – 100% of residents areinsured

USA- nearly 20% lacks insurance



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Spend a lot time NOR US

on paperwork or disputes 8% 17%

over medical bills

Insurance denied

payment or did not 2% 25%

pay as much as expected

Problems With HealthInsurance



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Insurance Restrictions onCare Are a Major TimeConcern

NOR US

17% 48%




Quality & Access tobenefits



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Quality and Equality to

Access All residents in Norway are publiclyinsured.

No major health risk is excluded from the

public insurance scheme

An equal use of health care services forindividuals with equal needs regardless

of income, age, education, gender,ethnic background and place of residence.

B l k i h H i l



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Bottlenecks in the HospitalSector

The 1998 OECD Economic Survey of Norway identified major challenges forthe Norwegian health care sector

because of capacity shortages assuggested by long waiting lists

The number of nurses has risen fasterthan that of physicians

The level of per capita acute bedsremains below the OECD median

That putting too much emphasis onactivit -based financin takes awa

B l k i h H i l



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Official reports suggesting that thereallocation of health care resources fromlower to higher priority areas has proved

difficult to implement

In 1990 with the introduction of a legal“waiting time guarantee”, stipulating a

maximum waiting period of six monthsfor non-emergency patients

Bottlenecks in the HospitalSector

P iti Q liti f th



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Positive Qualities of theHealthcare System

The number of nurses has rise tobecome one of the highest in the OECDper capita.

long-term care beds per capita areamong the highest in the OECD



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N E l A d



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Norway Equal Access andHigh Quality

In a recent official opinion poll (NOU1997), about 95 per cent of therespondents expressed satisfaction with

the professional skills of their physicians 80 per cent gave a positive appraisal of

the results of treatment and the serviceattitude of medical staff.

The life expectancy at birth, at 74.2years for men and 80.3 years for women

N E l A d



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The number of avoidable years of lifelost under age 70 per 1 000 at around 5for males and 3 for females

In 2003, the US had an infant mortalityrate of 6.8 deaths per 1,000 live births.Norway’s rate was 3.5 per 1,000

The Act on Patient Rights introduced freechoice of all public hospitals by thepatients.

The level of fairness in financing is a

measure of equality. Norway ranks 8 to

Norway Equal Access andHigh Quality



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Both supply of services andresponsiveness have improved

Activity of both hospitals and private

physicians has increased. The technical efficiency of public

hospitals seems to have improved.

Waiting times have been reduced both inprimary and specialized care

Increase of Access



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More pharmacies are available in urbanareas without impairing supply in remoteareas, and they stay open longer hours

In June 2001, the government introducedmajor changes in primary care throughthe so-called “patient-list” system

As a result of the patient-list reform, 98%of the population is now registered with aGP.

Patients find that accessibility has

improved, while GPs consider it more

Increase of Access




Healthcare Problems& Reforms in Norway



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Typical Problem Areas

Long admission wait lists, lack of medicalstaff

This is the biggest problem in Norway

Healthcare Lack of coordination between hospitals

and municipalities

Cost efficiency Limited choice in providers



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Delay and Waitlist Problems

“Moral Hazard” of free healthcare

~280,000 Norwegians estimated to bewaiting for care on a given day

Hip replacement wait time: 4 months

Prostectomy: 3 months

Hysterectomy: 2 months



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Other Problems

Management and Coordination

Efficiency problems

Increasing potential tax burden

40-45% tax rate

10% of GDP expended on Health Care(Rank 7th)

Limited choice of health providers forpeople



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Reforms

Management Reform attempts

1990 Patients’ Right Act

Unsuccessful government attempt to solvewaiting list problem

Patients with a condition that could cause“catastrophic or very serious

consequences” have right to a treatmentwithin 6 months




America vs. Norway



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USA vs. Norway: Prisons

Incarceration Rate: 730/100,000 (1st)

Tough punishments for tough crimes;lockdown in jail, close quarters, life

sentences,

Private prisons, many inmates per cell,



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Incarceration Rate: 73/100,000 (173rd)

“Rehabilitate inmates” .. Recidivism rate:20%

No bars, no electric fences, maximumsentence of 21 years, guards do notcarry weapons

Kitchens, suite bedroom/bathrooms,organized athletics, fullmedical/dental/optical care

“Prisoners” work the jobs that help the



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Bastoy Prison,Norway

eco 411 final presentation - norway

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