The system of health care provision in Norway is based on a decentralized model. The state is responsible for policy design and overall capacity and quality of health care through budgeting and legislation. The state is also responsible for hospital services through state ownership of regional health authorities. Within the regional health authorities, somatic and psychiatric hospitals, and some hospital pharmacies, are organized as health trusts.
Within the limits of legislation and available economic resources, regional health authorities and the municipalities are formally free to plan and run public health services and social services as they like. However, in practice, their freedom to act independently is limited by available resources.
The municipalities have responsibility for primary health care, including both preventive and curative treatment such as:
- Promotion of health and prevention of illness and injuries, including organizing and running school health services, health centres, child health care provided by health visitors, midwives and physicians. Health centres offer pregnancy check-ups and provide vaccinations according to the recommended immunization programmes.
- Diagnosis, treatment and rehabilitation. This includes responsibility for general medical treatment (including emergency services) physiotherapy and nursing (including health visitors and midwives).
- Nursing care in and outside institutions. Municipalities are responsible for running nursing homes, home nursing services and other services such as the home help service. The health services in and outside institutions are, to a varying degree, organized jointly within the same municipal department for treatment and care.
In Norway there is currently a National Mental Health Programme. The programme was originally for the period 1999 to 2006, and it has been prolonged until 2008. This programme aims at improving accessibility, quality and organization of mental health services and treatment on all levels. A central idea of the Mental Health Programme is to promote deinstitutionalization, with considerable emphasis on community-based psychiatry, where treatment is given closer to the patient’s local community and primary health services. These community clinics represent an all-round psychiatric practice and consist of a network of services, such as multidisciplinary treatment and teamwork, in addition to programmes for accommodation, occupation and social support.
The county authorities are responsible for providing public dental services for the following groups: 1. children and adolescents (under 21 years of age), 2. mentally handicapped adults and 3. elderly people, disabled people and people with chronic illnesses who live in institutions or who receive home nursing care. Dental services for the rest of the population are mainly provided by private general dental practitioners, and paid for by the patients.
There are several different ways in which occupational health services are organized. Some large companies have their own private service, organized independently. Another type of arrangement is that several companies have a joint arrangement with an occupational health services company, which sells occupational health services to the group.
Pharmacies are mainly privately owned, but are subject to strict public control.
Reports and other useful documents about Norwegian health services can be found under Links / Links to useful reports in English.
Social services in Norway are organized according to a decentralized model. The state is responsible for policy-making, education of personnel and legislation. The municipalities are responsible for providing services.
The municipalities mainly receive funding for services through block grants from the state. For some areas that are given special priority, the municipalities receive “earmarked” grants. One example of such an area is services for elderly people. Another example is measures to enable people with mental disabilities to live in their own homes with adapted services, and to participate in work and leisure activities.
Within the framework of the Social Services Act and its associated regulations and guidelines, and other relevant legislation, the municipalities are free to develop their services and measures.
Examples of social services are
- practical help for people who need assistance because of disability, age or other factors
- relief assistance for people and families with comprehensive needs for care
- support persons for people who need help with leisure activities and with making contact with others
- sheltered accommodation with services
- salary for people who care for children or relatives who have comprehensive needs for care
- needs based financial support for persons without income or capital
Treatment services for alcohol and drug abusers are part of health services. But social services in the municipalities still have responsibility for giving alcohol and drug abusers advice and assistance, for ensuring that they receive treatment, and for following up with measures before and during treatment.
The municipalities are also responsible for prevention of social problems. Prevention of social problems must be seen in relation to prevention of health problems.
Children’s welfare services in Norway are not regarded as part of social services, but in many municipalities (particularly in small municipalities) these services are often organized as part of social services, and are provided by the same personnel.
A reform has just been implemented in Norway, in which the national insurance system and the national employment service have been amalgamated – Nav. The Nav reform involves, among other things, the establishment of municipal offices, responsible for providing state services related to national insurance and employment, and, as a minimum, administrating municipal means-tested benefits. The municipality and the Nav service can agree that other municipal services shall also be provided by the Nav offices.
The municipalities mainly provide all social services themselves. But there are examples of inter-municipal cooperation, and some municipalities buy services from private organizations. In particular, many humanitarian and religious organizations and special interest organizations provide services for elderly people, people with disabilities, and alcohol and drug abusers. Also, during the last few years, many commercial organizations have begun to offer services such as care for elderly people and people with disabilities, and full-time care or day care for people who have comprehensive needs for assistance.
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