Norway-USA in contrast: Different approaches to healthcare costs

Photo: NAV Norwegian version of a European Health Insurance Card.

Photo: NAV
Norwegian version of a European Health Insurance Card.

M. Michael Brady
Asker, Norway

Healthcare in Norway is universal and available to all as an essential part of the modern welfare state that employs the Nordic Model. As pointed out last November in an opinion essay entitled “American Exceptionalism” (Further reading), by Czech-Canadian scientist and policy analyst Vaclav Smil, the U.S. is the only modern affluent country without access to universal healthcare. That difference complicates comparing healthcare in the two countries in a single article in this newspaper. So here the focus is on the everyday aspects of the Norwegian healthcare system as experienced by its users.

Norway spends about 8.5% of its Gross Domestic Product (GDP) on healthcare. Overall, healthcare is mostly public, financed through income taxes and government appropriations. Private health services are growing and now account for about 16% of healthcare spending.

According to the latest OECD update of its Social Expenditure Database (SOCX) in 2014, Norwegian public and private spending on social security (including healthcare) is the 19th highest among developed countries. The public Social Insurance covers all residents of the country and provides pensions and welfare services. Like healthcare, social security is changing to adapt to an increasingly older, more urban population. Its services are made available to the public by local Norwegian Labor and Welfare Administration (NAV, Further reading) offices across the country.

Norwegian healthcare is divided into primary and secondary care, both in its administration and its practice. Primary care is what people usually seek upon first having a health problem, such as a visit to a doctor. It is provided locally. Secondary care is specialized and deals with health problems that cannot be sorted out in primary care, such as treatment by specialists or in hospitals. It is provided by four Regional Health Authorities, each of which administers, manages, and develops healthcare services within its boundaries and operates hospitals as a public service. Save for emergencies, such as treating the victims of accidents or acute illness, and births, patients are admitted to hospitals upon referral by doctors.

The cost to an individual user of a public healthcare service is called egenandel, literally “own share” (of the overall cost, most of which is covered by the healthcare system). In English it’s termed a “user fee,” as it applies to all healthcare services, not just those provided by medical doctors. The fees are standardized once a year for all services for the entire country. For instance, in 2016 a consultation costs NOK 187 ($23) with a GP and NOK 320 ($39.50) with a specialist, and an X-ray costs NOK 227 ($28). Stays in hospitals are at no cost to residents registered with NAV.

The overall cost of healthcare for the individual is kept down by granting free care for expenses over a ceiling set once a year. In practice, an exemption card (Frikort) is then issued for a group of public healthcare services for the rest of a calendar year. There are two groups of services: Group 1 includes the most commonplace services, including visits to a doctor, psychologist, or hospital outpatient clinic; for 2016 its user fee ceiling is NOK 2185 ($269). Group 2 includes specialist services, including physiotherapy, treatment of periodontal diseases, and stays at approved rehabilitation centers; for 2016 its user ceiling is NOK 2670 ($329).

The Norwegian healthcare system interacts with the healthcare systems of other European countries, all of which support universal healthcare for their residents. If you travel in Europe and are a citizen of and a member of the National Insurance scheme of one of the 28 member countries of the European Union (EU) or four European countries not in the EU (Iceland, Liechtenstein, Norway, and Switzerland), you may carry a European Health Insurance Card that entitles you to treatment on a par with the citizens of these countries. The cards are of a uniform design and each carries the two-letter abbreviation of the name of and an explanatory text in the language of the country that issued it. In Norway, if you are a citizen or are married to a Norwegian citizen and are a member of the national Social Insurance scheme, you may apply for a card at the Health Economics Administration (Further reading).

Further reading:
“American Exceptionalism” by Vaclav Smil, IEEE Spectrum, November 2015, p. 22, link: spectrum.ieee.org/at-work/education/american-exceptionalism.

Helsenorge (“Healthcare Norway”), helsenorge.no/other-languages/english, a website compiled by the Norwegian Directorate of eHealth (NDE), ehelse.no/english, established January 1 this year to use information and communication technologies (ICTs) to improve the healthcare system and make it more accessible to and understood by the public.

NAV, the Norwegian Labor and Welfare Administration, homepage in English at www.nav.no/en.

Helfo, the Norwegian Health Economics Administration, homepage in English at helfo.no/english.

OECD Social Expenditure database (SOCX) update, November 2014, 8 page free PDF, link: www.oecd.org/els/soc/OECD2014-Social-Expenditure-Update-Nov2014-8pages.pdf.

This article originally appeared in the July 1, 2016, issue of The Norwegian American. To subscribe, visit SUBSCRIBE or call us at (206) 784-4617.

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