Norway’s health system is based on the principles of universal access, free choice of provider and decentralization. It is funded by a combination of taxes, income-related employee and employer health insurance contributions and out-of-pocket payments. All Norwegian residents are automatically enrolled in the National Insurance Scheme that entitles them to publicly funded health care services. The universality principle in social health insurance coverage is based on the 1997 National Insurance Act No. 19 and the 1999 Patient Rights Act. No. 63.
The Norwegian Parliament determines what services are covered, although there is no defined benefit package except for new and costly treatments and technologies. Norway’s Ministry of Health and Care Services (MoH) plays legislative and administrative roles by establishing health system policies and governing subordinate agencies such as the directorate of health and others. The MoH is also responsible for hospital and specialty care administered through the four regional health authorities that govern the 27 state-owned hospital trusts. The municipalities are responsible for providing primary, preventive and nursing care.
Norway spent 8.1% of its GDP on health care in 2022. Norway’s per capita health spending significantly exceeded the EU average. In 2021, it was US$ 9,163 per capita in Norway versus US$ 4,215 in the EU (in then year US dollars). In Norway, the government is responsible for 85.6% of current health expenditure (CHE),[1] which is one of the highest in Europe. Norway’s share of government health expenditure as a percent of general government expenditure is also high at 17.9%, and it exceeds the EU average of 15.7%.
The health system guarantees near-complete coverage for inpatient care at 99% and outpatient care at 89%, with low unmet needs for medical care irrespective of income. Health spending is distributed evenly among inpatient, outpatient and long-term care in Norway. Notably, spending on long-term care is the highest in Europe at 29% of CHE, nearly double the European Union (EU) average both in terms of current and per capita health expenditure.
The out-of-pocket (OOP) spending is 14% of CHE in 2022, which is close to the EU average of 14.55% in 2021. OOP spending is mostly comprised of copayments. Twenty-five per cent of OOP spending is on pharmaceuticals, 23% on dental care, 19% on outpatient medical care and 17% on long-term care. User fees are capped at about US$ 250 per year for health services. About 9% of Norwegians have private voluntary health insurance (VHI), paid by employers to provide faster access to publicly covered elective health care services. The share of VHI in total health expenditure is negligible at 0.4%.
A reform, known as the Coordination Reform, shifted towards more decentralized and patient-centred care and included the launch of municipal acute bed units in response to the demand for integrated and coordinated patient care at a local level. Another reform, effective since January 2024, restructured the central health administration and clarified the roles and responsibilities of state agencies subordinate to the MoH.
References
[1] World Health Organization, Global Health Expenditure Database, Health Expenditure Profile (choose country)
