I've been following the diaries on socialized medicine, in part to get some idea of the discussion back stateside, but mostly so that I could jump in with corrections of misperceptions, as needed.  I've been living in Norway for just over 3 years now, and have already acquired a lot of experience with the way the national health scheme here works.  So, inspired by other expatriates who have described their experiences, I thought I would write a bit about how the system here has worked for me.  

Some of the information I'll be giving out will get rather personal, but will be necessary to be able to describe the levels of care that I have received.  Just hop below the fold with me, and I'll do my best to describe the system as it works here.  To make it a little easier to write, I'll tackle this diary as a Q&A.  This diary is not meant to be an all-encompassing analysis of the entire public health system in Norway.  It's about my direct experiences with it, with some mention of problems I've read or heard about.  It is quite possible that I've made some factual errors.

Who qualifies for the public health services in Norway?

Anyone who has permission to live and work in Norway has complete access to the full range of health services that are available, regardless of how long one has lived here or whether or not one has paid any taxes.  When I first got here, it took a month before all of my paperwork was in order and I had my first work visa.  From that point on, I was in the system.

How does it work?  Do I get to choose my own doctor?

Shortly after moving to a new municipality (kommune), it is mandatory that one registers with the Folkeregister, or Public Registry.  Shortly thereafter, you will receive a letter with instructions on how to choose your GP (fastlege), with a list of who is available.  You can also choose a doctor in a neighboring municipality, if you wish to do so.  You are encouraged to do this online, which goes a lot faster.  Each GP has a quota of how many patients they have on their lists; I think the limit is something like 1,100.  If your chosen doctor's list is full, you can still get on it, if you used that doctor previously, then moved away and have now moved back within 3 years. You can change GPs up to 2 times in any calendar year.  You can't always get a same-day appointment with your GP, but if you call their office before 9 AM you are guaranteed to see the on-call physician.  To be guaranteed to see your GP, for a referral or checkup or similar, you need to get the appointment in advance.

Is it free?  Really?

Well, no.  It isn't.  Every year, each person receives a deductible card (egenandelskort) and a deductible which is set by Parliament for each year.  This year the deductible was 1780 kroner, or about $278.  Any time you see your GP the cost starts at 130 kroner, or roughly $20.  A specialist costs 280 kroner, or about $44.  All of these costs go against your deductible, as do certain prescriptions for chronic conditions, something called a blåresept or blue prescription (due to the color of the paper it's printed on).  Transport to and from specialists and/or hospitals is also counted towards your deductible.  This includes use of your own car to drive to a neighboring town for treatment as well as bus tickets, and in some cases, taxis. After you've met your deductible for the year you can apply for something called a free card (frikort).  Anything you pay over and above your deductible until you get your free card gets refunded rather quickly.  This includes transportation costs.  I tend to qualify for a free card by May.  

If you have an emergency, you first go to the emergency room (legevakt). In most cases, you can be treated and released, which costs the same 130 kroner during the day, and 220 kroner ($35) at night or on the weekends. As I recall, you have to pay this cost whether or not you are admitted to the hospital.  However, that is the only cost associated with admission to the hospital in an emergency situation.  My husband has been admitted twice now, both in emergency situations, and not had to pay anything apart from the emergency room consultation.  I am not sure how this works in the case of life-or-death situations, such as serious accidents or heart attacks. In one instance, he underwent a long series of tests, including CAT scans and x-rays, and spent the night in the hospital.  The cost?  220 kroner plus I had to pay to park the darned car.  

For outpatient and day surgeries, the cost is 355 kroner ($56).  I had to have two recently; one was an outpatient procedure to remove a benign skin tumor from my forehead, and was done with a local anaesthetic in an operating room.  (It was a tricofolliculoma, for any docs/Latin nerds out there.) The second was a D&C, to finish off a miscarriage that had started and was taking too much time to resolve itself.  For that, I received full anaesthetic and was in the hospital for half a day; I was able to decide myself when I wanted to leave and also received transportation home via taxi; I live about 60 kilometers from the hospital.  The taxi cost me an additional 125 kroner ($20) but since I was long over my deductible, I get the costs of both surgeries and all transportation refunded.  

In some cases, treatments come with their own co-pays outside of the usual levels.  The example I'm most familiar with is fertility treatments.  These have a lifetime cost limit of 19,500 kroner or about $2,900.  This covers 3 attempts at IVF.  15,000 kroner of this go to the medicines; they cost about 9,000 kroner per attempt so you pay for the first attempt and half of the second.  The remaining 4,500 is paid to the clinic for the actual treatments and covers the medicines the day of treatment, all labwork, and embryo storage for 5 years (after which point they become non-viable, and are destroyed).

What about those long waiting times?

Waiting times depend on the urgency of the problem.  My father-in-law has a pacemaker and when he needed that, of course he didn't have to wait to have it put in.  If you have cancer, or any other situation that requires urgent treatment, you get it.  If you need a knee replacement, or something similar that can wait a bit, you will wait but generally not longer than 6 months.  You also have a right to up to 1 year's paid sick leave, if you are unable to perform your job duties, so it's not like you will be forced to work with a bad knee slowing you down in the meantime.

There are other, more serious situations that unfortunately have a longer waiting time.  Psychiatric services, including counseling and rehab, have about a year's waiting time.  The government is working hard to shorten these, but there is also a shortage of qualified providers in this area.

An example from my experience: I visited my GP to ask for a referral to a specialist, since despite our best efforts, I hadn't conceived after more than a year.  The wait to see the GP was about two weeks, and the wait for the specialist about a month.  When several months' treatment with the specialist had yet to achieve any results, we asked to be referred to the public IVF clinic.  We received an answer from them that there was a 4 month wait, then one week later, we had our first appointment.  So results may vary.  

Another example from experience: the aforementioned tumor.  I had to wait 3 weeks to get the biopsy, then waited about a month for the results because of Easter holidays and a long backlog.  After the results showed that I needed to get the tumor removed, I waited 2 more weeks for the surgery appointment.

What about prescriptions?

I spend 60 kroner a month on metformin to manage my PCOS; that's about $10.  My husband takes pills for high blood pressure; they cost about $15 for 3 months' worth.  The few other common prescriptions I've had (antibiotics, painkillers, cough meds) have been similarly reasonable in price.  I can't say much about other meds at this point.  My metformin was recently switched from one manufacturer to another, who apparently had a lower price.  One thing I will note, however, is that all of my prescriptions are manufactured in Europe, which is reassuring given the recent scandals involving Chinese-manufactured generic pharmaceuticals.

It all sounds so perfect!  What are some problems that still exist?

Hospital capacity is a real problem at all levels: regular hospitals, rehabilitation (physical and drug-related), and nursing homes all lack beds.  Some of the bigger hospitals struggle with "corridor patients" in especially busy times, such as flu outbreaks.  

Another problem is similar to one that is common in the USA.  There is a shortage of GP doctors, which is worse in the countryside such as where I live.  There is so much more money to be made as a specialist in Oslo or Bergen.  

Wrap it up, already!

Ok then. My experiences with the public health system in Norway have been nothing but positive. No worrying about whether some essential item is covered or not, or whether I can afford to treat some problem or other.  That said, it's not entirely problem-free, on the large scale.  And I don't think that the Norwegian model would be very workable in the United States, which has roughly 100 times the population of Norway.  That doesn't mean that I don't believe that some sort of socialized system can be implemented there, and I hope, for the sake of my family and friends still Stateside, that something can be implemented soon.  

EDIT:  I changed the title to "Single-Payer" from "Socialized".

Originally posted to ssundstoel on Mon Jun 29, 2009 at 04:42 AM PDT.


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