Health reform in NorwayCoordination reform 2012

Starting point (OECD evaluation)

• Norway’s health system is high performing, and delivering high-quality care• System is performing well also when

benchmarked against countries that would be considered peers • Norwegians live long due to good health• Norway has shifted care away from the

hospital sector and towards primary care settings.

The Norwegian Health Care System

• Universal • Mainly

publicly/governmental funded• Two main authority levels

• 428 Municipalities• Primary care

• 4 Regional health authorities• Specialist care

Picture: David Liuzzo /Wikipedia

The Norwegian Health Care SystemMunicipalities • Public health • Prevention • General practitioner services • Basic emergency services • Physiotherapist services • Rehab. & post-hospital srv • Nursing homes • Home based care • Social services

Regional health authorities • Hospitals • Specialist outpatient services • Ambulance services • Laboratory and radiology

services • Transportation • Specialized rehabilitation

• Integrated patient care

• More effective prevention

• Increased user influence

• Services will be provided closer to where people live

• Municipalities should be given greater responsibility

• Specialist and primary care should enter into binding agreements

• Ensuring sustainable development

Objectives of the Coordination Reform 2012

Primary Health Care in Change

• The Government (2015) introduce measures to reduce fragmentation:

• Nurses and doctors working in teams• Stronger coordination within the system• Enhanced professional expertise• Enhanced professional leadership

New process after introduction of the coordination reform

• Common process

• Options when creating emergency care beds in the municipalities and intermediate care departments in the municipalities

Home Hospital Home

Home Hospital HomeEmergency care beds

Intermediatedepartment

Nursing home

Future Development of the Coordination Reform

• Increased use of services at home• Mobile teams to take care of the patients discharged from

hospital and the patients in need of immediate day services• Avoid fragmented patient care• More use of integrated, generics clinical pathways • Reducing patients' stress• Reduce complexity and bureaucracy

Mental Care

• The reform has had effect on mental health

• Strengthening care is delivered by municipalities

• At the same time; increasing specialist services, increasing resources going into the system and making mental health a policy priority.

How?

• Carrot and whip!

• The introduction of the economic incentives under the Coordination Reform

• The municipality is co-funding of hospital care, and financial penalties for municipalities if discharge is delayed

• Use of supplemented primary health care units

Prevention

• Involvement of the patient at all stages

• Focus on lifestyle and exercise/physical activities

• Help to stop smoking

• Eating habits

Challenges

• Aging population

• Refugees/migrants