Norwegian healthcare system. Comparative analysis of healthcare systems in different countries

Medicine in Norway. The country's healthcare system is constantly in the process of restructuring and change. Today she gets financial assistance from the state and actively introduces modern technologies, in part...

Medicine in Norway. The country's healthcare system is constantly in the process of restructuring and change. Today it receives financial assistance from the state and is actively introducing modern technologies, in particular telemedicine. Quality medical services, the level of attendance and convenience of medical centers is very high - among the best in the world. The vast majority of medical centers in Norway are state-owned. However, over the past five years, the share of private healthcare business has grown significantly. It is the private medical sector that targets foreign patients from neighboring Scandinavian countries, Germany, the Netherlands and some other Western European countries, as well as from Russia and the CIS countries. Doctors and administrative staff of private clinics in Norway are fluent in not only English language, but also Swedish, German and Russian. The cost of most medical services in private centers lies in the range of average prices in Western Europe, but is 20-25% lower than in the UK and Germany.

The real pride of modern Norwegian medicine is wide application telemedicine. In this area, this country shows the best results among Western European countries. Telemedicine in Norway is developing in various directions: radiology diagnostics, general practice, dermatology, laboratory research, psychiatry in Norway, gastroenterology, cardiology and others. The National Center for Telemedicine is coordinating work in this area. Not only video conferences are held, but also consultations with doctors general practice from remote regions of the country, as well as consultations with leading medical centers from other countries.

Foreign patients come here mainly to undergo quality and safe treatment in the field of dentistry, orthopedics, ophthalmology, plastic surgery, as well as for childbirth in Norway. Private clinics treat astigmatism, myopia and farsightedness using the most modern laser equipment. Among patients from abroad, dental services are most in demand. Most often they are interested in: surgical dentistry(sinus lifting before implantation, etc.), prosthetics (metal-ceramics, metal-free ceramics), cosmetic teeth whitening, veneer coating, different kinds therapeutic treatment, orthodontic therapy (including braces), pediatric dentistry. Behind last years The number of pregnant patients coming for help from Norwegian doctors has increased significantly. According to the results of a study conducted International Foundation Help for Children, this Scandinavian country is recognized as one of the countries in the world that provides the most comfortable conditions for the birth of children and postpartum rehabilitation in Norway. The services of Norwegian specialists in the field are becoming increasingly popular aesthetic medicine and plastic surgery. The most popular surgeries include: breast augmentation and reduction, removal of age wrinkles, contour facelift, rhinoplasty. These procedures are equally popular among both women and men.

Resorts and spas in Norway. The country of white nights, fjords, waterfalls, northern lights, Vikings and trolls has been attracting lovers of pristine nature and a fantastic atmosphere for decades. Picturesque views, secluded bays and islands, mountains and hills surrounded by a sea of ​​greenery, thousands of clean lakes and rivers, waterfalls, unique flora and fauna - all this creates the ideal atmosphere for wonderful relaxation and recovery, strengthening the body. Among the majestic glaciers and coniferous forests, in the mountains and on the shores of lakes, there are many comfortable spa centers and recreational resorts, which offer both modern procedures and treatments, as well as those borrowed from the original people of Lapland - the Sami. Leisurely walks and boat trips, peace and quiet restore internal balance and harmony, and exquisite spa treatments replenish the body's vitality, youth and immunity.

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Since I am not a doctor or a professional patient, I have the information at the level of an ordinary person. But this will be quite enough for the overall impression.

Let me start with the fact that it is difficult to become a doctor here. First, you need to graduate from school with only A's (here the letter A replaces A), it seems that only 4's are allowed. Then it will be a long and difficult time to study at the university. If you are a doctor from another country, you will have to confirm your education. For residents of Europe, the rules are simpler; for Russians, for example, starting a practice will be more difficult. The rules change constantly. More precisely, they are constantly becoming tougher. There is no special reverence for Russian doctors.

Norwegians are a special nation when it comes to their attitude towards illness. Their main difference from Russians is that they rarely go to doctors. By our standards, they are not treated here at all! They have a wonderful medicine without a prescription - Ibyux, which replaces a whole range of medications. There are 3 types available - weak 100, medium 200 and strong 400. Paracetamol is also in favor, here they are called Paraset.

Norgs are initially less susceptible to disease. Since childhood, they have been riding bicycles in the rain, they wear decorative scarves, and storms and snowfall are no obstacle for them to go about their business. Viking Nation!

The law provides for the opportunity to take three days for self-treatment 4 times a year. Usually a normal cold goes away within this period. After three days I need to take sick leave already.

Doctors see you for a fee. Each resident of the country is assigned to one doctor (you choose yourself through your personal page on the Internet), where he runs in cases of illness. Doctors make house calls only to children (and not always) and in small towns. In Oslo, you always go for a life-saving recipe yourself. The bill for the appointment is partly paid by the patient, the rest by the state. If a person is very sick and his annual treatment costs exceed a certain amount, a special card is issued and from then on the state covers all expenses.

There are also private doctors. It is easier to get an appointment with them, but you will also have to pay in full. And this is five times more expensive.

A couple of years ago I became very ill. At the same time, I suffered from several illnesses at the same time. And one fine day I literally fell. I called my medical center and asked to see me as soon as possible. The answer I heard on the phone was that it would be soon in 2 weeks. I didn’t have the strength to argue with them, and the next day I went to the Volvat private clinic. They admitted me almost immediately, convened a council of doctors, gave me sick leave for 4 (!) days, prescribed an antibiotic and sent me home. I was sick for another three weeks, by the way... I was treated mainly with sleep and hot tea.

On the one hand, I also adhere to the position: the less medications you take, the better. However, I am very bothered by the difficulties of getting an appointment. For example, today I was scheduled for 11.10, and I saw the doctor an hour and a half later. And I’m even lucky!

The conclusion is this: it’s better not to get sick :-)

I have heard more positive things than negative things about childbirth and the treatment of serious illnesses.

Like many of my Russian friends who have scattered all over the world, I have a box with domestic medicines. Classic fairvexes, activated carbons, noshpas, suprastins and other joys travel in the suitcases of Russian women all over the world. One day, the husband stayed in London with his childhood friend, and he was married to a Russian young lady. In a tragic whisper, he invited my sweetheart into the kitchen to demonstrate the healing box. And if my box is delitant, then hers is a real pharmacy (my mother is a doctor).

Treating animals is also very expensive. Unfortunately, some surgeries are so expensive that many choose to euthanize their pets. A friend's cat was diagnosed with diabetes. She paid 2,500 kroons (10,000 - 12,000 rubles) for an appointment with a veterinarian and a couple of tests; the operation on her neighbor’s dog cost 15,000 kroons (more than 60,000 rubles).

The ambulance leaves only in the most severe cases. Helicopters fly to hard-to-reach places.

Michael Tanner

Norway

In Norway the system health insurance is universal, tax-financed, and built on a single-payer basis. The nationwide insurance system covers all Norwegian citizens, as well as foreigners living and working in the country. Norwegians, however, have the right not to use the public system, paying for medical services directly from their own pockets. In addition, many of them go abroad for treatment to avoid the “waiting lists” that have become widespread under the state system.

The system is financed by general tax revenues to the budget: there are no targeted taxes for health care in the country.

Thus, healthcare is the most important factor contributing to the high tax burden in Norway - taxes in this country amount to 45% of GDP. Of all industrial developed countries only in Sweden the level of taxation is higher.

Insurance covers quite wide range services: outpatient and hospital treatment, diagnostic examinations, specialist care, maternal and child care, preventative health care, care for the terminally ill and prescription drugs. There is no charge for stay and treatment in public hospitals (including medicines). However, a small patient share may occur if we're talking about about outpatient treatment, services of therapists, psychologists and psychiatrists. The program also provides sick leave and disability benefits. As Michael Moore noted, the Norwegian health insurance system in some cases even provides for payment for treatment mineral waters.

Although overall management of the system is carried out by the central government, some managerial and financial functions are delegated to regional and municipal authorities. As a rule, municipal authorities are responsible for primary medical care, and the authorities of four regions of the country - for the services of specialists.

Before 2002 public hospitals were under the jurisdiction of local or district authorities. However, due to chronic problems- primarily due to long waiting lists for treatment and rising costs - in January 2002 the central government took over direct management of these institutions. In addition to state medicine, the country also has a small amount of private hospitals.

The state develops a single budget that limits the total amount of health care spending and sets the cost of fixed assets for hospitals. Most general practitioners and non-hospital specialists receive a fixed salary, although some contract specialists receive fees for services rendered in addition to an annual grant. Compensation levels are set by the government; Additional invoicing is prohibited. Most other doctors are salaried government employees.

The patient's choice of doctor is limited. All Norwegian citizens must choose their GP from a list compiled by the state. This general practitioner serves as the “dispatcher” for other health care services and their providers. A citizen can change a doctor, but no more than twice a year, and only if the new therapist he has chosen does not have patients on the “waiting list.” You can only get an appointment with specialists with a referral from a therapist.

Within the Norwegian health care system, serious problem long - and ever-growing - queues for medical services. It is estimated that at any given time, 280,000 Norwegians are on "waiting lists" - despite a total population of 4.6 million. Waiting time for replacement surgery hip joint on average exceeds four months, for a prostatotomy - almost three months, and for a hysterectomy - more than two months. Approximately 23% of patients referred for inpatient treatment must wait more than three months before a hospital can admit them.

The Norwegian authorities have responded to this repeatedly unsuccessful attempts Legislatively prohibit "waiting lists". For example, according to the 1990 Patients' Rights Act, people whose illness results in "catastrophic or extreme serious consequences", must be provided with appropriate treatment - if possible - for six months. In 2001, after a series of government inspections revealed numerous violations of this regulation, the government issued new act, requiring that the patient's condition be at least"studied" within 30 days. Despite all these paper guarantees, there is no significant reduction in the waiting lists.

Moreover, given the rationing of health services in Norway, such delays in medical care may represent just the tip of the iceberg. In some cases, a patient may simply be denied medical care if it is deemed unprofitable. Knut Erik Traney, emeritus professor at the Center for the Study of Medical Ethics at the University of Oslo, who has been a member of the government's Health Priorities Commission since its inception, explains: “It must be taken into account that

1. V public service In Northern European healthcare, any given amount of resources can always be used in different ways. Besides,
2. It is neither medically nor morally justifiable to use scarce resources for purposes that are likely to produce less beneficial results than other uses - saving fewer lives, curing fewer patients" .

Traney distinguishes between Norwegian-style medicine and “a system in which patients purchase services in a market where fairness means equal opportunity to get what you need. There decisions about alternative options resource use is accepted mainly by patients."

Although surveys indicate that Norwegians are generally "very satisfied" with their health care system, there is growing dissatisfaction with issues such as choice of health care provider, participation in decisions about care or treatment, and waiting lists - which are a recurring issue in Norway. political discussions. So far, however, there is no broad movement for serious medical reform in the country.

The Kingdom of Norway is a state in Northern Europe, occupying the western and northern parts of the Scandinavian Peninsula and part of the Arctic archipelago of Spitsbergen. Norway is a country that can serve as a model for policy that is reasonable in all respects.
The quality and availability of medical services in Scandinavia, and Norway in particular, are known throughout the world. Scandinavian countries are often jokingly called “countries of victorious socialism,” and there is some truth in this joke. Indeed, the basic principle of Norwegian medicine is to provide medical care to all residents of the country, regardless of their social status and the thickness of their wallet.

The Norwegian healthcare system is constantly evolving and reforming. The first state medical institutions were founded here in the 18th century, and specialized clinics and psychiatric hospitals appeared only towards the end of the 19th century. Today, 420 thousand people work in Norwegian healthcare; the average salary in the industry is about 3.5 thousand euros per month. Long-established and firmly established local self-government continues to develop: regional and local authorities are taking on more and more functions central authorities.

System management and structure
The Norwegian health care structure has three main levels, which correspond to three levels of government: central, regional (19 counties) and local (435 municipalities). To avoid duplication of medical services, the country recently abolished the Swedish-Finnish system of hospital care, under which it was carried out by regional authorities. The country was divided into five medical-territorial districts, which are governed by the county. Local authorities are responsible for organizing medical care; At the central level, only regulation and supervision are carried out. All permanent residents of Norway are covered by public insurance. However, healthcare in Norway is financed by the state. The government pays most of the cost of medical services - approximately 95%. During pregnancy and childbirth, assistance is provided free of charge.
Central level. The central health authorities include the Ministry of Health and social security, State Institute public health and State Council on health care. The Ministry is responsible for developing health policy, its legislative framework and main directions of development, budgeting, planning, organizing an information network. The state coordinates the activities of the Institute of Public Health and some other scientific and preventive institutions. The State Board of Health is an independent professional organization that, together with the county health services, oversees and ensures compliance medical care quality standards and laws. Highly specialized care (eg, treatment of rare diseases, organ transplantation) is provided at the national level.
Regional level. At this level, hospital and consultative care is provided. In outpatient departments, specialist consultations are provided for patients with referrals from a general practitioner and specialized hospital care is provided in hospitals. To ensure highly specialized medical care was effective and cost-effective, since 1974 the country was divided into five medical-territorial districts, in each of which a district health committee was established. In the early 1990s. the state decided to expand their responsibilities: starting from 2000, each district is obliged to submit to the Ministry of Health its long-term health care development plan in accordance with the main directions of state policy in this area.
Local level. The country's 435 municipalities are responsible for financing and organizing primary health care and medical and social services.
Typically, a municipality has three departments: medical care, patronage and home care, and social security. To ensure that health and social services meet the needs of the population, in 1986 municipalities were given the right to determine their own priorities in their financing and organization.
This level includes all types of primary health care provided by a general practitioner. This includes a medical center, a nursing home and a home for elderly people in need of care. The medical center has 1-2 general practitioners, a physiotherapist, nurses and midwives. At the initial visit, the patient is consulted by a general practitioner. Here patients are monitored and patients undergo a period of follow-up treatment by a physiotherapist. The medical center provides monitoring of children, pregnant women, and vaccinations. If necessary, the patient is sent to a regional medical facility.

Features of medicine financing
Distinctive features of Norwegian healthcare are financing primarily through taxes, which are the highest in the world and amount to about 50% of population income, the predominance of the public sector and a small share of paid medical services. All permanent residents of Norway are provided with medical care. The state also pays for them medical vouchers to any resort. Funding is provided by central, regional and local authorities (municipalities have the right to introduce local taxes in addition to national ones), as well as the state insurance system.
Local governments receive government funding based on population size. Local health services receive funds from the state budget (general and targeted subsidies), the state insurance system (insurance compensation) and from the population ( paid services). Although the state does not directly influence the distribution of funds, in practice the independence of local authorities is limited by the standards and financial policies it sets.
In 1997, the county's share of health care funding declined to less than 30%, while the share of government spending by the end of the 1990s. increased to 50%. Since many patients are treated outside their county, there is a cross-payment system: the county where the patient lives reimburses the costs to the county in which the patient was treated. The state insurance system finances healthcare by approximately 17.9% (covers the costs of medicines and transportation of patients, pays for the services of private practice doctors working under contracts). Doctors receive a salary from the municipality, as well as payment from patients, which can amount to up to 70% of a family doctor's income. If necessary family doctor refers the patient to a specialist. In this case, payment is made at the expense of the health insurance fund.
Global budget funding introduced in 1980 has forced some counties and hospitals to narrow their scope of activities due to budgetary constraints. Long waiting lists for hospitalization forced the adoption of the current funding scheme in 1997, which takes into account the volume of services provided by the hospital. The main goal of the innovation is to increase the efficiency and profitability of hospitals. Although the introduction new system funding was voluntary; by 1999, all counties had switched to it, with the exception of one.
Voluntary insurance in Norway is poorly developed. The main source of additional financial income is paid medical services. A visit to a specialist at a hospital outpatient department costs at least 19 euros. In addition, in such departments, patients pay part of the cost of laboratory and X-ray studies, some medicines. Co-payments apply for treatment by general practitioners, out-of-hospital specialists and psychotherapists, for some medications and for travel costs associated with examination and treatment. Copayments for medical services account for about 10% of health care costs. In the early 1980s. a maximum level of citizens' spending on paid medical services, including medicines, primary and outpatient medical care has been introduced. Individual groups of the population and patients with certain diseases are exempt from copayments.

Levels of care
Primary health care. Municipalities are responsible for primary health care, including prevention and health promotion, diagnostic and therapeutic interventions, rehabilitation and long-term care. The municipal council approves a healthcare development plan in accordance with the needs of the population living on its territory. Local authorities determine the amount of healthcare funding themselves, and the list of medical services that they are required to have is established by the Law on Healthcare and the Powers of Local Authorities. Each county has an official responsible for overseeing these services. There are also seven specialized medical-administrative institutions subordinate to the Ministry of Health that provide expert opinions. State preventive programs, for example for the early detection of breast and cervical cancer, are implemented under the guidance of relevant specialized institutions. The leading role in primary health care is played by general practitioners, most of whom are united in groups of 2-6 people with assistants, the number of which depends on the funds allocated by the municipality. Typically, general practitioners specialize in general or family medicine. Most general practitioners are municipal employees or private practitioners working under contracts with municipalities.
Patients are not limited in any way when choosing a general practitioner. The patient has the right to choose his own doctor twice a year. Physiotherapists and chiropractors can treat you without a doctor's referral, but the treatment will be more expensive because it is not covered by government insurance. Specialist doctors receive payment for services from state insurance funds only if the patient is referred to them by a general practitioner. IN Lately Demands on general practitioners have increased. First, the number of hospital beds and length of stay have decreased. Based on this, improving the work of general practitioners has become one of the top priorities. For this purpose, official registration was introduced throughout the country in 1997 taken by a doctor patients, and his income began to depend not only on the size of the population served, but also on the medical services provided.
Specialized medical care. Since 1969, for the planning, financing and organization of specialized medical services (general hospitals, psychiatric clinics, laboratory and other specialized medical services, dental clinics for adults) correspond to the county. The county is quite independent in organizing and managing hospital care. Each of Norway's five health districts has a district hospital that provides highly specialized medical care. All district hospitals serve as teaching facilities; four of them belong to the county, the fifth is national. Several hospitals are owned by voluntary organizations, but the status of these hospitals is practically the same as that of public hospitals. The private practice segment is insignificant. Norwegian laws strictly restrict the activities of private hospitals, where most laboratory and radiology tests are performed. There are also about 30 private laboratories and other institutions involved in diagnostic studies. Private institutions are financed by public insurance.
Thanks to the strengthening of the role of outpatient care and the development day hospitals average duration hospitalizations are declining. Average bed occupancy in Norway is higher than in many others European countries, while the utilization rate of inpatient treatment is relatively low. Over the last decade, the most pressing challenge in healthcare has been waiting lists for hospital care. They tried to solve this problem different ways. Now the situation has improved somewhat.
Parts of Norway, especially the north and the islands located in the North Sea, allocated to the fifth region, have a very low population density and a relatively weak transport infrastructure. Particular attention in this region is paid to the development of telemedicine, that is, remote methods of consultation and diagnosis using the most modern telecommunication technologies, in particular video conferencing. People in need of help are transported to the place of medical care by helicopters or airplanes.
Medical and social services. Social services in Norway are provided according to a decentralized model. The state is responsible for policy formulation, staff training and legislation, while municipalities are responsible for service provision. The latter mainly receive funds for services through subsidies from the state. For some areas of special attention, municipalities receive “targeted” grants. These are, for example, services for older people or measures to ensure that people with mental disorders could live in their own homes with adapted services, as well as participate in work and leisure activities.
Examples of social services:
– practical assistance to people who need it due to disability, old age, etc.;
– emergency assistance to people and families with complex care needs;
– support for people who need help in organizing leisure time and establishing contacts with other people;
- shelter services.
Alcohol and drug addiction treatment services are integral part medical services.
In addition, municipalities are responsible for preventing social problems. Mostly they provide everything social services independently, but in some cases municipalities purchase services from private organizations, in particular from many humanitarian and religious organizations regarding the organization of services for the elderly, disabled, people addicted to alcohol and drugs. In addition, over the past few years, many commercial organizations have begun to offer services such as care for the elderly and disabled, as well as full-time care or day care for people who have complex health care needs.

Chronology of reforms
Reforms of the 1990s were mainly aimed at increasing the efficiency and accessibility of medical care and reducing queues for hospitalization. In 1993, a list of basic prices for medicines was established (and expanded in 1998). At the end of the 1990s. The funding scheme for hospitals and the terms of payment for private practitioners have changed. In 1998-1999 a number of laws have been adopted, some of them deserve special attention. First, district health committees were given the responsibility of planning health development in their district. Secondly, under the Specialized Health Care Act, mental health services were merged with other medical services, and the organization long term care for patients with mental disorders is entrusted to municipalities. Thirdly, such rights of patients as the right to choose a hospital, to provide consultation with a specialist no later than 30 working days after receiving a referral from a general practitioner, to consult another doctor were legalized. Patients who require long-term complex treatment have the right to individual plan medical care, allowing you to coordinate the actions of different services. In the spring of 2000, a system for registering patients in primary health care institutions was introduced. Among other things, this system allowed citizens to change personal doctor and, if desired, seek advice from another general practitioner. Recent reform has entailed the unification national system Insurance and National Employment Service - NAV. This reform involves the creation municipal departments responsible for providing public services related to national insurance and employment. In the future, it is planned to remove restrictions from the pharmacy chain in order to increase competition in retail trade medicines; provide hospitals with greater independence in matters of organization and management.

Problems and prospects
A negative aspect of the Norwegian healthcare system is that hospitals are too large in capacity, which does not contribute to better conditions stay of patients in them. Overall, Norwegian health care has made great strides since reform began, but will face new challenges in the future. For example, combine decentralization of health care with government regulation guaranteeing universal access to medical care. To solve this problem, the following areas of reform have been chosen: reducing queues for hospitalization, especially for certain categories of patients; strengthening planning at the level of medical-territorial districts; supervision of the official registration of patients in the primary health care system. In addition, in the future it is planned to introduce new methods of managing hospitals and new forms of ownership, provide medical personnel to all regions of the country, and clearly separate the functions of the central authorities and the county in the financing of hospitals.

Prepared by Andrey Martynovich

The article was published in issue 22, November 2008, on pp. 18-19

The quality and accessibility of medical services in Norway are known all over the world, because the main principle of Norwegian healthcare is to provide medical care to all citizens of the country, without exception, regardless of their social status and the thickness of their wallet. Norway ranks third in the world, after Luxembourg, in terms of health care spending per capita.

In Norway there are three levels of medical care, which are represented by four types of medical institutions:
- hospitals general type, located in each district and containing more than 13 thousand beds;
- outpatient facilities where general practitioners practice (they make up about 26 percent of all doctors in the country);
- psychiatric hospitals available in each district;
- university clinics that provide highly specialized medical care.
A university clinic often exists alone in several districts, thus creating a larger administrative territory. This is done due to the fact that the sizes of Norwegian districts are uneven and most often small (the population in them can vary from 50 to 500 thousand people), and the provision provided in each of them is only inpatient care the general type is not appropriate in all cases. Therefore, each of the districts is assigned to a specific clinic that provides specialized care and thereby ensures access to the necessary medical care for everyone in need.
Every person living in Norway on a permanent basis has municipal insurance, thanks to which the vast majority of medical services, namely about 95 percent, are provided to him free of charge, since the financing of the country's healthcare system is a state matter. If we go into detail, then members of the medical and social insurance everyone who works and pays taxes in Norway becomes. The contribution to the fund is deducted from the salary.

The primary role in medical care belongs to general practitioners, most of whom are private doctors working under a contract with the municipality or city employees. The patient has the right to independently choose a general practitioner twice a year, if for some reason he is not satisfied with the existing one. Through the general practitioner, a request for other specialist services occurs, necessary research etc. Treatment by a physiotherapist and chiropractor it is possible without a referral from the treating doctor, however, in this case the treatment will cost much more, since it is not covered by municipal insurance.
In case of injury or sudden acute illness the patient, including during non-working hours, has the right to contact the On-Duty Medical Service; there are points in every city. In particular in case of emergency It is possible to call an ambulance. If hospitalization is necessary, the patient has the right to choose his own hospital. Elderly people who require special medical care, access to obtaining it in a nursing home has been achieved.

But one cannot look at Norwegian medicine only in a rosy light - despite significant efforts on the part of the government to constantly improve the healthcare system and full access to medical services for all citizens of the country, a serious problem of “waiting lists” is currently gaining momentum. According to preliminary estimates, in recent years more than 280,000 Norwegians are on waiting lists, with the largest queues being for inpatient treatment.

The patient participates in the payment of medical care when it comes to the services of therapists, psychiatrists and psychologists, as well as outpatient treatment. At the same time, Norwegian citizens retain the right to choose to participate or refuse the state insurance system, then they pay for medical services from their own funds without paying tax.

Voluntary health insurance is not developed in the country, as it is not in demand. The source of additional financial income is paid medical services. At the same time, at the beginning of 1980, Norway legally established a maximum level of monetary expenses for citizens to receive paid medical services, including medicines, outpatient and primary care. Above this level, the state bears the costs. Certain groups of the population (socially vulnerable groups and some others), as well as patients with certain diseases, are exempt from any additional payments by the state.

Norwegian social regulation affects approximately 30 thousand people living in the country illegally, whereas until recently they were entitled to medical care only from emergency services in critical and emergency situations.