OECD Reviews of Health Care Quality

English
ISSN: 
2227-0485 (online)
ISSN: 
2227-0477 (print)
DOI: 
10.1787/22270485
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These reviews examine the quality of health care in various countries, highlight best practices, and provide a series of targeted assessments and recommendations for further improvements to quality of care in the subject country.

 
OECD Reviews of Health Care Quality: Norway 2014

OECD Reviews of Health Care Quality: Norway 2014

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English
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Author(s):
OECD
21 May 2014
Pages
200
ISBN
9789264208469 (PDF) ;9789264208452(print)
DOI: 
10.1787/9789264208469-en

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This book presents a comprehensive review of health care quality in Norway. It finds that Norway has an impressive and comprehensive health system, which is the result of sustained commitment to providing health care for the whole Norwegian population, investment in the health system, and readiness to make changes to drive improvements. On most indicators Norway’s health system appears to be performing well, although there is some room for improvement. There have been a number of significant health care reforms in Norway over the last decade, most recently the Coordination Reform, which took effect in January 2012.

Broadly this is a positive story, but challenges do lie ahead for Norway. Norway is putting in place measures to respond to these challenges, notably with the 2012 Coordination Reform, but still has some way to go before the fruits of such labour are truly felt across the health system. Norway’s ambitious reform agenda must now be balanced by structured efforts ‘on the ground’. Attention should now turn to putting in place appropriate data infrastructures, promoting meaningful engagement between key stakeholders, and by balancing a generous health budget that allows for important investments in developing new structures and services with attention to getting the most out of existing services.

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  • Foreword and Acknowledgements

    This report is the sixth of a new series of publications reviewing the quality of health care across selected OECD countries. As health costs continue to climb, policy makers increasingly face the challenge of ensuring that substantial spending on health is delivering value for money. At the same time, concerns about patients occasionally receiving poor quality health care have led to demands for greater transparency and accountability. Despite this, there is still considerable uncertainty over which policies work best in delivering health care that is safe, effective and provides a good patient experience, and which quality-improvement strategies can help deliver the best care at the least cost. OECD Reviews of Health Care Quality seek to highlight and support the development of better policies to improve quality in health care, to help ensure that the substantial resources devoted to health are being used effectively in supporting people to live healthier lives.

  • Acronyms and abbreviations
  • Executive summary

    This report reviews the quality of health care in Norway. It begins by providing an overview of policies and practices aimed at supporting quality of care in Norway (Chapter 1). The report then focuses on three areas that are of particular importance for Norway’s health system at present: the role of primary care physicians (Chapter 2), the shifting of care towards primary care settings and away from the hospital sector (Chapter 3), and mental health care (Chapter 4). In examining these areas, this report examines the quality of care currently provided, seeks to highlight best practices, and provides a series of targeted assessments and recommendations for further improvements to quality of care.

  • Assessment and recommendations

    Norway has an impressive and comprehensive health system, which is the result of sustained commitment to providing health care for the whole Norwegian population, investment in the health system, and readiness to make changes to drive improvements. Despite this positive story, challenges do lie ahead for Norway. As in all OECD countries, changing demographics are putting increased pressure on health services, and with hospital lengths of stay dropping and discharges increasing, many of these pressures will be felt by community and primary care services. Norway is putting in place measures to respond to these challenges, notably with the 2012 Coordination Reform, but still has some way to go before the fruits of such labour are truly felt across the health system. Norway’s ambitious reform agenda must now be balanced by structured efforts "on the ground". Attention should now turn to putting in place appropriate data infrastructures, promoting meaningful engagement between key stakeholders, and by balancing a generous health budget that allows for important investments in developing new structures and services with attention to getting the most out of existing services.

  • Quality of health care in Norway

    This chapter provides an overview of policies and strategies to assure and improve the quality of health care in Norway. After describing the organisation of the Norwegian health care system and the roles of the central government, the county and local level, the chapter focuses on the assurance of the quality of professionals, medical devices, pharmaceuticals and health care institutions. Policies to monitor and improve quality of care are then described, including the Norwegian patient safety agenda, the information infrastructure, and the use of national guidelines and health technology assessment. Specific attention is finally given to policies aimed at strengthening the role and perspective of the patient, as well as contracting and paying for quality.

    This chapter concludes that Norway has an impressive number of quality initiatives, but challenges remain to complete a quality improvement culture with robust assurance mechanisms. Individual professional performance could be made mandatory for all medical doctors, accreditation programme might be set-up for health care facilities and patient safety could be strengthened to more primary care services. The implementation of incentive structures through quality contracting and targeted reimbursement would further enhance performance.

  • Primary care physicians in Norway

    Norway benefits from a strategic vision of how primary care and health care more broadly should develop over the short to medium term, as set out in the Coordination Reform. It also benefits from having several engaged and competent institutions that are ambitious to improve primary care quality. The few broad quality measures that exist suggest that Norway has a high performing primary care sector. In the absence of much central guidance, monitoring or accountability, this is in no small measure due to high levels of trust between those paying for and those delivering primary care and a reform process founded on consensus rather than confrontation.

    The chapter opens with a description of how primary care is organised in Norway, followed by a discussion of key quality initiatives in the sector. It presents some indicators of the quality of Norwegian primary care alongside international benchmarks, describes the challenges facing the sector and closes by discussing recommendations for how primary care can be strengthened and its contribution to continuous quality improvement secured.

  • Shifting care away from the hospital sector and toward primary care settings in Norway

    This chapter describes existing supplemented primary health care units in Norway and it provides advice on how the set-up of these units can contribute to goals of improving quality of care. Supplemented primary health care units are community-based structures created to provide short-term intervention to preserve the independence of people who might otherwise face unnecessarily prolonged hospital stays or inappropriate admission to hospital. Whilst comparable units have already existed for several years in a number of Norwegian municipalities, the 2012 Coordination Reform required their development and has given an added impetus to their systematic establishment. The overarching goal is to boost lower-level care, expand primary care services, and reduce unnecessary hospital admissions.

  • Mental health in Norway

    Norway’s mental health system appears to broadly offer good, appropriate care to the whole population, with Norway having committed significant efforts and resources to improvements across recent decades. These efforts – strengthening care in the community provided by municipalities, increasing specialist services, increasing resources going into the system and making mental health a policy priority – suggest that Norway is moving towards having a strong and comprehensive mental health system. In terms of collecting indicators of mental health care quality Norway is also making impressive progress in many respects.

    However, shortcomings in Norway’s mental health system remain, and Norway can do more to secure high-quality mental health care for the whole population. There are opportunities for Norway to further strengthen data collection and to use data to help drive improvements in outcomes, to ensure that all mental disorders are appropriately treated, to make sure that responsibilities for service delivery amongst health authorities are clearly established and followed through, to promote better co-ordination, and to assure high quality of mental health care across the country.

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