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Using the World Health Organisation (WHO) health systems framework(or other relevant framework), describe the health system of your allocated country- NORWAY and evaluate the performance of the country’s healthsystem over an appropriate period of time, including recent policies and/or attempts at health system reform. Discuss the future challenges and emerging issues that are likely to impact on the health system of your chosen country. Lessons learned from other health systems, includingwithin the region(from Assessment Task 2), can be included in your analysis.Your report must include a detailed evaluation of the performance of your allocated country’s health system, for example:

1. An analysis and critique of health system policy and initiatives focusing on key institutional, social, cultural, economic and political influencing factors; and 
2. An analysis of past and future health system reforms; including in response to emerging issues identified within the region .

The Three Types of Healthcare Systems

Healthcare system in Norway is based on the principles of decentralization, universal access and the free choice of the preferred health service provider

Healthcare is considered to be a very significant facet of any given nation, as without it, a country would fail and struggle to exist. Thus, the types of healthcare system a nation chooses to depend upon is vital, depending on whether she wants to please, the poor, the rich citizens or to serve them equally. There are three types of healthcare systems, that is, the universal healthcare systems whereby the cost of healthcare is covered by the existing government, private healthcare system in which people have to pay for the healthcare services provided to them and additional private sectors which are extra clinics or hospitals to universal care, accessible to individuals to get healthcare services paying from their own pockets. According to the world health organization (Gearhart, 2016), health care system contains people, actions as well as organizations having basic and key interest is to maintain, restore and promote health. Health systems can be explained as a whole through the use of various blocks or groups.

There are six different building blocks that has been used to explain health systems; service delivery which states that a good health service delivery should be effective, safe and offer quality interventions to the people who need such services. A health workforce which is described as one which operates in a manner that is efficient, fair and responsive so as to achieve quality results using the available circumstances and resources. health information system is also one of the building blocks of health system and it ensures that there is utilization, dissemination, evaluation and the manufacture of appropriate and consistent information on the performance of the health systems, health status and health determinants. Important health products, technologies and vaccines. These technologies and products must be of high quality, cost effectiveness, safety and efficacy. Another important health system blocks is the financial system which is required to raise and provide funds for health in a manner that ensures that the society can use the basic services as well as being protected from impoverishment and financial inefficacies which result from low funds (World Health Organization, 2002). The last health system blocks are the governance and leadership which entails ensuring sustainable policy framework are put in place and effectively implemented.

Based on the, per head analysis, the health care service expenditure in Norway is considered as one of the highest expenditures globally. Every member of the country has the non-discriminatory constitutional right to have access to equitable, safety and quality healthcare service in the country. Even though the country has free treatment, there is a yearly limit on the amount an individual has to pay for the services provided.

The Six Building Blocks of the Healthcare System

The health system is Norway is organized nationally by the government. Healthcare system in the country is Beveridge-oriented yet it is not organized as the initial Beveridge system of the Great Britain (Marinova, 2017). The system in the country is semi decentralized with specialist care falling under the sole obligation of the government while primary care falling under the responsibility of the municipalities. The healthcare system in the country is mostly financed by the local and central governments, the out of pocket payment and the national insurance scheme. However, the primary care is funded by the block grants coming from the central government, specified grants and the municipal taxes (Ringard et al, 2013). The overall control and responsibility of coordinating health care systems in Norway is under the care of the Government and the government has the direct responsibility and coordination department of care and health services. It should be noted that the care and service ministry has the mandate to establish a good, adequate and effective health care service to the citizens as well as organize the care and health service via a great host of lawful requirements, and in association with different state authorities (Regjeringen, 2016).

The care and health service ministry have the mandate to the four regional health authorities, that is, North, mid of Norway, southeast and the west. The four regional authorities offer special and unique health care service via psychiatric health centers, somatic health centers and are also offering ambulance services.  Even though are offered via the unique healthcare service, psychiatric services are also partly being offered via primary care services. The country has nineteen counties in which each county is in charge of the communal dental services. Nineteen regional states have also mandates of offering adequate as well as quality dental related services via chosen groups of the citizens. The main reason why counties use chosen groups of citizens is that the people has to have equal right in receiving dental related services of efficient quality which will eventually create a strong foundation for effective and best dental health.

                                                                            

The state has the direct responsibility and authority over all the municipalities, however, the same government has indirect control and authority over primary care and health services. the country’s municipalities have the direct and straight authority and control of primary care and health service and the such service is funded via income from the tax and the government transfers. The financial capital spent on the primary care and health service is viewed and described as free income; capital is not stated and required to be used on precise services. nevertheless, municipalities have the mandate of offering definite health and care services having specified content, a degree of safety and quality, in accordance to various legal requirements of the country.

Healthcare Expenditure in Norway

According to Regjeringen (2013), the primary care of the country consists of the nursing homes, day care to the aged members of the society, homecare services, health services to various learning institutions, services which are offered to individuals having mental problems and the each of these primary care services are monitored via set legal requirements.

Homecare service is one of the biggest primary care and medical service as well as is also part of the of the primary care service in the country. The provision of equitable, safe and quality homecare service is the responsibility of the municipal authorities in the country and they are regulated by various legal requirements (Valentina, Gutiérrez and Carlos, 2013). The citizens reach these services through the application to the local agencies that have the mandate to handle every application by the citizen. After the application, it is normally assessed by the local authorities in order to ascertain and decide on the forms of services the applicant need. The most form of the homecare services is that after the application is made, the municipalities are to consider the recipient as an individual in the process of coming up with a care plan resulting in a greatly customized care service (Holm, Mathisen, Sæterstrand & Brinchmann, 2017). Most of the homecare services include caring of patients having short term illness, medical administration, caring of patients with long term illness, psychiatric and somatic services and practical assistance.

Due to the wide array of various medical condition in the clients, homecare amenities, thus require holistic collaboration of all the health stakeholders especially among the professionals like nurses, physiotherapists, ergo therapists and the health care specialists (Van and Jerry, 2013). These professionals normally have a leader who has the responsibility to manage day to day operations. These professionals operate in close proximity with the various elements in the basic care and the local authorities so that they can be able to offer the clients quality and interdisciplinary care.

As mentioned earlier in this article, the municipalities are responsible for the delivery of primary in line with the present legislation, directives of the government and the requirements to deliver quality health care as spelt out by the health directorate. The GP scheme in which the public register having one health practitioner do cover about 99.5% of the population. Research indicated in 2015 that there were about 1128 patient per GP. The law allows individuals to change their respective GP twice annually. There is always a contractual agreement between individual GP and the municipalities in which the individual GP normally receive capitation of about 36% of the income from the municipalities, service fee from the health economics administration of about 36% as well as out of the pocket of about 31% from the patients. Financing of the GP is influenced at the national level by the negotiation between the medical association of Norway and the health ministry (Ramstad, Jahnsen & Diseth, 2016). In the service fee scheme, there are various fees that are offered for the reconciliation of the medical services, for having taken part in the care coordination and in taking part in the coordination of the follow up as well as the creation of the personal plans for the clients who have complicated and intricate needs, however, these have been reported to be relatively low.

Organization of Norway's Healthcare System

Specialist care in Norway; the regional authorities which are managed by the state do report to the health ministry and have the responsibility to supervise specialist in-patient psychiatric and somatic care and substance abuse and alcohol health related treatments (PR Newswire, 2015). Health ministry is responsible for offering budgets of the regional authorities and the issuance of the yearly document with instructions to the authorities’ priorities and aims. Outpatients care is offered by the private specialists (Fønnebø & Launsø, 2009) as well as the hospital specialists who are paid by the government. In is important to note that the private specialists are usually contracted by the regional authorities who are paid yearly contract money based on the number of clients served on the 36%, service fee payments of 36%, and the copayments by the patient list and the type of service offered to the client (The European observatory on health care systems, 2000).

It should also be noted that the yearly contract money is set by the state while the service fee is decided between the medical association of Norway and the state. in the actual sense, clients do have the freedom to choose their specialist, however, in practice the availability of specialist is determined the geographical location of the client.

Public hospitals owned by the state and are officially registered with executive board and managed as public entities owned by the state (Norway - Healthcare Providers,’ 2018). however, few hospitals are privately owned while some are owned by the nongovernmental organizations. Clients normally have the freedom to choose their respective hospitals yet for any cases of emergency they do not have such freedoms (Danielsen, Garratt, Bjertnæs & Pettersen, 2007). Public hospitals are funded by the regional authorities. Mental health cases are fully funded by the block grants while somatic services are funded only by 50% of the block grants. Mental health care is offered by the GPS as well as other health professionals like the social care staffs, psychiatric nurses or the psychologists employed by the municipalities. In case of any specific care service, GPs normally refer individuals to either private-owned psychiatrists or the psychologists or they can be referred to a district psychiatric center (Sun, Ahn, Lievens & Zeng, 2017).

The state strategy and health paper for quality improvement in social and health services which was conducted between 2005 and 2015 emphasized on the patient-centered care, equity, continuity, care coordination, efficiency, safety and efficacy in healthcare access (Lindahi, 2018).

Primary Care in Norway and the Role of Municipalities

Norway is currently facing new challenges in healthcare delivery based on the aging population just like other western countries in Europe. Therefore, to improve on the development healthcare and quality delivery of healthcare services, the country has to emphasize and put more focus of prevention of illness and health promotion. There are different reforms in the healthcare sector;

In the 1990s, there were a host of reforms that were formulated and implemented in the country. The regional planning of healthcare service reforms in the health laws were discussed in 1998 and came into effect un 1999 after being passed by the parliament (Regjeringen. Helse- og Omsorgsdepartementet. 2016). The laws were formulated on the premise of the introduction of new laws that could regulate the responsibilities and roles of regional authorities. The major purpose of the reform was to enhance both the regional and national planning so as to ensure labor division and coordination in the counties (OECD. 2014).

Another reform was based on the specialized healthcare service. The law or the act contains the policies on the specialized somatic services as well as the regulations touching on the organizations and financial questions concerning mental health care. This can be translated ad found in the Hospital act of 1969 and the mental health act of 1961 (Ringard, Segan, Sperre Saunes & Lindahl, 2013).

A host of proposal have been mooted to offer reforms in the drug market. The proposals have revolved around the liberalization of the retail market which will enable free development of new ownership and pharmacies by individuals who are not professional pharmacists so as to increase outlet numbers in the country.

Even though healthcare system in norway has been hailed as one of the best in the world (Buttigieg, Rathert & Eiff, 2015), it has some glaring challenges that must be addressed by both the national and regional authorities. With the development and improvement in the health sector, the country has seen increased population increase and government has majorly left out its focus on the aging population (Gupta, 2013; Haugan, 2016). The current trend in the county is to offer health services and less cash benefit to the elderly, the children and some personal health issues.

Healthcare systems in the country is highly decentralized which is characterized by greater levels of medical professional medical expertise, education and fair service distribution. however, the greatest challenge facing health care system in the country is meeting the over increasing and dynamic expectations of the public and the service gaps. Waiting lists as well as the rationalization of the health services pose vital challenges in the current health care system. Another challenge affecting health care system in Norway is due to the inadequate collaborations between different stakeholders which affect quality delivery of clinical work. It should effective and efficient collaboration has to be realized between the health care providers and the patients. There is also lack or inadequate collaboration between the patients and the health care professionals in a system that is viewed as fragmented. Another important challenge facing the health care system in the country is the increased expenditure which is associated with increase in the cost of production and development drugs which further escalates the prices of drugs in the country. This has the ripple effect of raising the overall need in setting up priorities in the health sector.  

Homecare Services in Norway

Conclusion

Healthcare systems very important for any country and for its survival. Healthcare system in Norway has been hailed as one of the best in the world, however, there are some challenges that has greatly faced the system. In order to curb and maintain these challenges, the government has come up with various reforms and policies that will enable healthcare system to sustainably meet the needs of the people.

References

Buttigieg, SC, Rathert, C & Eiff, W von 2015, International Best Practices in Health Care Management, Advances in Health Care Management, Emerald Group Publishing Limited, Bingley, U.K.,

Danielsen, K, Garratt, AM, Bjertnæs, ØA & Pettersen, KI 2007, ‘Patient experiences in relation to respondent and health service delivery characteristics: A survey of 26,938 patients attending 62 hospitals throughout Norway’, Scandinavian Journal of Public Health, vol. 35, no. 1, pp. 70–77, 

Fønnebø, V & Launsø, L 2009, ‘High Use of Complementary and Alternative Medicine Inside and Outside of the Government-Funded Health Care System in Norway’, Journal of Alternative & Complementary Medicine, vol. 15, no. 10, pp. 1061–1066, 

Gearhart, R 2016, ‘The Robustness of Cross-Country Healthcare Rankings among Homogeneous Oecd Countries’, Journal of Applied Economics, vol. 19, no. 1, pp. 113–143, 

Gupta, N 2013, ‘Models of Social and Health Care for Elderly in Norway’, Indian Journal of Gerontology, vol. 27, no. 4, pp. 574–587, 

Haugan, S, 2016, Norwegian Welfare System Facing Major Challenges. https://www.forskningsradet.no/en/Newsarticle/Norwegian_welfare_system_facing_major_challenges/1253967894814 

Holm, SG, Mathisen, T., A., Sæterstrand, T., M. & Brinchmann, B., S 2017, ‘Allocation of home care services by municipalities in Norway: a document analysis’, BMC Health Services Research, vol. 17, pp. 1–10, 

Lindahi, A., K 2018, The Norwegian Health Care Systems. https://international.commonwealthfund.org/countries/norway/ 

Marinova, D., I 2017, Comparative Analysis Of The Bulgarian And Norwegian Health Care Systems. https://www.duo.uio.no/bitstream/handle/10852/57320/Master-Thesis--Denitsa-Marinova.pdf?sequence=1 

Norway - Healthcare Providers’ 2018, Healthcare Providers Industry Profile: Norway, p. N.PAG, 

OECD. 2014, “OECD - Better policies for better lives.” OECD Reviews of Health Care Quality: Norway 2014 - Raising standards - Executive summary. 21 May 2014. https://www.oecd.org/els/healthsystems/ReviewofHealthCareQualityNORWAY_ExecutiveSummary.pdf (accessed February 9, 2016)

PR Newswire 2015, ‘Deep dive into the Healthcare System and Medical Device Market in Norway - report incl. surgical procedures’, PR Newswire US, 28 December,

Ramstad, K, Jahnsen, R. & Diseth, T., H 2016, ‘Associations between recurrent musculoskeletal pain and visits to the family doctor (GP) and specialist multi-professional team in 74 Norwegian youth with cerebral palsy’, Child: Care, Health & Development, vol. 42, no. 5, pp. 735–741,

Regjeringen. Helse- og Omsorgsdepartementet. 2016. https://www.regjeringen.no/no/dep/hod/id421/ (accessed April 22, 2016)

Ringard, Å., Segan, A., Sperre Saunes, I. & Lindahl, A., MK. 2013, Norway: Health system review. Health systems in Transition, 2013; 15(8): 1-162

Sun, D, Ahn, H, Lievens, T & Zeng, W 2017, ‘Evaluation of the performance of national health systems in 2004-2011: An analysis of 173 countries’, PLoS ONE, vol. 12, no. 3, pp. 1–13

The European observatory on health care systems, 2000, Health Care Systems In Transition. https://www.euro.who.int/__data/assets/pdf_file/0010/95149/E68950.pdf 

Valentina, G., Gutiérrez, V. and Carlos, J V 2013 “Home Health Care Logistics Management: Framework and research perspectives.” International Journal of Industrial Engineering and Management (IJIEM), 15 March 2013: Vol. 4 No 3, 2013, pp. 173-182.

Van V. and Jerry, D 2013 “Leveraging the Patient-Centered Mdical Home (PCMH) model as a health care logistics support strategy.” Emerald Insight, 2013: Vol. 26 No. 2, 2013, pp. 95-106.

World Health Organization 2002, “Provision Of Personal And Non-Personal Health Services: Proposal For Monitoring.” World Health Organizaton. 2002. https://www.who.int/healthinfo/paper25.pdf .

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