Free Health Care or Just Insurance?
A lot of people say that in Norway you get ‘free health care’ but that is only true if you are unhealthy. There is a threshold where unhealthy pass into the ‘free’ zone. However, if you are healthy you must pay.
When I say a ‘healthy’ person, I mean someone who only needs to see a doctor no more than 13 times a year. In the last year I only went to the doctors once for a regular smear test so I am considered ‘healthy’. (A side note: While in Australia I would get a general yearly check-up just for good measure. This is considered a waste in Norway, especially by doctors, and especially if you are considered ‘healthy’.) Any healthy person must pay up to NOK1880 as of 2011, (or US$342), a year to see the doctor before the ‘free’ kicks in. A regular consultation for 15 minutes is priced at NOK136 in Norway 2011. Hence, 13 normal consultations a year.
This unfortunately does not cover any extra costs such as disinfectants, bandages, or needles for blood samples, for example. These certainly get added to your bill. When I had the smear I paid for the consultation as well as the disposables, items used and the test.
Women get ‘free’ care when they are pregnant because they are considered at high risk health and need to see a doctor at least 8 times which includes equipment, disposables and tests, plus the hospital costs for the labour and birth.
Children do not get completely ‘free’ health care either. They get free regular consultations but any equipment or disposables such as bandages require payment. For example: The other week Lil’ Red, my two year old son, and I were in my work’s costume room. He pulled out a box and an unframed mirror fell onto his nose. Blood everywhere, so off to the medical centre we went to get stitches. The consultation was free but we had to pay for the equipment and disposables such as bandages, tape, glue, thread, disinfectant etc. If this accident happened while Lil’ Red was in school, the extra costs are waved as the government pays for own ‘institutional’ expenses. (I’m presuming work should cover medical costs too, including disposables etc, if you get injured on the job.)
Children do, however, get free dental up until they leave high school. Adults don’t get free dental. The public dental service isn’t free, but charges a fraction of the price of private surgeries. Most people go private as the waiting lists for public are painful.
Critical emergencies are an exception to the rule. Ambulance rides are covered, and helicopers, etc.
So there is a misconception of ‘free’ health care for all. It is ‘free’ for people who surpass the ‘unhealthy’ payment threshold, but for those who are healthy, you will have to continue to pay until you become a pensioner or unhealthy. But maybe this is why Norway doesn’t call their national medical scheme ‘health CARE’. They call it Health INSURANCE. Just like any insurance, an excess needs to be paid before the insurance company will pitch in. Everyone over 18 is required to subscribe to this insurance through their tax payments. It is compulsory. Another obscurity on ‘free’. ‘Free’ has to come from somewhere, and when it comes from the government, we all know where it really comes from.
So for a healthy person, ‘free’ health care is only an insurance in case you become unhealthy.
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I’ve lived here (almost) all my life and I didn’t actually know all that (paying for equipment, and the 13 a year thing)
I think you must blame people like me who come from the U.S. who are really eager to shout “free health care” simply because we are soooo excited by the system here! No matter what they did it would be an improvement on the embarrassing U.S. system. I have a hard time complaining because I’ve seen much worse (in the UK and US), but it is an interesting point. And given the amount of taxes we pay …
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from L-Jay:
Coming from Australia, I can say that Australia has a better ‘free health care’ than Norway. If you go public in Australia, which isn’t necessarily a bad, lesser service, you don’t pay a cent to the doctors if you are below a certain income threshold – not even for extras like disposables. Though, about five years before I left they did bring in a service payment mainly to stop doctor-hoppers but this fee was reimburse at the end of financial year. However, there were still many centres that didn’t charge. And when you go to the emergency room at the hospital – no fee. But you do have to subscribe to the ambulance service. In Oz, if you are capable, meaning above a moderate income level, you are required to pay for your own health ‘insurance’, which I think is fair when you have the money. In Norway, even the billionaires can use ‘free health care’. The only difference with Australia is that you can choose to go to a private hospital if you want to – not every place in Norway has a private hospital. (But be warned, privates are just as bad in Norway as public – in Tromsø the other week there was a big mess about a private hospital operating on the wrong knee of a patient.)
America? I think every country that has ‘free health care’ feels sorry for Americans. I know Norwegians and Australians, at least, don’t understand why America can’t see the benefit of ‘free health care’ even when it could just be for low income earners. But I certainly understand how people from countries without ‘free health care’ can see Norway’s system as a huge drawing card. People from ‘free health care’ countries (like Australia, New Zealand, UK and Canada), not so much.
Are doctors reimbursed by the national health plan if they can only charge NOK136 or about $25 for a 15 minute consultation? I don’t see how a doctor could charge such low rates and still pay office expenses , overhead, nurses, etc while having a good income for himself or herself as the case may be. The U.S. medicare doesn’t pay for annual physicals either except for the first one when you sign up at 65 years of age. The govt. sets maximum rates that doctors may charge and those rates are considerably below regular office rates. Then, the system only pays 80% of the approved rates and the individual must pay the difference or subscribe to optonal insurance coverage. Many doctors will not accept medicare patients because of the low mandated rates and as a result, many people have a hard time finding a doctor.
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from L-Jay:
It is the Norwegian government that sets the rate. All doctors are paid by the government and pretty much paid the same within their job description – GP’s get the same as GP’s. They also set the patient expense rate and I’m sure they add a little extra in for the doctor to bump up their hourly rate. But doctors here can earn bonuses for example, if they live in a remote area, if they take on more patients and if they up-grade there qualifications. Actually there has been a little controversy in the Alta kommune that doctors have been collecting the seminar bonuses without attending seminars. The one thing that sets Norway apart from other countries is the gap between GP wages and average wages is not that big. It has been said that truck drivers in Norway can almost earn the same as a new GP. Everything is regulated by the government in Norway to flatten the wage thresholds. Two of my friends in Norway, one a dentist and the other a computer programmer (with only a two year diploma) earn the same amount of money. This is what a ‘socialist’ country does. Which is good in the sense that every person can see a doctor but it creates lazy, undriven workers. Norway does have a private sector but they get sent a lot of patients from the public sector and therefore get paid by the government to sustain themselves. I wish I could pay for my own private health insurance because then it would mean I could choose my own doctor, service and hospital. In Norway you don’t really have that option. The choice is not there especially when you live in a remote area. Some remote areas do have a private hospital – but where is the choice when there is only one…lol?
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Ok – I just googled doctors pay in Norway and this is what is says:
Translation:
When you consider that the average income in Norway is NOK400,000 you can see that the average income and doctors income wage-gap is quite small.
Hei, doctor consultation in Trondheim is more expensive and costs about 200 NOK… Moreover, I find it strange that you can say to doctor about one problem. If you have problem with another part of body you should take the next visit, because “he/she has a tim only for one thing in a shedule…”
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from L-Jay:
In the national insurance website it says it costs only 136kr per regular consultation. I think you better check out why you are paying more. Maybe your cap is 1880kr still but you get there quicker than 13 regular consultations? I’ve heard that some surgeries add on a percentage on every visit to cover extra costs like disposables, even if you don’t use any. Norway has a habit of doing this – and they don’t inform the customer of what they are doing. A digression: At the Nordkapp entrance gate they were charging everyone entry plus an extra 50kr for viewing the Nordlys film. However, viewing the film was optional – Nordkapp was poaching money whether or not the tourists saw the film. Naughty, naughty.
We try to squeeze in as many problems as possible in one visit…lol. Sometimes we get away with it but other doctors say we have to come again. So yeah, it seems like you can only visit the doctor for one thing at a time, you can’t build up illnesses/problems to get a doctor to have a look at them in one go…lol. Not very economical.
My doctor, also in Trondheim, charges me 136 NOK as he should. Letting him know in advance that I have several things to discuss, everything’s fine. I’ve also discussed other problemI didn’t mention when I scheduled the appointment. I guess this depends very much on the doctor in question.
We can choose doctors freely and hospitals, so I don’t get your point there? Of course, living in remote areas, there’s not enough people to sustain several broad and specialized clinics/hospitals/etc.
And the wages… Hehe, I must admit I prefer the socialist way of reducing the gap, but that is of course a purely personal view. (And maybe a bit influenced because I am Norwegian.)
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from L-Jay:
About choosing doctors and hospitals –
Yes, a lot of the choice is taken away because of where you live (most of the people in Norway do not live in Oslo, etc to have such a big place to choose doctors etc from). Of course. But you also do not have a choice of doctor because of the registering system. You have to go to Helfo and see what doctors are left on the service – you can only choose from them. When I lived in Harstad I could not go to a doctor that was just down the road from me as he was not on the ‘available’ list. I was forced to choose a doctor that lived on the other side of the district because he was the only one ‘available’. That is not choice. Neither is having a doctor or no doctor (this is an ultimatum…lol.) In Australia, you can choose any doctor or clinic you want no matter what and it is common to have two or three clinics that you go to. Capacity is not an issue. It means that I could have different doctors for different things at the same time – not something I have heard of in Norway. When you are used to choosing which ever doctor you want, it is a culture shock to ‘down-size’ when you get to Norway. It makes you frustrated and ask ‘If Norway is supposed to be a western country, ‘the best country in the world to live’, then why am I stuck with the only doctor on the list? The only thing that can be excused is that Norway is a small place with few people. But logic has it that, if it is the best place in the world to live, I should be able to freely choose whatever doctor I want, where ever I want. I don’t know, call me crazy, but when ‘choice’ is on the table I also want ‘freedom’ for dessert…lol.
I like the small gap too as it promotes that every occupation in society is important for it to function properly – and I’m from a capitalist country
…lol. But I also like a system that makes people want to excel. I don’t think Norway is quite there, but culture has a lot to do with it. The best loved Norwegian heros are the ones who are lovable fools who don’t excel – Askeladden for example. (In Australia we have the ‘great Aussie battler’ – someone who is always battling hardship…lol)
Haha! Never thought of Askeladden in that way, but it’s true: he’s very much representing an ideal Norwegian, that is, hardworking and honest, expecting pretty much nothing in return. Although it can be discussed whether this ideal is valid nowadays; seems as people are becoming more selfish, and by selfish I mean — as a “true” Norwegian — for instance not helping out in maybe a dugnad ifyou don’t get paid.
Great Aussie battler? Tell me more
(And note: the registering system with doctors definitely needs some upgrading. The positive thing about it is that then you’ll have a doctor that knows your entire health history, but the negative things are what you pointed out, that you hardly have any choice, just going along with the leftovers.)
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from L-Jay:
Askeladden describes Farmor and Fafar to a tee! The old idea of what it means to be Norwegian is certainly easier to work out. The modern idea is much tougher. Nowadays I think modern heros/idols still give a good idea as to where a culture is at for ‘ideal’. Though the skier Petter Northug is proud and daring, and a little too cocky (which I think reflects the younger generation of Norwegians) overall he doesn’t seem to be in Norway’s good books. The rally driver Peter Solberg, who wore his bunad at a motor gala, seems to be a good example of the ideal modern Norwegian – a gracious winner, innocent and brave, but always proud of his culture. But I’m just guessing
The ‘great Aussie battler’ is a name for common heros. They are just normal people fighting against authority (the police, a landlord or a bully, etc) to keep their lands, family or dignity. Ned Kelly is one of Australia’s greatest heros – he robbed banks supposedly to put the authorities (the British Imperials) in their place and to pay them back for all the hardships they caused his family. A hero is Australia isn’t necessarily all good, more like Robin Hoods – stealing for a good purpose. We like our bad boys with a golden heart. But we do have another brand of hero called ‘the golden boy’. He is a boy-next-door type who can do no wrong and earns his wins with hard work and dedication. But he does like the glory too.
You know, when you see only one doctor available in your district on Helfo, you can’t help but think ‘I wonder why no one wants this doctor? What is wrong with him? There must be a reason why everyone has chosen all the other doctors first instead of him.’…lol. It is a little suspicious.
Most probably disagree with me, but frankly, this is responsible spending and I see no problem with it. Ambulance is free, and the healthcare is available to everyone at a reasonable price, no one said it has to be free after all. That’s all that really matters. A responsible government shouldn’t just be throwing cash at everyone that wants to see the doctor – it’s not exactly sustainable. As long as the prices of the doctor visits are kept fairly low then anyone should be able to afford the necessary checkups, and indeed once a point is reached where it is becoming too expensive then by all means it is time for the health system to kick in a lend a hand, but if you made every single doctor visit free to every single citizen the country will set itself up for a rapid deficit.
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from L-Jay:
Paying for your own medical is certainly not a bad thing and keeps people responsible for their own health. (In fact, I thought that the excess amount would be more in Norway.) The post was about how you don’t get ‘free’ healthcare but ‘insurance’ in Norway – more about a definition than a ratting out. I get a lot of people wanting to immigrate to Norway asking me about the ‘free’ healthcare. It is good for people to know that even though Norway offers a lot of health benefits they are still required to financially contribute to their own health. I don’t think people should move to Norway because of ‘free’ healthcare. It bugs me. (Thats why I pointed out that Norway is ‘free’ but Australia is ‘freer’ – to curve peoples reasoning for choosing Norway.) I think people should move here because they like the values of Norwegian society, love the people and way of life, and want to contribute. I’m an idealist.
(Well, me, I moved here for love. But now, I don’t find Norway half bad
)
The “free” part in Australia is great.. but just about everything else sux in the hospitals. I am a pensioner with no insurance and I still choose to pay for private care when it comes to things like dental, optical & surgery because the care is so poor by comparison and the waiting is ridiculous. Appointments mean nothing at all cos you still have to wait hours, and should they run out of time or anything goes wrong, you can face YEARS before getting another appointment. Andreas has been shocked by the hour waits we’ve had at every hospital appointment during my pregnancy – he paints a better picture of Norway in terms of waiting.
However I’m pretty happy with GP visits here.. most people pay a gap for the doc and for medication, but as I’m in the low income bracket it’s all free for me (as long as it’s a covered medication, which most are). I like being able to shop around and find a GP I trust, get second opinions, and generally feeling like they care and aren’t rushing me out the door! My childhood doc always talked to me about life and was more like a friend then just a doc
Unfortunately the waiting can still be a problem, as I have to know about 2-3 days in advance if I need to see my doctor cos that’s the earliest I can get in (the downside of picking a good one!).
My bub is due tomorrow so here’s hoping for a good hospital experience when it happens
I definitely appreciate not paying thousands to have a bub in Oz, unlike my sister in the US!
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from L-Jay:
All the best for your big event! Very exciting.
The waiting in Australia is annoying but in Norway they turn you away at the emergency centre…lol. (I’ve never experienced that in Australia.) It just so happened that the time they turned us away our little one seizured at home and we had to go to the hospital via ambulance anyway. Silly, silly. But you do also have to wait in Norway – but they make you wait at home. You call up the hospital and they give you an appointment to come in at a certain time so they don’t have as many waiting in the emergency centre. I think this is much better. But there has been times with our local GP that we have had to wait six weeks for an appointment – CRAZY! After six weeks a child should be better! Maybe in bigger cities people don’t have to wait but most Norwegians don’t live in big cities.
There are so many people who want to immigrate to Norway, I don’t understand why doctors don’t. Or maybe there is something more sinister at hand – like the government says ‘no’ because they don’t have the money to pay for more doctors?
Oh yeah,here if you want to benefit of ‘free’ you should let your health go to minimum,or why not,even close to death.Only then,doctors open their eyes and shine in their brilliant instruction.
Why people who says it’s normal to pay this additional tax to GP forget that actually a good part from their salary goes into health service?That money is payed for what?
Oh,yeah,for doctors who having a line of 5-6 and even more patients waiting for him while he has to greet and talk to all his collegues or take coffe brake?
Come on!Norway is lucky to have so many zombied patriots.It’s said by the government they should pay,they pay,without realising that their money goes to wind,for the sake of Norway to boast on high internal income.
You say no need to spend on patients imaginary ilnesses?How about cases that were about to die because every time they went to doctors,they were sent home,as according to the same clever doctors,fresh air and long walks will make them forget about all health problems??????!!!!
I went personally with a problem of serious decrease in blood pressure and feeling dizzy to get the automatic ‘you know,it’s not a sympthom to say there is a problem in your body’ and went into blood test only after me insisting.Another time I got a brilliant answer(but maybe the woman wanted to tell me the truth and save some of my money) not to go to a specialised doctor,since he won’t tell me many different things from GP’.
And no, I don’t live in the North,but still I didn’t choose my doctor.
Pregnancy well controlled?Joking?With only 3 usual visits to doctors and 1-2 screening during the whole period,because women should take it more naturally?
I’m wondering how many more years will Norway live in full ‘zombiness’?And how big the taxes and fees they pay should be so that them to realise that they work for the worldwide reputation of Norway?
As someone who already in April ended up with having a frikort (“free card”) issued, meaning that all my expenses – except for the disposables, which irritates me a lot – are covered for the rest of the year. Some of the medical expenses have been refunded through my university college, though the process is time consuming.
Feeling weird and “old” about pulling this card up at every usable instance (I’m 30!) puts every purchase and transaction at 0,- which feels… well, good. As a student becoming sick can be very expensive (when you can’t work and so on). I’ve had the amusing insight in what medication costs before the government covers them. Turns out that a bottle of 100 pills of my required medication costs between 500-600 NOK. I paid nothing. The other medication I will have to start on (but which will give me a much better life, and that I’ve read many stories of mostly from America where people struggle to cover their expenses on them), would have cost me 80 000 NOK a year. I won’t have to pay a bit, for which I am eternally grateful.
There are lots of unpleasantness when it comes to the Norwegian health care system. I know, and I’ve only been through the mill a couple of times now.
I think a good measure of health can be life expectancy, and when that is taken into account most Western countries (America, Norway, Australia, Britain) comes out pretty well.
I can see certain benefits to a system like this.
Every winter in Canada, healthy people overcrowd the already strained emergency rooms with minor sniffles. News programs plead with the population not to burden hospitals with non-life threatening ailments.
You also find that lonely old people will go to emergency rooms seeking out companionship. They’re so desperate for somebody to talk to that they’ll take up a doctor’s valued time. It’s really kind of sad.
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from L-Jay:
You know, I think that is one thing Norway does right, having a nurse do a preliminary check. In Tromsø when it is busy, to limit people who don’t really need the service, you see a nurse as soon as you arrive to the emergency clinic. She asks you questions and checks you out. If you pass (meaning that you are sick enough) you get to go through to the waiting room. If you don’t pass you are sent home with advice to take some paracetamol…lol.