Thursday, June 9, 2011

Have it Your Way, Norway: Global Healthcare’s Gold Standard

“I really shouldn’t be doing this since I have such a terrible fever” said the woman as she dropped the needle she was about to stick me with on the floor. She used her left hand to sanitize my skin, and her right hand to wipe the sweat off her brow. Despite how this sounds, I haven’t turned to a life of intravenous drug use in dark and forgotten alleyways in some third-world country. A minor medical inconvenience had given me the opportunity to witness one of Norway’s few faults in an otherwise flawless healthcare system. I was at the doctor’s.

I had a virtually inconsequential infection, but since such things require basic prescription medications, I was forced to pay a visit to one of Norway’s urgent care facilities since I am not a Norwegian citizen and thus am not covered by the National Insurance Scheme that provides for the rest of country. The fact that there exists a convenience store inside the urgent care center which sold novels and hot meals should have curbed my expectations of a quick trip. But I was planning on, at the very least, being home for dinner since I was headed up there right after lunch. Unfortunately, pillows might need to be the next comfort item that the convenience store stocks.

Every 30 minutes or so one of the lucky patients in the waiting room—there were probably 30 to 40 of us—would sprint to the doors that led to the treatment rooms as their name was called. After three hours of waiting—and knocking out several hundred pages of the book I was reading—I conceded defeat and bought some of the hot food for dinner that I had earlier scoffed at. My stubble had evolved from nearly clean-shaven to a healthy shadow as my name was finally called. A tired nurse directed me toward a row of chairs in a deserted hallway after I entered the mysterious doors through which so few of my fellow sufferers had previously been ushered. The lack of activity I found was somewhat surprising given the disquiet of the ailing masses in the waiting room. Multiple doctors poked their heads out of rooms and asked if there was anyone who needed assistance: I picked the one who seemed the least desperate for a patient. I was given fine treatment, but the urgent care facility clearly needed an operations specialist to analyze the bottlenecks and throughput of their system—sorry about the business-school terms. Such inefficiency is surprising given the—well-deserved—stellar reputation of Norway’s healthcare system.

In Norway, 100 percent of citizens are covered under the National Insurance Scheme. Funded by general tax revenues, Norwegians have no co-pays for drugs or hospital visits. And minimal co-pays cover outpatient procedures. Each citizen chooses their own general practitioner (GP) from a government-approved list, and they can choose to switch GPs twice a year provided there is no waiting list for that particular GP. Referrals to specialists must be made through the GP too. A very generous system, the National Insurance Scheme also pays for sick leave, and, in some cases, such luxurious perks as spa treatments.

Aside from a somewhat inefficient urgent care system, healthcare in Norway has one other shortcoming common to most countries with universal healthcare schemes: long waiting times. One study estimates that about a quarter of all Norwegians requiring hospital treatment wait at least three months before being admitted. And, if treatments are not deemed to be “cost-effective” they can be denied. But Norwegians rightfully love their system.

I’m treading on extremely sensitive political grounds here, but I’ll summarize some of the basic arguments for and against the Norwegian system.

American person: “Healthcare isn’t free in Norway! You’re paying for it with your taxes. And you’re paying for everyone else’s too! Commies.”

Norwegian: “The portion of our income that goes towards healthcare is roughly 3 percent: comparable to what you might pay for private insurance in the United States. And I will gladly pay for someone else’s treatment so that they can recover and rejoin the workforce so that the collective output in our country will increase. We’ll be even richer than we were before! You capitalist pig.”

American person: “I want to choose my own doctor. I work hard to support myself and my family. I don’t want to burden myself with someone else’s health expenses on top of that! I’d rather pay for my care when I need it rather than paying extra to cover whatever ills might befall me AND others. You socialist, tree-hugging, hippy bastard.”

Norwegian: “But you are already paying for everyone else in the United States’ healthcare essentially! Your taxes cover some of the funds that the government sends to hospitals to help those who have no insurance. And there are still long waiting periods in the United States. And even if you have health insurance, you will still pay thousands of dollars to the hospital, doctor and other health companies for a reasonably significant procedure. You greedy, overweight, uncultured narcissist.”

These generalizations are ridiculous of course, but they highlight the main arguments on both sides. Although I’ve pretty much outed myself on the left side of the argument, I do think both systems have something to argue for. But the Norwegian system clearly has more merit to me. Granted, it’s an easier system to implement in a country with a population fewer than 5 million. But it’s hard to really see its virtues without meeting those who use it and believe in it. Equally complicating the issue is that the system would probably never work in a nation with such divided politics and lack-of-consensus like the United States. But that doesn’t mean that there aren’t lessons to be learned from the system: (1) consider long-term prosperity and the output of the workforce when judging a healthcare scheme, and (2) don’t let a nurse with SARS-like symptoms inject you with a dirty needle.


  1. its a pity you had such a bad experience in the emergency dept, i have been to norwegian emergency depts a few times and never had too much of a problem or a long wait, i am always pleasently suprised by how good they are, but obviously im used to the UK where you pretty much have to wait days to been seen in the emergency room :P

  2. The system is set up for residents, who have a personal physican. If you go to the emergency room, they practice triage. So the more serious emergencies are given priority. If you came in with a minor medical inconvenience, several people may have come in after you, yet been seen before you, if their conditions seemed more urgent.

    Waiting lists are similar. The more urgent conditions get treated the quickest. The longer waits are suffered by the ones who want treatment for dandruff or snoring. And sometimes, someone messes up, and the newspapers have their headlines.

  3. Thanks For sharing the Information. I Really Like Your Blog. You have Sharing the Good Information.

    family urgent care