The Norwegian health care system and pharmaceutical system
An introcuction for foreigners with a comprehensive presentation of the pharmaceutical system, pricing and reimbursement in Norway.
Health care system
The Norwegian health care system is founded on the principles of universal access, decentralisation and free choice of provider.
It is financed by taxation, together with income-related employee and employer contributions and out-of-pocket payments (co-payments). All residents are covered by the National Insurance Scheme (Folketrygden, NIS), managed by the Norwegian Health Economics Administration (Helseøkonomiforvaltningen, HELFO). Private medical insurance is limited.
While health care policy is controlled centrally, responsibility for the provision of health care is decentralised. Local authorities at municipal level organise and finance primary health care services according to local demand. The central Government has overall managerial and financial responsibility for the hospital sector. Norway’s four regional health authorities control the provision of specialised health services by 27 health enterprises.
Most hospitals in Norway are public hospitals, funded and owned by the state. A small number of hospitals are privately owned. However, most private hospitals are funded by the public.
All Norwegian citizens are invited to choose their general practitioner (GP) from a list. Outpatient doctors act as gatekeepers for specialized care.
The Ministry of Health and Care Services (Helse- og omsorgsdepartementet, HOD) is the legislative authority. The Norwegian Medical Products Agency (Direktoratet for medisinske produkter, NoMA) (subordinate to the HOD) is in charge of marketing authorisation, classification, vigilance, pricing, reimbursement and providing information on medicines to prescribers and the public.
HELFO decides on reimbursement for individual patients for pharmaceuticals without general reimbursement or indications not covered by general reimbursement. HELFO also monitors the prescriptions issued by out-patient doctors.
All major international pharmaceutical companies are represented in Norway, but only a few of them have established their own manufacturing units in the country.
In Norway there are 3 wholesalers providing a full range of products to the market, belonging to the leading European pharmaceutical distribution companies. Each of the wholesalers is vertically integrated with their own pharmacy chain.
In general only community and hospital pharmacies are allowed to dispense medicines. In addition medicines are dispensed by small outlets belonging to the pharmacies. Grocery stores, gasoline stations e.g. are allowed to distribute a restricted list of OTC.