Health reform in Norway Coordination reform 2012

Starting point (OECD evaluation) Norway’s health system is high performing, and delivering high-quality care System is performing well also when benchmarked against countries that would be considered peers Norwegians live long due to good health Norway has shifted care away from the hospital sector and towards primary care settings.

The Norwegian Health Care System Picture: David Liuzzo /Wikipedia Universal Mainly publicly/governmental funded Two main authority levels 428 Municipalities Primary care 4 Regional health authorities Specialist care First I will give you a short introduction to the norwegian helath care system as a backgrond. We have a universal system that covers all the inhabitants. It is mainly publicly/governmental funded. And we have two min authorities: Municipalities and Regional Health authorities own by the state. The municipaliteise have from 200 till 650 000 inhabitants.

The Norwegian Health Care System Municipalities Public health Prevention General practitioner services Basic emergency services Physiotherapist services Rehab. & post-hospital srv Nursing homes Home based care Social services Regional health authorities Hospitals Specialist outpatient services Ambulance services Laboratory and radiology services Transportation Specialized rehabilitation

Objectives of the Coordination Reform 2012 Integrated patient care More effective prevention Increased user influence Services will be provided closer to where people live Municipalities should be given greater responsibility Specialist and primary care should enter into binding agreements Ensuring sustainable development White paper 47 (2009-2010) described the challenges of the present and future: Fragmented services Insufficient prevention Demographic trends threaten economic sustainability White paper 16 (20011- 2012) described how the government planned to meet these challenges with economic, legal, organizational and professional measures. Looking internationally, there are parallels to our reform" in different western countries that attempts to ensure better coordination of services and pushing greater efforts toward primary care. Main objectives of the reform are to achieve: Integrated patient care More effective prevention Increased user influence Services will be provided closer to where people live Municipalities should be given greater responsibility Specialist and primary care should enter into binding agreements Ensuring sustainable development

Primary Health Care in Change The Government (2015) introduce measures to reduce fragmentation: Nurses and doctors working in teams Stronger coordination within the system Enhanced professional expertise Enhanced professional leadership To meet the challanges in the community healt care, the government this year has made a white paper about the primary health care and will also this autumn deliver a national hospital plan. The coordination reform is still integrated in this documents.

New process after introduction of the coordination reform Home Hospital Home Common process Options when creating emergency care beds in the municipalities and intermediate care departments in the municipalities Emergency care beds Intermediatedepartment Home Hospital Nursing home Home The most common process has been home - hospital - home. Organization emergency care beds and intermediate departments to receive discharge patient from hospital, has for some patients led to short stays both before, but frequently after hospitalization. Some patients can get a more disjointed process. That was not the intention of the reform.

Future Development of the Coordination Reform Increased use of services at home Mobile teams to take care of the patients discharged from hospital and the patients in need of immediate day services Avoid fragmented patient care More use of integrated, generics clinical pathways Reducing patients' stress Reduce complexity and bureaucracy

Mental Care The reform has had effect on mental health Strengthening care is delivered by municipalities At the same time; increasing specialist services, increasing resources going into the system and making mental health a policy priority.

How? Carrot and whip! The introduction of the economic incentives under the Coordination Reform The municipality is co-funding of hospital care, and financial penalties for municipalities if discharge is delayed Use of supplemented primary health care units

Prevention Involvement of the patient at all stages Focus on lifestyle and exercise/physical activities Help to stop smoking Eating habits

Challenges Aging population Refugees/migrants