1. Universitetet i Tromsø Equality in Norwegian primary health care. One step forward two steps back? Nils Kolstrup University of Tromsø.

2. Universitetet i Tromsø2 Initial success After a list system in 2001, Norway got Fewer problems with GP vacancies in rural areas A system that covers practically all GPs and 99,5 % of the population Health care centers outside the system nearly vanished High patient satisfaction (44 % very satisfied 2004 a 12% rise from 2000) 2008 Norwegian GPs scored the highest customer satisfaction among public servants (74.4 of 100 points) 2/3 of the GPs satisfied High satisfaction among other health care providers

3. Universitetet i Tromsø3 Too much success? Is the system suffering from its own success? The GPs work load has increased Difficulties in recruitment of young doctors (too much work, also fear) Higher patient expectations Higher expectation from other health care providers

4. Universitetet i Tromsø4 Some worrying numbers Since 1990 the number doctor work years in the primary health sector has increased 42 percent. The same increase for the specialist health care is 93 per cent The percentage of GPs to total number of doctors has dropped from 35% to 28% during the same period Increasing age among the GPs. In 2001 there were 596 GPs between 55 – 66 years of age, in 2006 there were 1023 Too few doctors on call (doctors can get exception when they are above 55 years of age) Although better coverage in the districts, the doctors only stay there short time

5. Universitetet i Tromsø5 When GPs has too much to do who sufferers? GPs need to give more attention to patients with special needs in the municipality Immigrants from non western countries Youths – diminished care in the municipality due to fiscal constraints Psychiatric patients – fewer beds in the specialist health care Drug addicts – this is now defined as a medical problem And to some extend old patients – sharp increase in the number of patients

6. Universitetet i Tromsø6 ”Solution”?? Private insurances schemes that guarantee access to a GP, without having to wait, is beginning to crop up again.--- Is privatization the solution to higher demands? The program “Faster back” give specialist priorities to patients who have work, but who are on sick leave or at risk of being sick. --- Is “all patients are equal, but some are more equal than others” the solution? The minister of health has announced that he wants: –2700 more GPs by 2015 –reduce the growth rate in specialist health care Is that possible?