1. Health reform in Norway
Coordination reform 2012

2. 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.

3. 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 inhabitants.

4. 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

5. 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 ( ) described the challenges of the present and future:
Fragmented services
Insufficient prevention
Demographic trends threaten economic sustainability
White paper 16 ( ) 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

6. 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.

7. 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.

8. 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

9. 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.

10. 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

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

12. Challenges
Aging population
Refugees/migrants