Transcript N Kolstrup

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