Gp in Europe


Norway is one of the few countries in Europe where there is a shortage of doctors. By the end of 1994, there were 600 vacant posts for doctors in Norway, out of which 450 (eight per cent of the total number of posts) were in hospitals, and 1 50 (five per cent of the posts) in primary healthcare. For all the doctors in Norway, this means long working hours!The hospital services in Norway are mostly financed and administered by the 19 county councils, including the council of Oslo. A few small hospitals are run on a private basis, and due to the waiting list guarantee, even the public health service buys operations from these private clinics. According to this system, each county has to guarantee its inhabitants surgical operations or treatment for a defined list of diseases and medical conditions within six months. To fulfil this guarantee, some counties have to book surgical operations from other counties or from private clinics.For treatment in hospital on a polyclinical basis, the patient will pay approximately the same as if visiting a general practitioner (GP). 

If the patient is hospitalised, the treatment is free of charge.The situation among hospital doctors is critical. They are paid on a salary basis only, and for several years they have experienced a loss of income compared to other comparable professions. This has lead to a drift of specialists from hospitals to private practices. In many hospitals this has meant a loss of experienced doctors, and it must be seen as a serious threat to the quality of patient care.The primary health service is organised on the basis of public insurance, with right of access for all citizens to the public health service. All citizens have the right to choose treatment from any GP. They also have direct access to specialists outside hospitals. However, the specialist is paid less by the National Insurance if the patient is not referred by a GP, and most of the specialists therefore now require referral from GPs.

The financial situation for doctors in primary care (and for specialists outside hospitals) is somewhat special, since there are many different financial arrangements. The GP can:

be paid on a salary basis for daytime work, but is paid on a fee-for-service basis for overtime hours;

have a contract with the community (specialists have contracts with the county), which means he or she will annually receive approximately NOK 280 370,000 (depending on practice standards), and is obliged to keep opening hours and practice standards in accordance with the contract. The practice is run on a fee-for-service basis, with a refund from the National Insurance. These GPs have to take part in out-of-hours work;

be organised private, and have the right to get a refund from the National Insurance. They have no contract with the community or council, and are not obliged to take part in the out-of-hours service;

be organised fully private. The doctors starting a private practice after 10/10/1992 have no right to a refund from the National Insurance, and are not bound to work overtime;

be a list doctor. Since May 1993, there has been a project toset up a primary healthcare system organised in many ways like the Danish healthcare system, in four communities.


Most of the 3,500 full and part-time GPs in Norway have a contract with the community, and they run their practice through a fee-for-service system. This is now recognised as the best and most economical system for both patients and doctors, and for the community.Many of the salary paid posts in general practices have, for this reason, been converted into posts in contract-based practices. Many salary paid posts suffer from a large turnover of doctors. Most GPs also work part-time within other areas of the profession, in maternal and child health centres, in institutions for the elderly, and as medical officers of public health.For the patients, this heterogeneous system implies different fees for the same service, depending on the doctor they see.

If they are registered with GPs on salary or with a contract, a daytime consultation will cost them an average of NOK 100. Children under the age of seven get free medical treatment.If the patient chooses a doctor without a contract, but with the right to a refund from the National Insurance, he or she will pay more (children will also pay). If the patient is registered with a GP who does not even have the right to a National Insurance refund, he or she will have to pay substantially more.In any period of time within a year, if a patient spends more than NOK 1,200 on prescriptions or on visiting GPs, private specialists, hospital outpatient departments, psychologists, etc, he or she will then get these same services free of charge for the rest of the year.This of course does not apply to patients seeing doctors without contracts and/or refund rights.If you think this is difficult, think about how the Norwegian patients feel...


The general medical services
The GP is generally the first point of contact with the hoalthcare system. The range of services provided by GPs in Norway is considerable. On average, the Norwegian full-time GP has to answer the needs of 2,000 patients in urban areas less in rural ones. These requirements are met through consultations at the surgery and home visits, and include such areas as maternal and childcare, health examinations, prescriptions, etc. GPs examine and advise the patient, and can then refer them to a specialist or direct them to other branches of the healthcare system, if appropriate. GPs can refer to or initiate help from:specialists in practices outside hospitals;hospitals, including their outpatient departments;physiotherapists;chiropractors;psychologists;midwives;home visitors and nurses;school health and dental service personnel.


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