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Norway
On the brink of a major change in general practice?

Johnny Mjell

A new financial and organised model for general practice
In spite of the huge incomes from our North Sea Oil, economical calculations show that in the last few years, the Norwegian Government has been spending a smaller part of the Gross National Product (GNP) on health services compared with other countries in Western Europe.Over a three year period, four municipalities in Norway have been trying out a model with a personal list system for general practitioners. However, in many ways the system has not proved to be as good as some people expected it to be. This spring the Department of Heath presented Parliament with a proposal concerning a new financial system for primary healthcare. For a variety of reasons the proposal was strongly opposed to by the General Practitioners' Organisation (Aplf) and the Norwegian Medical Association (NMA). Consequently, when Parliament approved the resolution in )une, the new system was almost exactly what we wanted, whereby in many ways it is similar to the way general practice is organised in Denmark.There are still some difficult negotiations to come between the Department of Health and the NMA. The Department plans to implement this new system from January 1999. An additional possible problem is that from October 1997, Norway will have a new Government composed of three political parties that constitute a minority in Parliament.Norway is still one of the only few countries in Europe where there is shortage of doctors at present there are more than 650 vacant posts. This is a huge problem when we are facing this new organised model. In northern and rural parts of our country there are many municipalities that only have short-term stand-ins as general practitioners. Many of these are from Sweden and Swedish is easily understood in Norway. But an increasing number of stand-ins are coming from countries with languages that are difficult to understand. Thus a major concern is how we can have enough doctors in rural parts of the country to make it a patient's right to choose their doctor.

Problems in relation to the National Insurance Company
Particularly over the last two years, general practitioners in Norway have noticed more difficulties in their relations with the National Insurance Office (RTV). The RTV has started to control refunds to general practitioners. The problem is that the RTV have created their own 'standards' for general practice, eg, how many blood samples per patient a general practitioner should be refunded for, but they have no suitable explanation to justify these practices. Thus, up until autumn 1997, there was a year of conflict with the RTV. However, after negotiations this spring and summer, it seems likely that co-operation between the two groups is imminent.