Norway should strengthen primary care to address evolving healthcare needs, says OECD


21/05/2014 - Improving primary care systems and co-ordination between health services would help Norway meet the changing needs of its healthcare system, as the population ages and hospital stays become shorter, according to a new OECD report.

OECD Health Care Quality Review of Norway says that the country has a world-class health system and consistently out-performs most OECD countries on hospital care indicators. With health expenditure at 9.4% of GDP, it is also one of the more generous health spenders in the OECD.

Mortality rates from heart disease are 5.3 per 100 hospital admissions, well below the OECD average of 8.5. Hospital deaths within 30 days after admission for heart attack (acute myocardial infarction) are a relatively low 4.5% in Norway, compared to an average of 7.9% in other OECD countries.  

But the proportion of the population aged over 80 years is projected to rise to 9% by 2050. This will be accompanied by a rise in chronic disease such as diabetes, heart disease and cancer.

To meet these challenges, a series of reforms, such as the recent Coordination Reform, are steps in the right direction, according to the report, but more needs to be done. Better coordination between levels of government and different parts of the health sector, and involving GPs more closely, would enhance quality of care.  

Patient safety also needs more attention. Norway has several patient safety initiatives, but they are mainly focused on hospitals. Primary care could be better included as part of the National Reporting and Learning System within the National Agency for Patient Safety.

Improvements can be achieved by using electronic clinical records that health workers can access in both primary care and hospitals. Assigning a care co-ordinator would ensure that patients receive appropriate follow-up care after they are discharged from hospital.

General practitioners (GPs) should be included in the financial incentives provided to other health professionals, as part of the 2012 Coordination Reform. Under these reforms, financial penalties push municipality-provided care to play a bigger role. But these measures do not apply to GPs, who are at the centre of primary care. There are few strong incentives for GPs to take on more of the burden of care in Norway, or to strive for excellent quality.

The OECD report also recommends that Norway:

  • Develop minimum quality standards, especially for the new primary health units (“Distriktsmedisinsk senter” or “Sykestue” in Norwegian);

  • Introduce an accreditation system for hospitals;

  • Pay greater attention to quality of care for people with mild-to-moderate mental illness. This could be done by strengthening the role of GPs through training and support;

  • Improve the way data is gathered and reported, and extend it to primary care;

  • Use performance data as part of annual contractual agreements with health services.  This could be linked to specific payments, to make quality of care part of governance arrangements;

  • More efforts to support patient groups that promote patient involvement in decisions affecting their care.

Journalists can find the report’s main findings and recommendations as well as the full report at For further information about OECD’s Health Care Quality Review of Norway please contact Mark Pearson (tel. + 33 1 45 24 92 69), Francesca Colombo (tel. + 33 1 45 24 93 60) or Emily Hewlett  (tel. + 33 1 45 24 75 10) of the OECD’s Health Division.

OECD Reviews of Health Care Quality examine what works and what doesn’t in countries, benchmarking their efforts and providing advice on reforms to improve quality of health care. The country reviews will be followed by a final summary report on the lessons and good practices relevant to all governments. 


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