Reimbursement mapping: NORWAY

1. Reimbursement mapping: NORWAY 2011

2. Content • Key Economic Indicators • Healthcare Overview • Reimbursement Systems • Market Access • Funding Mechanisms • HTA • Decision makers, Acronyms and Links • Austerity Measures 2011

3. Key Economic Indicators Norway

4. Healthcare system overview • The system of health care provision in Norway is based on a decentralized model. • The state is responsible for policy design, overall capacity and quality of health care through budgeting and legislation. The state is also responsible for hospital services through state ownership of regional health authorities. • Within the regional health authorities, somatic and psychiatric hospitals and some hospital pharmacies, are organized as health trusts. Within the limits of legislation and available economic resources, regional health authorities and the municipalities are formally free to plan and run public health services and social services as they like. However, in practice, their freedom to act independently is limited by the available resources. • The municipalities have the responsibility for primary health care.

5. Procurement carry out on national level • It seems to be a trend in Norway that more and more medical equipment now is procured on a national level. • There are still major regional and local differences across municipalities, counties, state and regional hospitals. • At the Norwegian Medical Suppliers Association there is a growing concern regarding what consequences the on-going increase in procurement on a national level might have for the competition climate in the health care sector and by that the resulting price of a goods and the diversity of the goods being offered. • The Norwegian Medical Suppliers Association in mainly focusing on the actions of the Norwegian Labour and Welfare Association and the Procurement services for Health Enterprises – PSHE which is a company responsible for coordinating public procurement on the behalf of the Norwegian Health Enterprises.

6. Reimbursement system • The blue prescription regulation in Norway determines which pharmaceutical and medical devices to be included in the state reimbursement system. For medical devices it is primarily single-time use equipment, used by patients both in- and out-house that is of interest. The Norwegian Medical Association is currently looking into this list, trying to assess whether or not the list is of old stature and should be updated. • The Health care expenditure adds up to almost 10 % of the total government spending increasing steadily every year. In general health care expenses in Norway are financed by the government, either by direct reimbursements or through their ownership in all regional hospitals.

7. Market Access • There are several barriers to market access in Norway. The market is in general denoted by an incomplete DRG system, an extensive use of tenders, designed by governmental agents lacking fundamental insight into how the market functions. The Norwegian Medical Association is currently looking into these issues. • Medical devices are mainly financed through governmental/hospital budgets. The Norwegian Health Directorate is continuously developing the DRG system.

8. HTA • The Norwegian Health Directorate has given to the Norwegian Knowledge Centre for the Health Services the task of assessing the possibilities to use the HTA in the Norwegian Health care system. • The Norwegian Directorate of Health, the Norwegian Ministry of Health, the Norwegian Health service research centre and the Norwegian Medicines Agency are the actors involved in the decision making process.

9. Links

10. Austerity measures Price referencing (domestic and cross-border) General price pressure. Late payments procedures Payment within 30 days.

11. NORWAY