Norwegian patients with chronic pain conditions that can be managed with reasonable cost/benefit now have a legally binding right to treatment in Norway

Abstract

The national health care system in Norway benefits from a higher percentage of the BNP than most other nations in Europe. In spite of long distances in thinly populated areas, poor road and railway systems, and a lot of foul weather conditions, our national health care system takes well care of those with acute and serious diseases or trauma. However, it has been apparent for decades that the Norwegian health care system is less than perfect for those with chronic health problems, that are not directly lifethreatening but often reduce health related quality of life. Twice the government has developed rules for priority setting (Norsk Offentlig Utredning, 1987, 1997) in which it was clearly stated that those suffering from burdensome chronic health conditions should be given high priority. This resulted in a law passed by the Parliament, the Patients’ rights law of 1999. In spite of this legal imperative to give priority to those suffering chronic diseases, health care expenditure has continued to go mainly to acute diseases, to save “life and limbs”, leaving mostly small leftovers of resources for chronic diseases. During the last 4 years the Department of Health has instructed the government-owned hospitals to make sure that patients suffering from chronic pain get better care by giving priority to pain clinics and ensuring collaboration between specialist care and primary care. In three of the five main health regions in Norway there has been some improvement, whereas in the biggest region in the south-east of Norway where half of the population live, nothing has happened. Even worse, the systems for pricing and reimbursing services at the pain clinics have been changed so that incomes from outpatients at pain clinics have decreased by about 50%. This has made any expansion of pain clinic services impossible. This development is contrary to what health care policy makers have intended for the last two decades (Norsk Offentlig Utredning, 1987, 1997). New hope for more and better care for patients with chronic pain conditions