Sula kommune

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PATIENTS INFLUENCE AND PARTICIPATION IN
NORWEGIAN HEALTH CARE. BELGRADE 17TH NOVEMBER
2008 Norwegian Centre for Municipal Development.
Specializing in Health Care
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The development of institutions for the poor and
elderly

• An example The Hospital of Trondhjem, started in
  1277 and still in operation
• It was started as an institution for the pilgrims
  who had come to the St Olavs church in search for
  salvation and cure as they were suffering from
  various diseases

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Homes for the elderly and nursing homes

• Homes for the elderly who could not be taken care
  of by their families, were established in the
  late 19th century
• It became obvious that they were not suited for
  patients in need of medical treatment and
  extensive care
• The nursing home was established as the formal
  institution and service in county/regional health
  care in 1970
• The later development shows an increase of beds
  in nursing homes relative to the increase of
  elderly and the decrease in beds in the homes for
  the elderly.

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Table 1 Proportion that has their mother or
father in a home for the elderly or in nursing
home (of respondent that has a parent 75 years or
older). Percentage.
Daatland og Herlofson (2004)
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Growth of public health care

• There was an increase in public care from 1945
  and until 1965. By 1965 50 of Norwegian
  municipalities had a home care unit
• The period between 1965 and 1985 showed a
  formidable growth in public health care. The
  number of employees doubled between 1970 and 1980
• In 1986 fixed funding was introduced to decrease
  the growth

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Phasing out the institutions in municipal health
care

• A reform in 1991 transferred the responsibility
  for the mentally disabled from governmental to
  municipal level. The reform was based on the
  principle of non-institutional care.
• Since the beginning of 1990, there has been built
  many municipal care homes. These are flats that
  are developed with disabled people and elderly in
  mind
• At the end of 1990 there was a commitment to move
  young people out of nursing homes

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Drawing 1. Amount of people between 85 years of
age that have 1) Been hospitalized, 2) received
home-care last 12 months, 3) have had contact
with a doctor during last month, in Norway,
England, Germany and Spain.
Daatland og Herlofson 2004
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Municipal self-government

• A law of 1837 formalized Norwegian municipalities
  as politically governed public bodies. 432
  municipalities, 4 769 100 inhabitants.
• 3 significant reforms
• The Municipal Bill- of- health-law (1984) The
  Municipalities was given responsibility for all
  primary health care- services
• Nursing home- reform (1988) All Nursing homes
  became a municipal Responsibility
• HVPU- reform (1991) All services for the
  disabled became a municipal responsibility

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Privat and public health care

• The responsibility of hospitals and health care
  treatment services are national
• Primary health care services is a municipal
  responsibility
• Dental care is mainly a private responsibility
• Care services are a municipal responsibility
• The municipality is often the supplier. There are
  also private suppliers, who are financially
  supported by the municipality
• Housing is normally a private responsibility

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The influence of interest organizations

• Lobbying, taking part in different workgroups and
  influence the political order of the day through
  media and so forth. This is done openly and is
  accepted.
• Public Reports, Announcements to the Storting,
  and Propositions to the Odelsting. Public
  hearings.
• Municipalities Council for the
• elderly, Council for the disabled.

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Formalized patients participation on an
individual level
The Norwegian Storting

• Laws, regulations and control

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Public Administration Act (1970)

• Regulates administrative procedures
• All cases are to be investigated, concluded and
  substantiated. There will always exsist a written
  decision.
• Right to lodge a complaint and take legal advice.

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Act relating to social services (1966/1991)

• Regulate practical assistance as in cleaning,
  shopping and cooking etc
• Patients influence is taken care of through the
  Public Administration Act. There is an obligation
  to consult the client and obtain information
  through consultation with the client.

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Act relating to the municipal health services
(1984)

• To regulate health services as homecare, nursing
  home, school healthcare, casualty clinic,
  physiotherapy services, occupational therapy
  services, general practitioner etc
• Patients influence is secured through the right
  to obtain necessary healthcare. All inhabitants
  have the right to a GP (general practitioner) and
  the possibility to lodge a complaint

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Patients' Rights Act (2001)

• Secures everyone access to health care of good
  quality
• Patients influence is insured through provisions
  of the right for information, participation,
  consent, insight into personal journal and
  lodging a complaint

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Individual plan (2005)

• Ensure that extensive social and health care
  services will be coordinated for the patient
• Patients influence will be secured through the
  right to participate in the planning and the
  right to approve

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Internal Control

• Health Services Supervision Act Everyone who
  provides a health service shall establish an
  internal control system
• Health Personnel Act Health care shall be
  organised in such a way that health personnel are
  able to comply with their statutory duties
• Internal Control Regulations Internal control
  should be carried out in such a way that failure
  in the health services may be prevented.

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Supervision and formal complaints

• The Patient Ombudsman is to handle complaints
  from individuals related to service quality
  issues
• The County Governor supervises the municipal
  health and care services. Also treats formal
  appeals on decisions of type and amount of
  individual care services
• Norwegian Board of Health Supervision is the
  national supervising body

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National Insurance

• There exist economic services to support family-
  and self-care also
• Basic financial assistance covering extra
  expenses related to illness, assistance related
  to private care, and assistance to cover for
  extensive care for children

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Personal assistance in Norway

• Status quo and the way forward

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