Scotland

Charging Patients: managing demand for healthcare visits in Norway

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Supported by the Scottish Government

Tor Ingebrigtsen is professor of clinical neuroscience at the University of Tromsø, the Arctic University of Norway and senior adviser to the CEO at the University Hospital of North Norway (UNN) in Tromsø, Norway.

Chaired by Lesley Riddoch, writer and broadcaster

Spending on health in Scotland is proportionally less than in other European nations, and our NHS is often overwhelmed. Last winter delayed discharge of elderly patients led hospitals to cancel scheduled operations and miss A&E targets.

In Norway patients pay to see GPs and need referrals to A&E, and councils, which run hospitals, are charged for bed-blocking. This system was designed to boost doctors’ income, screen out trivial complaints and encourage the creation of more GP practices as well as home adaptations and nursing home places. Iceland, Sweden and Denmark have similar systems.

Previously a Tory MSP raised eyebrows by suggesting that Scotland should copy the Norwegian system for tackling overcrowded hospitals with a tough-sounding combination of cash payments and penalties.

So should Scotland take a leaf from the Norwegian book of tough love and manage demand using charges? Or is charging unlikely to work in the absence of other factors such as the high level of health spending in Norway, greater income equality and a hyper-fit population with a far better diet.

Tor Ingebrigtsen has 20 years’ experience as a clinician, researcher and leader, including 10 years as CEO at the University Hospital of North Norway (UNN) in Tromsø, the northernmost university hospital in the world.

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