Is there a Nordic approach to health care?
In a new comparative study “Nordic health care systems: recent reforms and current policy challenges” edited by Jon Magnussen, Karsten Vrangbæk and Richard B. Saltman, that will be presented at the Norwegian Directorate of Health on 26 October, the European Observatory on Health Systems and Policies focuses on the “Nordic model” of health care.
While this model has been long considered as one of the cornerstones of the Nordic social welfare state, praised for its consistent pursuit of universalism and equity through close coordination between different levels of public administration, more recently it has also been criticised for not allowing citizens to take a more active role in their healthcare, limiting patients’ choice as well as rationing uptake of healthcare services in various implicit ways, such as slow implementation of new technologies.
This study demystifies and challenges this idea of a monolithic model. While it is true that the health systems in Finland, Sweden, Denmark, and Norway have important common features, such as tax-based funding, universal access, a high level of decentralisation, and publicly owned and operated hospitals, the editors conclude that the reality is – or at least has become - considerably more complex. Especially since the early 1990s, healthcare systems in the four European Nordic countries have undergone a process of gradual change. Where they have mainly kept the goals and aspirations for their health system, each one of them has chosen their own path of reform, with different timing and approach. The centrally initiated ‘big bang’ hospital reform of Norway and Denmark, for instance, contrasts markedly with the more pragmatic and voluntary changes underway in Sweden and Finland. The different Nordic countries have shown considerable variation at the structural level in the way that institutions are designed but also, at the policy level, substantial differences in the way strategies are conceived and implemented.
One notable area of change in the Nordic region has been in the provision of health care services, where principles of state monopoly and local political control have been questioned in terms of their ability to achieve the key goal of equity, both socially and geographically. As a result, different innovative forms of “new public management” (NPM) approaches have been introduced to managing healthcare delivery.
It is this pragmatic approach to adapting the health system to new developments and expectations while maintaining focus on the basic values and goals, that makes the Nordic systems both interesting and relevant, not only for policy makers in these countries but also more widely for health systems elsewhere in Europe and the world.
Oslo, 26 October 2009
Nordic health care systems: recent reforms and current policy challenges. Edited by Jon Magnussen, Karsten Vrangbæk and Richard B. Saltman. Published by Open University Press - European Observatory on Health Systems and Policies Series