Beth Jordan – GSAL Alumna (2019 Leaver)
Former student Beth Jordan was an editorial member of Salutaris, the Sixth Form academic journal, during her time at GSAL. This thought-provoking essay on health care in Norway was originally published in Salutaris 2019, a project led by Mrs Gray, E-Learning Designer. Mr Dodd (TGJ Staff Editor)
Life expectancy at birth is one of the 3 dimensions of HDI (Human Development Index.) Good health is key to a good standard of living because it improves day to day life and allows people to continue doing activities that those in ill health may not be capable of. In this essay I will look at accessibility to health care, a controversial topic in the UK, and how a successful health care service can improve the quality of care in a country by comparing ours to the Norwegians’.
Country Life Expectancy (years)
( Figure 1)
Looking at this data there is only a very small difference in expectancy between the two countries. This measurement does not necessarily represent the health of people alive. A better way to look at how people can use a healthcare system and how well the system works is to look at spending and entitlement.
Country Healthcare spending per Capita (US$)
( Figure 2)
Norway has the highest proportion of nurses and midwives per head and Finland has the highest numbers of hospital beds per capita in western Europe. These statistics are evidence of the quality of healthcare in the Nordic countries. For the UK, the last few years has seen the NHS in crisis. In 2018 the NHS was short of 41,722 nurses and this, along with other staff shortages, meant the NHS had to spend its already stretched budget on employment agency fees. This shows that when countries have fewer vacancies they have more of their budget to spend on the quality of staff, medicine and equipment. Some may argue that the problem with the NHS is the fact it is ‘free at the point of consumption’. This economic term means although people pay for the NHS through general taxation, there is no need to pay for medical care when that care is delivered. All UK citizens are entitled to free healthcare regardless of how they became in need of help, whether it be through fault of their own, such as unhealthy habits like smoking, or not. A free healthcare service to provide care for the 65+ million population of the UK is not currently working well enough, especially with our growing ageing population.
An ageing population is a challenge also facing the Nordic countries, but they seem more equipped with their superior healthcare systems. Norway is a prime example of a healthcare system that is partially government funded but also paid for by the consumer. This balance is what makes the system unique and successful. Excluding under 16s and pregnant women, all citizens must pay $246 USD each year to cover their medical costs. This covers the cost of appointments and emergency care. The only thing patients have to pay for is additional medicine or equipment. If the Norwegian hospitals cannot provide a certain type of care for a patient than this patient’s costs of care abroad are covered. Also, patients with long term illnesses will receive a tax cut to try and help with the costs of their treatment.
The idea of paying for healthcare seems oxymoronic to a welfare state, however it is a system built after the second World War that aims to ‘offer service provision that meets the requirements of the most of the people not a last resort’. This idea echoes with the general consensus of ‘many to support few’ through taxation. I have already discussed the high workforce participation but what are the benefits of a high tax burden to the government and healthcare? Increased tax revenues mean the government has more money to spend without amassing large amounts of national debt. This money can be put into the healthcare service and improving it. Alongside taxes, the added cost of $246 USD from each citizen can also go towards improving the healthcare. Taking into account that the average monthly wage of a Norwegian citizen is $3500 USD (before tax) this sum seems feasible for yearly, good quality ‘cover’. Whether you are ill or not, you are supporting the ‘few’ who are ill, through taxes and the yearly deductible. The combination of taxes and the deductible arguably remove the idea of ‘moral hazard’. A moral hazard is when someone is less careful of hurting themselves because they are insured or eligible for free healthcare. If the citizen has knowingly contributed financially to healthcare they will be more inclined to look after themselves. This could reduce the number of patients and increase the quality of care received by those who are in fact injured or ill.
To improve healthcare in the UK the government could implement a similar system to Norway. Most politicians would agree that funding is the biggest problem facing the NHS. If we could raise extra funds by charging people an annual fee there would be more money to invest and improve the health service. This could work even better in the UK as we have a larger population, and therefore the money raised from per capita deductible would be higher than that of Norway. It would also improve the efficiency of the NHS, as more money could be spent on up-to-date equipment; increase employment as there is more money for wages/training; and reduce moral hazard. People would be likely to complain about an increase in income tax, for example, to raise money for the NHS, but paying directly to the health service seems fairer to people. It would also allow more government money to be spent on other things such as Education or Disability Benefits. There would, however, be problems. Firstly, it could be seen as inequitable as the rate is regressive. This means as income increases the proportion of income that you are paying for healthcare decreases. This is inequitable, especially as everyone is entitled to the same healthcare. On the other hand, people who chose to use some sort of private healthcare, 10% of the population, could stop using private healthcare, and private insurance companies may struggle to stay afloat due to losing customers. The influx of patients who previously used private could put more pressure on hospitals, as numbers may have underestimated patient numbers without them. Overall, from a political stance, this may still be unpopular, and parties will be afraid to introduce something that could reduce their chances of getting votes. A change of system would take a long time and a large amount of funding to implement.
A health system like the Norway’s relies on a strong base of workforce participation to fund the government run hospitals through taxation.
 United Nations Human Development Reports, 2016 , Country Profiles (Norway and UK)
 World Health Organisation, ‘Nordic Health Care Systems’, Published 2009
 Denis Campbell,The Guardian, ‘NHS suffering worst ever staff and cash crisis, figures show’, September 2018
 Wikipedia, ‘Healthcare in Norway’ October 2018
 Check in Price, ‘Average and Minimum Salary in Oslo, Norway’ September 2018
 InterNations, ‘Private Health Insurance in the UK’