Introduction:
The population of Norway is 5.4 million. As with most other countries, the exact number of people in Norway with intellectual disability (ID) is unknown. What we do know is that approximately 20 000 people over 16 years of age who receive public health and care services are registered with ID (2021).
The Nordic nations – Finland, Iceland, Norway, Denmark and Sweden – have nearly similar approaches to social welfare, the so-called Nordic social welfare model.
The public health system in Norway has three administrative levels. In addition to the government’s overall responsibility, the primary health care is organised by the municipalities, and the specialist health service, including all hospitals, is organised by four regional health trusts.
Primary health care
Authorities at the municipal level organise and finance the primary health care services for the local population, with a goal to provide sufficient services as close as possible to where people live. Norway has a well-functioning public health and social system, but private providers are also available. The Norwegian health care system is characterized by universality. The system is built on individual rights and the principles of universal access, decentralisation, and free choice of provider. It is financed by taxation, together with employer contributions and user fee payments. Local authorities at municipal level organise and finance primary health care services according to local demand and within national frameworks.
The public health services in Norway are nearly cost-free, but there is a small fee for consultations, tests or medical examinations. The user payment, including primary and specialised health services, medical expenses and travel expenses, has an upper annual limit, which in 2022 constitutes approximately 292 Euro. Expenses above this are covered by the state.
As a result of a national reform in 1991, all institutions for people with intellectual disabilities in Norway were discontinued, and those who lived there moved into decentralised facilities in the municipalities. The aim of the reform was for people with ID to be integrated in the normal society and receive health and care services like all inhabitants. Today, most people with ID live in community settings where they rent or own their apartments and receive services there. The apartments are often located in smaller groups, and some are linked to a municipal service centre with service providers. Service providers can be a mix of social educators/disability nurses, registered nurses, and health personnel/care providers with or without professional training.
All inhabitants are entitled to a general practitioner (GP)/ family doctor. One may select and change one’s regular GP twice per calendar year if one is dissatisfied. For all medical services in Norway, the first contact is through the GP (except emergency). When specialised health services are needed, the GP refers patients to the specialist health services, which includes the habilitation service (described under the specialist health services), medical specialties, or hospital services for further assessment or treatment. GPs do visit patients in their homes, but mostly patients visit the GP’s office when needed.
To improve health care for people with ID in shared-housing facilities, an ongoing project called Primary Health care Teams (PHT) is being piloted at 13 GP practices distributed in eight municipalities in Norway (2018-2023). A Primary Health care Team consist of doctors, nurses, and health secretaries. They make home visits to people with ID to assess and follow up their health needs, and they perform video consultations with care providers. Evaluations so far find that PHT leads to better co-operation between GP, patient, next of kin and care providers in the community.
People with ID have access to free dental care service throughout life, unlike for the general adult population who mostly must pay the real cost of dental service.
Specialist health services
The specialist health service includes all hospitals in Norway. The hospitals offer the population specialized treatment, and the state owns the public hospitals. The hospitals are organised in four regional health trusts.
When the institutions for people with ID were discontinued in 1991, the habilitation serviceswere established in each of the 19 counties in Norway to support people with ID with specialized health care. The habilitation services are part of the specialist health services, organised under the hospitals and health trusts. They offer both inpatient and outpatient services for people with ID. The services cooperate closely with the primary health services, and it is the general practitioner GP who refers patients into the system. The service is divided in two sections: children and youth habilitation and adult habilitation. It must be added that people with ID receive services in the hospitals on equal terms with the rest of the population and from habilitation service and other specialized health care providers.
The habilitation services have interdisciplinary staff, including professions such as medical specialists, psychologists, physiotherapists, occupational therapists, social educators/disability nurses and other health specialties. The habilitation units’ obligations covers assessment, treatment, medical check-ups and health training for people with ID.
The Norwegian government actively motivates the municipalities to focus more on prevention to limit the use of expensive hospital services. Patients are transferred to the municipal health service as quickly as professionally advisable, in order to be treated and followed up as close as possible to where they live, or in their homes.
Norwegian psychiatry services are organised in the same way as the somatic health services. The health authorities have a goal of providing the services as close as possible to where people live, and most people receive help from the psychiatry services through the decentralised system of District Psychiatric Centres and a few in specialist psychiatry in the specialist health service. People with ID will mostly receive mental health care in the habilitation service.
People with mild ID often come for visits at the health service alone, but most people with ID have a service provider from their housing accompany them. If the patient needs a companion of a care provider from their housing during the hospital stays, the cost to cover this must be an agreement between the hospital and the municipal health administration.
Acute/emergency medical care
Emergency care for people with ID in Norway is the same as for the general population. When one’s GP’s surgery is outside normal office hours, one must contact the out-of-hours medical service. All municipalities in Norway offer an out-of-hours medical service for immediate medical assistance 24 hours a day. One can call a six-digit number (116 117) at no cost to contact to the local out-of-hours medical centre.
If there is an immediate risk to life, one must call the emergency medical dispatch centre (113) for instant help.