Myth: Norwegian health care is very good

Some days ago I fell for clickbait and read one article at our national broadcasting (NRK) website. The story is about a motorsports lady that had to give up motorsports after a broken hand got mistreated in the Norwegian health system - and I do have some comments to that story.

An arbitrary Norwegian hospital. Image source: Wikimedia Commons, Anders Bayer, 2008. Public domain

Most Norwegians seems to believe in a myth that we have a very good health care system in our kingdom. This lady got rushed into a hospital at Goha in Qatar, and the doctors there said she needed to be operated. I'm quite sure many Norwegians would say the same as she did: "no thanks, I'll do the operation at home in Norway instead". I guess the medical costs were covered by the insurance company, I guess her reason for saying "no" was because she believed in this myth; it's much safer to be operated in Norway!

In Norway, they were reluctant to operate. If I read the story correctly, here are some of the things that were said:

• "There is no need to operate, this is a gentle fracture" (and after that weeks and months passed without much improvements)
• "You want it operated? Yes, indeed, you may get faster back into sports if we operate ... but we won't do that, the risk is too high"
• One thing that wasn't written in the article, but I do know this for sure: to get a non-urgent operation done through the public health service, one has to wait - most likely for months.
• "We should probably send this latest X-ray-photo to a specialist, but you'll have to wait for two months to get a reply"
• Instead of waiting for a specialists opinion, she goes to the 24/7 emergency department in Oslo, they say "this looks quite OK actually, you can continue with sports".
• Finally she gets a consultation with a competent doctor, who can tell at once that the fracture didn't heal very well, and that there were quite some other problems, including a torn ligament.

I won't dwell more on her case - but I can tell a bit about my experiences.

A Personal GP (fastlege)

Some decades ago a new administrative procedure got introduced; we all have to register with one General Practitioner (GP). I always thought of this as silly nonsense. While it was said that one can opt-out from this arrangement, I've tried - in practice opting out from this almost means opting out from Norwegian public health care in general - and in Norway, health care in general is public, there aren't many private clinics. So, whatever happens, and wherever I am in this country, I'm is supposed to get an appointment with my personal GP. No other doctor would do. If I'm staying at another part of the country than where my personal GP has an office, I should be careful to break my leg at the end of the month - because then I can apply for a new, local GP.

Ok, to be fair - a broken leg is an emergency, so it's not really needed to visit the GP. Here in Oslo we also have an offer - a 24/7 emergency medical center (Oslo Legevakt) where anyone can come anytime, even if it's not a real emergency - but they will usually point out that you should have gone to your personal GP instead of going there.

Personal anecdote 1 - taking a HIV-test for a visum application

For a period there were mandatory with a negative HIV-test for getting a business visum for Russia. In Norway this procedure took more than a month. The procedure looks like this:

• I should get an appointment with my personal GP. I've found one GP now that generally has quite many free slots in her calendar, but in general it may be weeks of waiting time for non-emergencies.
• I should eventually travel to see my GP (of course, most A4-people have a home, a work place and a personal GP in the same town, and rarely leaves this town - personally I've always been dreaming about living a nomadic life style).
• I should meet up to my appointment, possibly sit for some extra hours waiting for the GP to get time to see me (nevermind that I actually had an appointment at 10).
• I should shake hands with the GP (this seems to be an important part of the ritual - nevermind that this is an important disease transmission vector).
• I should explain the GP that I need this test and why I need it (nevermind that I already tried telling this to the secretary while booking the appointment).
• The GP will log the conversation on the computer, and then send me out. He's not into taking blood tests, that's the work of a nurse. So now I have to wait for another hour until some nurse actually have time to take the blood sample.
• The nurse will take a blood sample
• Then I should pay for doing the handshake thing with my GP, as well as for the nurse taking the blood sample. Our public health services are heavily subsidized, but still it's expensive! (To be fair, it's not quite right to send the bill for my HIV-test to the taxpayers).
• The blood sample will be sent to the hospital for analyzing
• One or two weeks later, I can go back to the doctor to get the results.

Now once we had our wedding party planned in St.Petersburg and suddenly realized that I needed this HIV-test rather urgently if I would be able to participate in my own wedding! I did not have the time for doing it the formal route as mentioned above. I tried going directly to the hospital - they have the nurses to take the blood samples, they have the equipment for analyzing the blood samples, but ... no luck there. Finally I found some medical center for drug addicts, they had HIV-tests on their menu, and could do it for me. (When I tried to get it done there again one year later, they told me to get lost).

Once I had the chance to get this check-up done in Russia, as I was there just before my visum needed renewal. Procedure was like this:

• Get to any medical center offering this test
• Tell the administative staff what I needed (or rather, my wife did this for me due to the language barriers), and get pointed out where to queue up
• There were quite many people taking this test, so I actually had to wait for 15 minutes or so
• There were two persons working there, one checking the passports and doing the administrative work, the other taking blood samples. It was good pipelining, while I did the blood sample the previous person in the queue were getting the passport checked.
• Back to the administration to pay. I got the options to pay a normal fee and get the result the next day, or pay an express fee and get the result the same day. I chose the normal fee. It was relatively expensive, no subsidizing, but still cheaper than the handshake with the Norwegian doctor.
• Then back to the administration next day to pick up the test.

Now, that's quite much more effective.

Personal anecdote 2 - my son needing an operation

We were living in Tromsø in the arctic Norway at that time. We already knew that our son needed an operation (we'd been told so in Russia), but of course we had to go through all the bureaucrazy (misspelling intended) in Norway to get an operation done. First seeing the GP (waiting for a week for the appointment, and for half an hour in the doctors office), then getting an appointment with specialists in the hospital maybe a month later or so. I don't remember the details - but I do remember the visit to the hospital. We had the appointment before lunch hours, probably at 10. Now we were quite unlucky, there were quite many things going on that day, things that for sure were more important than my sons issues. But still, we had to sit there waiting for so many hours, we were starving, we didn't know if we could leave the waiting room to buy some food! At 17 we finally got admitted to the specialist, who spent some few minutes to decide ... "you need an operation!".

Next, waiting for a "slot" at the surgery. I think our visit to the hospital above was done in January. In the summer vacation our son was in Russia with his grand parents. They said ... "what? you still didn't get that operation done?" and rushed him to the hospital. They got the option to pay something for a same-day-operation or to wait for a week and do the operation for free (since our son has dual citizenship, he has rights in Russia - including free health care). They chose the latter.

We moved to Oslo over that summer. I forgot completely that we actually were waiting for an operation - until September, when we got a phone call from Tromsø: "hi, we see that you've moved to Oslo - so we wonder if you maybe want to wait for an operation in Oslo rather than in Tromsø?".

Other experiences in Norway

I had my back struggles for more than a year. One of the first things, I had to get a personal GP here in Oslo. Her primary job is to produce documents stating that I'm having back problems and that I cannot work 100% due to that. How much can I actually work? Now, that was quite much up to me to decide, the doctor should just confirm it. The biggest problem was that I would have to say in advance that for the next two weeks, I will be able to work ... say, 40%. With the intensity of my problems going up and down, my ability to work was not something I could predict easily. So, every second week I had to make a new appoitment to shake hands and get my papers renewed. Actually helping me with the back problems were beyond her competence - but she could recommend that I should see a physiotherapist. While our GPs are quite much subsidized, there aren't much subsidizing of physiotherapists. I ended up paying really a lot.

Other thoughts

The little I've seen of the health care in Russia tells me that the health care there is far more efficient, much cheaper and that their health care have a much better capacity than what we do have in Norway. I don't have much experiences with health care elsewhere.

Now, those experiences doesn't say much about quality - which probably is the biggest reason why most Norwegians rather would have surgical assistance in Norway than in Russia. It seems to me that the quality of the service can differ a lot in Russia, their hospitals may not always be equipped with the latest tech. Competence of the staff may also vary a lot, but in general I don't think the staff is any less competent in Russia than in Norway. I also believe that one will get faster to the specialist having the right competence in Russian than in Norway - at least in the urban parts of Russia.

I'm not sure if it's still like that, but in Norway it used to be many more wanting to become doctors than the number of places on the medical faculty - meaning that only those with the best marks from the school would have a chance to get a place on the medical studies. Now one can assume that there is a correlation between getting good marks from the school and being intelligent, and we do want intelligent doctors, don't we? Well, personally I'm not so sure the correlation is that strong, and if there is a lack of doctors, it would be better to educate more doctors, as well as to educate those who are truely motivated to be doctors even if they don't have the best documents from school.

Those people who do become certified doctors, they should be doing doctoring work rather than doing paperwork and signing sick leave papers.

When needing help from a nurse, it ought to be possible to get this help without first having to pay for a handshake with a doctor.

In general, one should have the possibility to see any doctor, not only one "personal" doctor. It should also be possible to go directly to a specialist. I think some of the motivation for the Norwegian system is that one does not want to waste the time of the specialist with silliness that the GP could handle. I do believe this could be solved by having receptionists or nurses doing the filtering in the office of the specialist. Actually they are pretty good at this in the 24/7 emergency service in Oslo - I believe they introduced this after someone died in the waiting room. Now they have nurses who checks up, decide if it's a real emergency or if it can wait - eventually send people home if they believe it's not worth the waiting time, or even give enough help and advises that one doesn't need to see the doctor at all.

How does the health care system work in your country? Would you rather go home than getting an operation done abroad?