Healthcare in the Nordics

The entire resident population of the Nordic region is covered by publicly financed comprehensive healthcare systems. These guarantee access to high quality healthcare at minimal or no direct patient cost. Access, treatment and public health are the three key dimensions to healthcare policy in the Nordic countries. Each element is tackled differently on a national or local level, but the overall structure and operation are similar throughout the region. The Nordic countries enjoy some of the best health statistics in the world and are rated highly by the World Health Organisation and in comparative studies.

IV drop at the hospital

Health outcomes stack up well in the Nordic countries with Iceland, Sweden, and Norway among the best and Finland and Denmark about average for Western Europe. All have life expectancies two to three years longer than the United States.

Cost of universal healthcare

Typically 75-85% is paid by tax revenues collected at the local and national levels, but there are some patient co-payments (especially in Sweden) and cost-sharing, for example, adult patients share the cost of prescription drugs with the state. Such patient payments are capped at modest levels and waived for low-income and certain chronic conditions.  Dental services are free for children but can be a major expenditure for adults. Private insurance is available for dental care and increasingly for ‘elective’ or non-acute hospital care, but remains a relatively minor part of the overall healthcare system.

Until the 1990s most health programmes were financed out of the public budget with block funds granted to hospitals, health providers and other parts of the medical system. Patients had few options other than the care prescribed by their general practitioners or the assigned hospital specialists. Since then, the trend has been to make the systems more flexible and efficient. Financial incentives are designed to encourage greater productivity by hospitals and medical professionals, give patients more choice, and increasingly guarantee access within specified time limits. The long waiting times for non-acute care (and occasionally even for serious illnesses) has been a particularly prominent source of public discontent.

Healthcare costs have in recent years increased rapidly in the Nordic countries as elsewhere, but the overall economic burden (as a share of GDP) has been relatively stable over the past decade, ranging from 8.5% in Iceland to 10.9% in Sweden (2017). This is average for OECD post-industrial societies, but 40% less than in the United States.

Administration of healthcare in the Nordics

The basic structure of universal healthcare has remained virtually unchanged since 1945, although the national systems have been re-configured several times. Patients choose their primary care physicians (subject to availability), and these doctors serve as ‘gate-keepers’ to specialised and hospital care. Emergency care is hospital-based with various ‘on-call’ systems to allow rapid access.

Hospitals are usually the responsibility of local or regional governments with major university teaching hospitals under at least partial national control. Some private hospitals for specialised services (e.g. cosmetic or orthopaedic surgery) have been established, and are growing in popularity. Supplemental private health insurance for non-critical medical and dental care is also widespread. Health management reforms have allowed private companies to make limited inroads in managing and servicing hospitals, especially in Sweden.

General practitioners are self-employed professionals who contract with the local health services. They are usually compensated by a combination of ‘capitation’ payments (patients registered on the physician’s list) and fees for services. Group practices and clinics are becoming more common. In remote regions health professionals, often recruited abroad, are offered extra incentives.

Health professionals in the Nordics

Salaries and contractual terms and conditions of physicians and other health professionals assigned to hospitals and state institutions are coordinated via collective agreements negotiated by professional associations and unions. It does not cost anything to become a physician or health professional as higher education is provided without cost to the students.

Recent challenges for healthcare in the Nordics

The growing healthcare burden on the Nordic healthcare systems comes from ageing populations, unhealthy lifestyles, and to a lesser extent growing immigrant populations. Other common challenges are financing advanced medical technology (equipment and pharmaceuticals), training and maintaining the skills of healthcare professionals, and increasing the effectiveness of health treatments for both economic and patient care reasons.

In common with most European and western systems, hospital stays in the Nordic countries have been significantly shortened during the past two decades, resulting in hospital closures and consolidations. In most cases specialised hospitals are now regional with support from several local and county governments. Technological advances have been adopted quickly at considerable expense. Despite health statistics in the Nordics being generally positive, there is growing concern about ‘lifestyle’ issues which has prompted increased interest in preventative policies including reducing use of tobacco, alcolhol and narcotics, improving diet and exercise, coping with ‘new’ contagious diseases (e.g. HIV/AIDS), and providing suitable care for the growing elderly population. Mental health de-institutionalization has also been a challenge. The growing non-western immigrant population has issues of utilization of healthcare (seeking treatment and particular illnesses). There are also barriers to non-European health professionals pursuing their careers in some of the Nordic countries.

History of healthcare in the Nordics

In common with most other European societies, pre-modern healthcare in the Nordic region was largely the responsibility of churches and charities and, after the Reformation, national and local governments. With the rise of scientific medicine in the nineteenth century, medical care became a mixed private (doctors) and public (hospitals) enterprise with national and local governments gradually expanding their role. At the same time, mutual health insurance societies took over the financial task of allowing ordinary people access to modern medical care from the medieval guilds. Charities and public hospitals cared for most citizens, but by the early twentieth century trade unions and public legislation made healthcare insurance available to most.

Further reading:

  • Organisation for Economic Co-operation and Development (OECD), Healthcare at a Glance (Paris: OECD, 2018).
  • World Health Organisation. European Regional Office. European Observatory on Healthcare Systems and Policies Healthcare in Transition Reports: Denmark, Finland, Iceland, Norway and Sweden, (Copenhagen: WHO Regional Office, 2012-13).   
  • J. Magnussen,  K. Vrangbaek, and R. Saltman, eds. Nordic Health Care Systems; Recent Reforms and Current Policy Challenges. (NY: Open University Press, 2009).