Norway: #5 in the 2024 World Index of Healthcare Innovation

Introduction

In the 2024 World Index of Healthcare Innovation, Norway secured the fifth position overall. Exhibiting a remarkable rise in the Index, Norway’s overall ranking moved from 24th in 2021 to 14th in 2022, and now to 5th. A significant boost in public health spending contributed to Norway’s exceptional leap in the Quality dimension, where it advanced from 9th to 4th. Despite improvements, Norway continues to trail in the Choice dimension, ranking 26th, though there too it has somewhat improved. In Science & Technology, Norway achieves a solid ranking (10th) due in part to a strong culture of health digitization.

Background

Since the discovery of oil in the North Sea in 1969, Norway has evolved into one of the world’s wealthiest nations. This prosperity has facilitated the expansion of a sophisticated, socialized healthcare system. The system is structured under four Regional Health Authorities, similar to Britain’s four National Health Services, managing 20 hospital trusts across the country.

Norway’s healthcare is financed through a blend of national and municipal taxes, providing universal and automatic health insurance coverage for all residents. The bulk of healthcare administration is handled by Norway’s municipalities, supported by robust federal funding. In 2023, municipal contributions to healthcare amounted to approximately 35 percent of the total health budget.

The Ministry of Health in Norway plays a crucial administrative role by setting budgets and legislative guidelines to define essential health benefits for all citizens. Despite the absence of a strictly defined benefit package, the Parliament makes final decisions on which services are covered.

Approximately 10 percent of the population opts for private health insurance, mainly provided by employers to grant faster access to elective services covered publicly, and more options among private providers. Even though private insurance enhances accessibility and choice, it represents a small fraction of overall health service consumption, covering less than six percent of all elective healthcare services.

The healthcare infrastructure in Norway predominantly consists of public hospitals, supplemented by a small percentage of private not-for-profit and for-profit hospitals that focus on elective treatments. In 2023, the co-payment required for general practitioner and specialist visits, outpatient hospital care, and same-day surgeries remained consistent, with public providers restricted from charging above set rates for their services.

Despite strong economic performance maintaining Norway’s debt-to-GDP ratio below 17 percent in recent years, healthcare spending has escalated, reaching 11 percent of GDP in 2023. Public financing continues to account for approximately 86 percent of national health expenditure. However, the rising costs are sparking concerns about the long-term sustainability of Norway’s healthcare system.

Norway employs a decentralized health system characterized by shared decisionmaking and financial responsibilities between the federal government and local municipalities. This arrangement allows for healthcare strategies that are adapted to local conditions while ensuring uniform national health standards. In 2023, local autonomy in managing health services was further emphasized, with significant investments in digital health technologies to improve service delivery across regions. The government’s role focuses on policy formulation, quality assurance, and the regulation of health services to maintain high standards of care and accessibility nationwide.

Dimension Performance

Quality

Norway ranked 4th in the WIHI dimension for Quality, three spots below its ranking in 2022. Norway’s high-quality care delivery can largely be attributed to its increase in the patient-centered care ranking, which jumped from 21st in 2021 to 2nd in 2024. Additionally, Norway performed exceptionally well in infrastructure (4th) with its modern hospital and outpatient care system. Furthermore, Norway scores exceptionally well in reducing forms of treatable mortality, leading to a solid ranking in measures of preventable disease (13th).

Choice

Norway ranked 26th in Choice, the same ranking as in 2022. Norway has above average access to new treatments (15th). Despite Norway’s high health care quality, the Nordic nation struggles to provide patients with autonomy and choice in their medical care. Its health coverage is also expensive. Accordingly, Norway ranked 27th in freedom to choose healthcare services and 14th in affordability of health coverage. For many Norwegians, private supplemental health insurance is expensive, and they have little choice in deciding the insurance and benefits they want.

Science & Technology

Norway is ranked 10th in the WIHI dimension for Science & Technology. Although its contributions in medical advances (15th) and scientific discoveries (13th) are near the median of the Index, its commitment to health technology is demonstrated by its 3rd place ranking in health digitization, positioning it within the top tier of all WIHI nations in this element.

Fiscal Sustainability

Norway’s socialized healthcare system ranked 9th for Fiscal Sustainability. Admittedly, Norway’s very high standard of living and strong economy helped it achieve high marks for national solvency (8th). Nevertheless, Norway dedicates massive resources per capita to public health spending through its socialized health care system, though its growth rate for health spending (3rd) decreased as a percentage of GDP over the last decade.