Are summer internships in Norway mainly paid?
The Norwegian health system
The core of the Norwegian health system is public health care for the whole population, financed largely through tax revenues. With eight percent of its gross domestic product, the country spends relatively little money on health care compared to other European countries. The private health sector plays a secondary role and is limited to the metropolitan areas.
The general national insurance fund, established in 1967, covers everyone living in Norway regardless of their citizenship. This fund not only finances health benefits, but also pensions, unemployment benefits, sick pay and other social benefits. The insurance fund is made up of 75 percent contributions and 25 percent tax subsidies. Employees and freelancers pay 7.8 percent of their gross income into the fund. There is no income threshold. The self-employed pay a maximum of 10.7 percent of their income. If your earnings exceed 12 times the basic amount of social security, i.e. 76,929 euros, the contribution rate is 7.8 percent. The employer's contribution is 14.1 percent. However, there are graduated lower rates for establishments in certain regions. The second source of funding is taxes levied by the 19 districts or the 435 municipalities. As a third financing basis, there are also relatively high deductibles.
The patients have to pay an own contribution of around 15 euros for each visit to their family doctor. A 36 percent co-payment per prescription and a maximum of 30 euros are provided for medication. If the expenditure exceeds 200 euros per year, all other medical services are free of charge. The deductibles paid for children are added to the parents. The national insurance fund only reimburses medication that is used for chronically ill,
Cancer patients and used in palliative medicine. Medicines that are on the so-called blue list are only paid for from the insurance fund if the treatment of an illness lasts longer than three months.
The Norwegian municipalities are legally obliged to provide primary medical care. In addition to general medical help, they have to provide home nursing and school health services, mother counseling, old people's and nursing homes as well as offers of help for the disabled. The 435 municipalities are largely autonomous in organizing and financing these tasks. On average, they raise half of the primary care funds through municipal taxes. About 15 percent are paid for with deductibles. The remaining 35 percent of the costs come from government subsidies.
In Norway there is the family doctor system, i.e. almost every person is registered with a family doctor who is responsible for primary care. The family doctor is the first point of contact for the patient. The health insurance only pays for the treatment costs if he refers the patient to a specialist. Around 10 percent of general practitioners are employed directly by the municipalities. 90 percent work freelance, but require a practice approval from the responsible municipality. The municipalities guarantee a base salary. In addition, there are flat rates per patient, individual service payments and patient deductibles. Most of the general practitioners work in group practices. Only about 10 percent work in individual practices.
Ensuring outpatient specialist care has been the task of the five health regions since the hospital reform in 2002. Specialists work almost exclusively in the hospital outpatient departments and can only be consulted by referral. Gynecologists are excluded. In total there are around 930 freelance specialists who have their practices almost exclusively in the larger cities.
The majority of hospitals have been maintained by the five health regions since the 2002 hospital reform. The clinics have thus been transferred to state sponsorship. However, they are organized as a company and are therefore no longer integrated into the state administration. The overarching health policy goals and framework conditions are still set by the state. Less than one percent of the hospitals are privately owned. The majority of hospital costs are borne by the state. The financing is based on two pillars: Half of the funds must be generated. This is based on a DRG system. The other half - a fixed amount - is independent of the activity of the clinics.
The doctors in the clinics are employed and receive fixed salaries. It is not possible to treat private patients in public hospitals. However, some clinicians also have a private practice. Doctors who work in hospitals have regular working hours. These are designed so that women with children can also work fully. In many hospitals there are kindergartens that coincide with working hours and thus also give young mothers the opportunity to work.
Since 2001, patients have been able to freely choose their hospital across the country. This choice should also be carefully considered, because a major problem in the Norwegian health system is long waiting lists, which are particularly complained of by patients who have to undergo a simple procedure. The consequence of these capacity bottlenecks is the so-called patient bridge to Kiel, i.e. many Norwegians undergo surgery in Germany if they have to wait too long for an operation. A legal guarantee was introduced in 1990 that was supposed to limit the waiting period to a maximum of six months. In the meantime, however, the waiting time is determined individually by the attending physician.
There are four universities in Norway that offer medical degrees: Oslo, Bergen, Trondheim and Tromsö. The number of applicants is about five times as high as the number of study places. The number of
University places almost doubled in the period from the late 1980s to the late 1990s due to a shortage of doctors in Norway. This also made it relatively easy for foreign doctors to gain a foothold in Norway in the late 1990s. Around 15 percent of doctors come from abroad, mainly from neighboring Scandinavian countries.
Depending on the university, the course lasts six to six and a half years. Compared to other European countries, the practical share is quite high. Students gain experience in both clinics and primary care. The course is followed by an 18-month internship, two thirds of which must be completed in a hospital and one third in primary care. After completing this internship, the doctor receives a license from the National Health Council to practice the medical profession independently.
The training to become a specialist lasts at least five years in the main subject and a further year in a complementary subject. There are currently 29 specialties as well as eight internal and six surgical subspecialties. In 1998 around two thirds of Norwegian doctors had a specialist qualification.
There is a specialty in the training to become a general practitioner. In principle, any doctor who has completed the internship and has been registered by the National Health Council can work as a general practitioner. In 1985 the specialty of general medicine was introduced. It provides for five years of training following the internship, four years in a general medical practice, one year in a clinical hospital department. The competencies between a specialist in general medicine and a general practitioner who does not have the special training do not differ. However, the specialist receives around 20 percent higher remuneration.
In Norway there is only compulsory training for general practitioners. They have to apply for the recertification of their diploma every five years and have to prove, among other things, that they have attended a certain number of advanced training events. For all other doctors, there is no continuous training requirement.
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