Organization and responsibility for the health sector

In the Nordic countries, the health care sector is mainly a public matter with universal access and equitable provision of care as guiding principles.

The health care sector is mainly organized and financed by the public sector; it aims to provide residents good-quality health and medical care and promotes good health for the entire population.

The systems operate across the state level, the regional level, and the local municipalities, with some degree of variation in the content and responsibilities on each level. On the state level the main responsibility is health care legislation, supervision, and guidelines/policy.

The responsibility for the organization and provision of the health services is decentralized to a varying degree, from the national level to regional and local health authorities. All the Nordic countries have highly developed hospital and specialist services, and well-established systems for primary health care. Health services include preventive health services for mothers and infants, school health care, vaccination schemes, and dental care for children and young people. Preventive occupational health services are available in all Nordic countries.

On health services in general

Preventive occupational health services and general measures for the protection of the environment have been established in all the countries. The countries generally have well-developed hospital sectors with highly advanced specialist treatment. Specialist medical treatment is also offered outside hospitals.

The health services are provided in accordance with legislation, and they are largely financed by public spending or through statutory health insurance schemes. Some patient charges are, however, payable for pharmaceutical products and to some extent also for treatment.
Salary or cash allowances are payable to employees during illness. Self-employed people have the possibility of insuring themselves against illness.


State-regional-municipalities responsibility

Responsibility for health services is relatively decentralized. The main principles are as follows: The State is responsible for legislation, supervision and guidelines. The regions are responsible for hospital services, health insurance and special nursing homes. The municipalities are responsible for primary health care, home nursing, prevention, rehabilitation after hospitalization, and child and school health services. The regional authorities have operational responsibility for health services.

Population coverage

In principle, primary contact shall always be with a general medical practitioner. Health care during pregnancy is the responsibility of the regions.

Child health care is provided according to the Act Relating to Health Visitors and is administered by the municipalities, while health examinations of children are carried out by general medical practitioners.

Contact with the health services: As a main rule, patients may contact general practitioners, dentists, chiropractors, physiotherapists, chiropodists, psychologists, dental hygienists, emergency wards and emergency and ambulance services without referral.

Free choice of hospital: As a rule, patients are free to choose the hospital where they wish to receive treatment.

Hospital, specialist and care

Public hospitals are owned by the regions.

Practicing specialists: Most practicing specialist physicians work under a contract with the health insurance scheme.

School and occupational health services are regulated by legislation. Municipalities are responsible for school health services, which are provided by health visitors and physicians.

Occupational health services are organized by companies and are led by committees with representatives for both employees and employers.

Dental services are provided by private dental practitioners. The services are only a public matter in some dental care services for children.

Home nursing care is provided by the municipalities and is free of charge after referral by a physician. Ordinary nursing homes are run by the municipalities, but there are many private (independent) nursing homes, which receive residents according to a contract with the municipality in which they are located. Certain specialized nursing homes are run by the regions, for example psychiatric nursing homes.

Pharmacies are organized as private companies, but are subject to government regulation. The state regulates the number and the geographic location of pharmacies, their tasks and the profit margin on pharmaceutical products.

Private sections and areas of health care

The regions have a contract with some private hospitals to provide treatment under the extended free choice of hospital arrangement. A few private hospitals operate totally independently of the public hospital services. Some specialized hospitals are organized under the hospitals, while others are owned by organizations.

Faroe Islands

State-regional-municipalities responsibility

The Home Government of the Faroe Islands lays down the rules concerning the tasks, benefits and administration of the health service.

The government is responsible for the hospital services, the general practitioner’s (GP's) service and the dentist’s service. Also, the government is responsible for the Health Insurance Scheme (Heilsutrygd).

Rehabilitation after hospitalization for people under the age of 67 is the responsibility of the government. The municipalities are responsible for nursing homes, home care and rehabilitation after hospitalization for citizens above the age of 67.

Population coverage

The main principle is that the primary contact is the GP’s. The GP’s refer patients to hospitals or other specialists if required. In general, there is free choice of hospital to receive treatment. However, patients might be referred to a certain hospital in order to reduce waiting time or due to limitations in services offered by certain hospitals.

The midwifery service is provided by hospitals.

Child health care is provided by health visitors and is administered by the government.

The government is also responsible for primary school health services, which are provided by health visitors and physicians.

Dentists may be contacted directly by patients for service. The service is free of charge for children and youngsters until the age of 23. For others, the service is paid for partly by the Health Insurance Scheme and partly by the receiver of the service. Other specialists like physiotherapists, psychologists and chiropractors may be contacted directly by patients without referral from a GP, but no remuneration for the cost will then be granted from the health insurance scheme.

A district psychology service is available as a supplementary to the in-patient treatments at the psychiatric hospital.

In 2021 a three years experimental scheme has been set up as a cooperation between the government and private psychologists. The scheme is for people 15 – 35 of age with light psychological diagnosis. A GP referral is required to take contact to the scheme.

Hospital, specialist and care

Three hospitals are in the Faroes: The main hospital is situated in the capital city, one in the northern part of the islands and one in the southern part.

The hospitals are owned by the government.

Self-employed specialists are mainly dentists, psychologists, chiropractors and physiotherapists.

Home nursing care is provided by the municipalities. Ordinary nursing homes are run by the municipalities. Pharmacies are owned by the government.

Private sections and areas of health care

There are no private hospitals in the Faroe Islands.

Rehabilitation home after hospitalization and rehabilitations homes for addicts are privately owned, but they receive financial support from the government.

Some companies have insurance schemes for employees covering direct access to hospital services from private hospitals in Denmark.

Cross boarder health care

The government has entered into agreements with hospitals overseas to provide health services not offered in the Faroe Islands. Patients to hospitals overseas are referred by the local hospitals.

Links to relevant legislation/organizations

Heilsutrygd, Health Insurance Scheme –

Law on the Health Care System in the Faroe Islands -

Law on the Hospitals -


State-regional-municipalities responsibility

In Greenland all residents are covered by universal public health care inclusive of medical treatment, dental care and pharmaceutical products.

Patients, who are referred for investigation, examination and/or treatment outside of Greenland, receive individual medical guidance and information on the reasons/assessment for the referral as well as the progress of the treatment outside Greenland. This very reason/assessment is made on the basis of decisions in the Visitation Committee, working out of the law and the instructions for obtaining services outside the country (for details, please see chapter 7 and 8 in If persons in the need of health care do not have residence in Greenland, the rules for temporary stay in Greenland apply.

Hospital, specialist and care

In Greenland all residents are covered by universal public health care inclusive of medical treatment, dental care and pharmaceutical products.

Cross border health care

Patients, who are referred for investigation, examination and/or treatment outside of Greenland, receive individual medical guidance and information on the reasons/assessment for the referral as well as the progress of the treatment outside Greenland. This very reason/assessment is made on the basis of decisions in the Visitation Committee, working out of the law and the instructions for obtaining services outside the country (for details, please see chapter 7 and 8 in If persons in the need of health care do not have residence in Greenland, the rules for temporary stay in Greenland apply. Greenland is not a member of EU, has not formally joined the EU Cross-border health care directive, but joins a general treatment obligation. 

Links to relevant legislation/organizations

Greenlandic medical Services Act (Grønlands sundhedslovgivning):

Health care include in Greenland (Sundhedscentre I Grønland):

Dental Care in Greenland (Tandklinikker):

Complaints about treatment in the Health Care System (Patientklagener):

Health professional notes in Greenland (Sundhedsfaglige notater i Grønland):

Health Statistics in Greenland (Grønlands Statistik «Sundhed»):


State-regional responsibility

Since 1 January 2023 the wellbeing services counties have been responsible for organising public healthcare, social welfare, and rescue services. There are 21 self-governing wellbeing services counties in Finland. In addition, the City of Helsinki and Åland Islands are responsible for organising health, social and rescue services within their own areas. The Health Care Act (1326/2011) together with The Act on Organising Social Welfare Services and Health Care (612/2021) and The Act on its Implementing  (616/2021) regulates the health care and nursing services that the regions are responsible.

Population coverage (Adult/Children/Youth, main route for health care contacts, freedom of choice etc.)

The wellbeing services counties are responsible for proving health care, including measures to promote health and welfare, primary care, and specialized nursing. More specifically each county must provide guidance and preventive health care, including children's health, maternal health, sexual and reproductive health, health education, counselling concerning contraceptive measures and health check-ups and screening. Medical treatment, including examination and care, medical rehabilitation and first aid. General medical treatment is provided in health care centres, in-patient wards or as home nursing. 

The wellbeing services counties provide services for people with mental illness that can reasonably be offered in health centres. Treatment has to be started within 14 days.

Citizens can choose whichever health centre in their home county to go to for primary health care services.  

Hospital, specialist, and care (Dental care, rehabilitation, occupational care, other)

A referral is required for specialized health care. Individuals requiring specialised medical care services can choose a treatment provider within their wellbeing services county. The treatment provider is chosen together with the referring doctor. Patients also have the right to choose their own doctor or other health care professional where possible. 

If a patient’s own health centre or hospital cannot provide treatment within the given time, the patient must be offered treatment either in another wellbeing services county or at a private institution, without extra cost. Except for emergency cases, patients must be examined and treated within a given period. The time limit for treatment is three months. The need for treatment must be assessed within three weeks after referral to a hospital. If a physician has examined a patient and has established that treatment is needed, such treatment shall be started within six months.

Wellbeing services counties are responsible for organizing primary health care for their residents. These services are defined by law and they include monitoring the health of the population, health counselling, including health education and contraception advice, maternity and child welfare clinics, school and student health care screening for specified diseases and vaccinations against infectious diseases, oral health services, mental health care and substance abuse services, appointment with physician or other health care professionals, emergency and treatment for accidents, in-patient care for patients for those patients who require nursing and home care services.

Wellbeing services counties are required to provide ambulance services and to ensure that occupational health services are established. Employers can either organize their own occupational health service, or they can enter into an agreement with a health centre or with others who provide occupational health services. Employers are responsible for preventive health care of their employees. On a voluntary basis, some also provide medical care. Employers may purchase these services from the wellbeing services counties.

Dental treatment that is assessed to be necessary shall be started within a reasonable time and at the latest within four months. Dental care includes advice and prevention, dental examination, and treatment. Dental care and treatment paid for by the health insurance scheme is provided for the entire population. Dental care is also provided for adults in health centres, particularly in rural areas. Most dental treatment for adults is provided by dentists in private practices. Young people under the age of 18 are entitled to dental care, free of charge.  

Rehabilitation organised by the Social Insurance Institution of Finland (Kela) includes adaptation training, psychotherapy, or vocational rehabilitation. Apart from Kela, rehabilitation is organised by public health care, occupational health care, regional social services, and associations for the disabled. Occupational rehabilitation is also organised by pension providers. Most rehabilitation services are free of charge for the rehabilitee. A client fee or a fixed non-reimbursable payment may be charged from the rehabilitee for some rehabilitation services, such as therapies and care periods at rehabilitation facilities. 

Specialised medical care services are provided at hospitals. Most of the hospitals are public, owned by wellbeing services counties. University hospitals and central hospitals are responsible for the most demanding medical treatment. Furthermore, there are regional hospitals and local hospitals, such as city hospitals. Health centres have inpatient wards, which may also be called hospitals. Private hospitals supplement the public services for example by providing day surgeries.

Wellbeing services counties are responsible for arranging the social and health services that older people require. These services are provided in as integrated health and social welfare services.

Only pharmacies, which are privately own, are entitled to sell medicines and most of over-the-counter products. Some sparsely populated areas have pharmacy service points where a prescription and self-administered medication can be purchased.

Private sections and areas of health care

The private health care sector such as health care companies and non-governmental organisations supplement regional services. Wellbeing services counties may also procure health care services from private service providers. 

Cross border health care

Finnish citizens and permanent residents can obtain medically necessary treatment in an EU or EEA country or Switzerland for a corresponding user fee that the residents pay with a European Health Insurance Card. Treatment in connection with a chronic illness, pregnancy or childbirth is also covered. The European Health Insurance Card is not necessary in the Nordic countries since treatment can be received by presenting a valid passport or other official identity document. Outside Europe, treatment for a corresponding user fee as that paid by residents can only be received in the Australian public healthcare system by presenting the KELA card (Social Insurance Travel expenses for care in the EU or EEA countries or Switzerland are reimbursed according to travel costs to the nearest local place of treatment. Travel expenses for care in some other country than an EU or EEA country or Switzerland are not reimbursed, excluding the expenses incurred in Finland.

Links to relevant legislation/organizations


State-regional-municipalities responsibility

Åland is a separate region for social and health care in Finland, because it is responsible for its own legislation. Social services are the responsibility of the 16 municipalities, but health care has been centralized since 1993 into one organization, Åland’s Hälso- och sjukvård (ÅHS).

Population coverage

ÅHS is responsible for all primary and secondary care of the inhabitants. Patients do not have the right to choose the hospital they wish to be referred to outside Åland. However, in accordance with the legislation on patient’s right, they have the right to a second opinion. Patients who need tertiary care are referred to Sweden and Finland. On an average there is one helicopter transport to the neighbouring countries every day.

The health care in the 59 inhabited islands other than the main Åland Island is organized with the help of local health nurses.

Hospital, specialist and care

The ÅHS runs a hospital with 121 beds and with most of the main specialities. Because of its unique geographic position, the hospital provides a wide-range emergency services.

Recruiting competent personnel is clearly one of the greatest challenges. Moreover, the language of the islands is exclusively Swedish, which restricts the possibilities to recruit from the Finnish universities.

Due to its special geography and its autonomous position, Åland may have an opportunity to rapidly form an advanced ecosystem for digitalized health care services.

Private sections and areas of health care

There are private sector actors in the city of Mariehamn, providing day care surgery, specialists, and general practitioner visits.

Cross border health care

As in Finland citizens and permanent residents can obtain medically necessary treatment in an EU or EEA country or Switzerland for a corresponding user fee that the local residents pay with a European Health Insurance Card. Treatment in connection with a chronic illness, pregnancy or childbirth is also covered. The European Health Insurance Card is not necessary in the Nordic countries, since treatment can be received by presenting a valid passport or other official identity document.

Links to relevant legislation/organizations


State-regional-municipalities responsibility

Health care services in Iceland are governed by the Health Service Act, No. 40/2007. 

Health policy is the responsibility of the Minister of Health as well as ensuring access to optimum health services. Quality of services is monitored by the Directorate of Health.

A policy for Iceland´s health services until 2030 was accepted by parliament in 2019. After the new policy was accepted, changes were made to the Health Service Act, e.g. with regards to the responsibilities of various types of health institutions.

Health services are divided into primary, secondary and tertiary services. The country is divided into seven health regions. Each region has a public health care facility which provides primary and secondary level inpatient and outpatient services in one or more locations. Home nursing care is also provided by the health centres. Two main public hospitals, in Reykjavík and Akureyri, in addition to secondary care, provide specialized tertiary health care services. In addition to public health care facilities, health services are provided by privately operating health care professionals and institutions via contracts with Icelandic Health Insurance.

Population coverage

Legal residents in Iceland automatically become members of the Icelandic social insurance system, regardless of nationality. A person moving to Iceland generally receives insurance six months after registering their legal domicile in the National Register. Each resident is registered at a specific primary health care center and this may be done either automatically or according to the individual´s choice. No referral is required to see physicians in private practice but children under the age of 18 are exempt from charges if they have a referral from their general practitioner. 

Many private practice physicians do not see patients unless they have a referral. No referral is required to receive dental care. As for outpatient private practice physiotherapy, occupational therapy and speech therapy, referrals are needed, in order to receive state refunds. This is also the case for psychological services for children with special referrals.

Hospital, specialist and care

Publicly funded primary health care centers provide both prevention and general treatment. 

Preventive measures include antenatal care, infant health care, school health programmes, immunization, family planning etc.

Inpatient secondary hospital services are provided by public regional health care facilities as well as by the public hospitals in Akureyri and in Reykjavík. Inpatient tertiary care is provided by the two hospitals.

Outpatient specialist medical treatment is largely carried out by specialists in private practice. The majority of private practice specialists operate in densely populated areas, especially the capital region. Specialist treatment is also offered in outpatient wards in public hospitals.

Dental treatment is provided in private dental practices.

Physiotherapy services are provided in health centres, but most treatment in urban areas is provided by physiotherapists in private practice.

Nursing homes are independent institutions, run by municipalities, voluntary organizations and the like. They are financed partly by user charges, but mainly by health insurance.

According to law, occupational health services are the responsibility of the employer. Larger companies buy these services from practicing physicians, consultancy firms, or from health centres.

Pharmacies are privately operated in accordance with legislation and monitored by The Icelandic Medicines Agency.

Private sections and areas of health care

Privately operated health care facilities almost exclusively have a contract with the state and receive some public funding. This includes detoxification services, nursing homes and rehabilitation centers, physicians in private practice, physiotherapists, and dentist.

Cross-border health care

In accordance with EU directive 2011/24 on patient´s rights in cross-border healthcare a patient may travel to another EEA country for treatment under certain conditions. Icelandic Health Insurance is the national contact point for cross-border healthcare.

Citizens of Iceland and other EEA countries who reside and have health insurance in Iceland are also entitled to the European Health Insurance Card.

For certain highly specialized services, contracts with health care facilities in other countries are in place.

Links to relevant legislation/organizations

Ministry of Health:

Icelandic Health Insurance:

Directorate of Health:

Icelandic Medicines Agency:

The Health Service Act no. 40/2007:

Patients´s Rights Act no. 74/1997: 


State-regional-municipalities responsibility

Health care in Norway is organized at three main levels; national/state, health regions and municipalities. A few health care responsibilities are held by the counties. The Ministry of Health and Care Services determines national health policy, prepares and oversees legislation, decides on the allocation of funds within the health sector, and delegates implementation of national health policy to different government agencies. Legislation broadly reflects the decentralized nature of the health care system. Responsibility for specialist care lies with the state, administered by four Regional Health Authorities (RHAs) owned by the state. Primary care is organized at the level of the municipalities, and dental care is organized at the level of the counties.

Population coverage

Outpatient specialist care is provided by public hospitals and private specialists. Patients need a referral to acute-care services from a GP. However, in specific cases (e.g., accidents, suspected heart attack), patients can be taken directly to the hospital via ambulance. Patients are free to choose a hospital for elective services, but not for emergency care.

GPs may refer patients either to private psychologists and psychiatrists or to community mental health centres (district psykiatriske sentre, DPS. More advanced specialized services are provided in the inpatient psychiatric wards of general hospitals or in mental health hospitals. Psychological care for children under the age of 18 is fully covered.

All residents have a unique personal identification number, used in primary care and for hospital medical records. Virtually all GPs use electronic health records and transmit prescriptions electronically to pharmacies. Electronic communication systems are used for referrals, for communication with laboratories and radiology services, and for sick leave. Some GP and specialist outpatient offices have electronic booking, while most hospitals do not.

Hospital, specialist and care

General practitioners (GPs) constitute an important link between primary and specialized health services and refer patients to specialized care when necessary. The municipalities are responsible for arranging after-hours emergency primary care. The Regional Health Administrations (Regionale helse administrasjoner, RHAs) are enterprises responsible for providing specialized care in hospital trusts (helseforetak, HF) and a few contracted private facilities. RHAs are also responsible for other specialized medical services, such as laboratory, radiology and ambulatory services, for services to persons with alcohol- or drug addiction and hospital pharmacies.

Hospitals provide outpatient specialist care and emergency care.  Hospital inpatient treatment is provided free of charge. Outpatient services are subject to the same cost-sharing as other ambulatory visits.
Municipalities and RHAs are responsible for coordinating rehabilitation services. Rehabilitation is provided at the primary level (physiotherapy, occupational therapy, etc.) and at the secondary level (specialized rehabilitation).

Adults receive dental care from private dentists and pay the full cost of treatment. Public dental care is free of charge for children and young people aged 0–18 years, except for orthodontic treatment. Young people aged 19–20 years pay 25 per cent of the costs.

The municipalities are responsible for providing long-term care and may contract with private providers. The majority of long-term care recipients receive care at home, while 10 per cent live in sheltered or assisted housing facilities. About 20 per cent of recipients live in an institution or a home with personnel available 24 hours a day. Most nursing homes are owned and funded by municipalities; only 10 per cent of all long-term care beds are in private nursing homes.

Private sections and areas of health care

Private treatment centres for addiction (mainly drugs and alcohol) are funded mostly through contracts with RHAs.


State-regional-municipalities responsibility

The Swedish health care system is comprehensive and decentralized with responsibilities on the national, regional, and local levels. Several government agencies cover different areas of expertise related to health care, social welfare, and public health.

The National Board of Health and Welfare (Socialstyrelsen) has a wide range of tasks and activities concerning social services, health and medical services, patient safety and epidemiology. The Public Health Agency (Folkhälsomyndigheten) is responsible for public health issues and promotion of public health.

The Health and Medical Services Act (Hälso- och sjukvårdslagen, HSL) lays down the responsibilities for health services based on the principle of equal access to good quality health services. Regional health authorities and to some extent local municipalities have the main responsibility for providing health services. There are 21 regional health authorities and 290 local authorities (municipalities). The organization of health services varies between regions and municipalities; however, the main principles are the same.

Population coverage

Most health services are delivered by regional and local health authorities themselves but both general and specialist health services are also provided by private providers, contracted by the regional authorities.

According to the Health and Medical Services Act, the regional health authorities are obliged to provide timely access to specific health services. If the health care provider is unable to provide care within these limits, patients should be offered options such as alternative providers within the region or elsewhere in the country.

About 660 000 persons had a private healthcare insurance in 2018, that is one in seven employed persons aged 16 to 64 years.  

Hospital, specialist and care

Regional authorities have the main responsibility for providing hospital care, specialized ambulatory care and primary care including maternity and child health care, and ambulance transport services. Regional authorities are also responsible for public health surveillance and immunization schemas.

Dental care is provided both by public and private providers.

Occupational health and related preventive services is the responsibility of employers and not provided by the health authorities.  

Local authorities are responsible for home help and nursing care in the community and to provide special housing for the elderly and people with disabilities. Medical care in special housing is the responsibility of the regional authorities and is mainly provided by contracted primary care physicians. School health and prevention among children and youth is the responsibility of the local municipalities.

Private sections and areas of health care

The private health care sector, especially in primary health care, is connected to the regions' systems of choice of care and provider, and financed with tax funds according to the same principles as the public providers. The cost for private health care sector providers is about 12 per cent of the total, mainly in accordance with agreements with the regions. Most Swedish hospitals are run by health regions; however, some acute care hospitals are run wholly and partly by private corporations. The focus of private hospitals varies within different specialties. A few private hospitals provide the same range of services as hospitals run by the health regions.  

Dental care is provided by all health regions at 880 units. Five regions run the services as public corporations. In addition, there are some 
2 000 private dental care providers with approx. 3 550 units. Two thirds of the adult dental care within the government subsidies system is provided by private dentists. 

Cross border health care

Citizens of countries in the EU/EES and Switzerland are entitled to health care and cost-coverage for certain health care abroad, in accordance with the patient mobility directive of the European Parliament and Council. The cost of services is covered according to the national health insurance schema of the country providing care, and a European Health Insurance Card is required. The European Health Insurance Card covers emergency medical and dental care by public health care providers, but not transportation costs. For a Swedish citizen to be reimbursed for planned care abroad, only treatments that you would have been able to receive in Sweden are reimbursable. The Swedish Social Insurance Agency is responsible for decisions on reimbursement for care and other payments of benefits in the Swedish Social Security Insurance system.

The National Board of Health and Welfare is the National contact point responsible for providing information regarding the Swedish healthcare system and to provide guidance on cross-border health care.

Links to relevant legislation/organizations

Medical Services Act (Hälso- och sjukvårdslagen)

Hälso- och sjukvårdsförordningen

Patient Act (Patientlagen)

Patient Safety Act (Patientsäkerhetslagen)

Dental Care Act (Tandvårdslagen)

Care guarantee (Vårdgaranti) 

Cross-border care