Healthcare services in general
Occupational health services have been established in Denmark, Finland, Norway, and Sweden. The purpose is to initiate preventive measures and improve employee health within the workplace.
Primary health care
In all Nordic countries, the healthcare services are primarily based on general (primary) healthcare, which takes place outside of hospitals. In addition, various forms of preventive healthcare measures are linked to the primary health services.
Specialist treatment is available in all of the countries. It is provided according to agreements with the public health agencies and subject to general or specific rules.
Due to the different ways in which the countries organise primary healthcare, it is very difficult to obtain comparable data on the number of medical visits per capita.
In all countries, home nursing is available for families, children, the elderly and the disabled.
In all countries, pregnant women and infants are offered public healthcare. In addition, all of the countries provide healthcare services for schools, and most children are immunised as part of recommended programmes. Screening programmes for breast cancer and other conditions are in place to some extent in all of the countries. In all of the countries, transport expenses incurred in connection with absence due to sickness are subsidised.
In this part we focus on a short presentation of the Nordic health care system as it matters in relation to social policies.
[See more on this topic in the section describing the organization of health services in the Nordic countries.]
Overview of practitioners in the Nordic countries
Here you will find a short listing of rules regarding general practitioners in the Nordic countries.
Self-employed general practitioners provide primary healthcare treatment, fully financed by and according to agreements with the public sector.
All general practitioners are public employees and are paid a basic amount that reflects the services provided.
Health and social services centres are the nearest and most familiar care facilities to residents, providing many of the healthcare services organised by the wellbeing services counties. Health and social services centres provide especially primary healthcare services and closely related social services guidance and counselling. In addition to these, health and social services centres monitor and promote the population’s health.
Self-employed doctors provide close to 20 per cent of the general medical treatment, as well as specialist treatment. The rest is provided by doctors employed by the public authorities at public health centres – which, in sparsely populated areas, may also incorporate hospital style wards.
Self-employed general practitioners provide approximately 95 per cent of the general medical treatment.
It is estimated that self-employed general practitioners provide approximately 20 per cent of general medical treatment.
Overview of user charges for medical visits
The table below provide an overview of national rules on user charges for medical visits in the Nordic countries.
Specialized health care
All the Nordic countries have general hospitals with outpatient clinics/polyclinics and emergency wards. There are also highly specialised hospitals, psychiatric hospitals and, in some of the countries, hospitals providing long-term care. Most hospitals are run by central government, the regions/counties or local authorities. The number of private hospitals is few.
It is very difficult to obtain comparable data on the capacity of specialised healthcare in the Nordic countries, as its organisation varies considerably from country to country. However, there is a general tendency toward shorter periods of hospitalisation, and more and more patients being treated at outpatient clinics.
In all of the countries, there has been a tendency toward shutting down psychiatric hospitals and instead focusing on treating psychiatric patients in their own homes.
Finland and Sweden are the only Nordic countries in which patients pay user charges for time spent in hospital. In Denmark, user charges are payable for treatment at private hospitals, except where the treatment is covered by the rules on free choice of hospital. Under these rules, patients may choose a private hospital if the public system is unable to provide treatment within the guaranteed waiting time.
All the Nordic countries have well-developed dental services. Except for Iceland, public clinic provide treatment for children and adolescents either fully or partly free of charge. In most of the countries, there are also special discount schemes for elderly people. Most of the rest of the population pay for most of their own treatment. Private dentists provide most of the dental treatment for adults.
People in Finland are entitled to dental care and choose between regional authority and private dental treatment. The sickness insurance fund reimburses expenditure on private treatment. The amount that patients themselves pay for public dental treatment is lower than the amount payable for private treatment.
In Sweden and Norway, the counties administer public dental-care services.
Specific rules on dental care in the Nordic countries
Here you will find an overview of specific rules on dental care in some of the Nordic countries.
Children and adolescents below the age of 18 have access to free dental care. Adolescents turning 18 after 1 January 2022 also have access to free dental until the age of 22.
People who receive social benefits equivalent to cash benefits or educational aid can get subsidies to help pay for dental care services, but only up to a certain limit.
Adults’ user charges are set by Faroese Health Insurance. The local authorities provide dental treatment for children under 18 free of charge.
Public dental care is chargeable for everyone except children aged 0–17 years. User charges for dental care are based on the national decree on public charges. Adults’ user charges account for 30 per cent of the expenditure on local authority dental treatment.
The sickness insurance fund reimburses part of the costs for dental treatment in the private sector. On average, patients’ user charges account for 70 per cent of total expenditure.
The Ministry of Welfare sets the rate for the dental treatment covered by the sickness insurance scheme. This usually differs from the rate used by private dentists, who can set their own prices. People aged over 67 and disabled people are reimbursed between 50 per cent and 100 per cent of the costs (based on the rate paid by the sickness insurance scheme), depending on their incomes.
Children under 18 are reimbursed an average of 100 per cent of the total costs (based on the rate paid by the sickness insurance scheme).
Adults usually pay the full amount for dental treatment. Young people under 18 and certain other groups, such as the elderly, the long-term ill and the disabled, receive free treatment. The National Insurance Fund also subsidises the costs of certain types of dental treatment, as well as costs associated with certain diagnoses.
Free dental treatment is provided for everyone under 24, while everybody aged 24 and over is entitled to subsidised treatment. The subsidy consists of two parts: a contribution towards treatment, which mainly covers examinations and preventive measures; and coverage of costs that exceed the maximum user charges.
Maximum user charges for health services
The rules governing user charges for health services differ somewhat between the Nordic countries. Finland, Norway and Sweden have rules that specify a maximum for user charges. In Iceland, patients are only partly exempt from user charges. In Denmark and the Faroe Islands, the rules apply only to prescription charges.
Specific rules on user charges in the Nordic countries
In this section you will find the specific national rules on user charges on prescription and hospitalization.
The subsidy system is based on the individual’s use of medicine. From 2023, subsidies are not available for medicine expenses below DKK 1.045 per year. Above this level of expenses, the subsidy increases gradually, to 85 percent of expenses exceeding DKK 3.795 per year. Medicine expenses exceeding DKK 11.570 per year are completely subsidized.
However, for children under 18, a subsidy of 60 percent is granted for medicine expenses less than DKK 1.045. The chronically ill can get a 100 percent subsidy for medicine expenses exceeding DKK 4.435 per year. In all cases, it is a requirement that the medicine is eligible for subsidy.
The subsidy system is based on need, i.e., the individual’s level of consumption of subsidised medicine. Subsidies are not available for medicine below DKK 587. Above this figure, the subsidy increases gradually to 100 per cent of expenses exceeding DKK 6 221. For old-age pensioners the subsidy is 100 per cent of expenses exceeding DDK 2 793. For children under 18 there are no prescription charges for subsidised medicine.
An expenditure ceiling of EUR 692 is placed on public social care and healthcare. Once this ceiling has been reached, treatment is free of charge. The expenditure ceiling also applies to medical treatment in primary healthcare at clinics, physiotherapy, ongoing treatment, visits to outpatient clinics, day surgery and short term stays at social and healthcare institutions. Transport expenses in connection with treatment more than EUR 300 per year are reimbursed in full.
In 2013, the maximum user charge payable for out-patient treatment at hospitals, primary healthcare and specialists was ISK 32 300 per year for people aged 18-66 and ISK 9 800 for children under 18. For pensioners aged 70 or over, disabled people and those who have been unemployed for more than six months, the maximum user charge is ISK 8 100.
Once a patient reaches the maximum amount, s/he only must pay a small proportion of the rates. Special rules also apply to charges for physiotherapy, occupational therapy, and other forms of therapeutic treatment.
A maximum user charge applies for medical treatment, psychological treatment, and associated travel expenses, as well as subsidised medicine. Central government covers expenditure higher than the maximum user charge. People under 16 are exempt from user charges. A ceiling also applies to user charges for physiotherapy, certain types of dental treatment, residential stays at rehabilitation institutions and private rehabilitation institutions that have entered into an agreement on regional health measures. This user charge ceiling is somewhat higher than the one that applies to medical treatment.
A maximum yearly user charge is payable for general medical treatment, physiotherapy, etc.
Another maximum user charge applies to the costs of prescribed medicine. In most regions, children under 20 years do not pay any user charges. There are no user charges for prescribed medicines for children under 18 years. Local authority care schemes are not subject to government rules on maximum user charge.
Overview of user charges for prescription and hospitalization
In the two table below, you will find and overview of the national rules regarding user charges on prescriptions for medicine and in the event of hospitalization or treatment at hospitals.