[Health care systems in the Nordic countries--more similarities than differences?].
The aim of this paper is to explore similarities and differences of the Nordic health care systems. The analysis is based on a three-part model involving patients, providers and the financing third party. In all Nordic countries, about 80% of the funding come from public sources. In Iceland, central government is providing most of the health care services, while the county councils are central in Denmark, Norway and Sweden. In Finland, the municipalities are providing most of the health care. Salary is the only payment system for general practitioners in Iceland, while it is used for some GPs in Finland, Norway and Sweden. Capitation in combination with service fees is used for all Danish GPs and the majority of the Finnish, while various fee-for-service systems are used for the others. All Nordic countries had global hospital budgeting in the 1980s; since then, Finland, Norway and Sweden have implemented others systems, predominantly combinations of diagnosis-related group financing and global budgets. The amounts of resources devoted to health care are about the same in all five countries whether measured by the proportion of GDP devoted to health care, or by hospital beds or doctor/patient ratios. In monetary terms, Denmark, Iceland and Norway spend more than Finland and Sweden. Despite similar amounts of resources, they are quite differently used across the countries. Differences of a factor of two or more are observed for hip operations, gal bladder operations and pharmaceuticals. Danes and Finns are very satisfied with their health care system; the Swedes are not. All the Nordic countries have increased patient co-payments during the 1990s. Finnish patients may pay an extra free to get a one-bed room. Finland also has the greatest number of private hospitals. Despite all these differences, the Nordic health care systems are quite similar when seen in a global perspective.
Kristiansen
I S
IS
Institut for Sundhedstjenesteforskning-Sundhedsøkonomi Syddansk Universitet, Odense. isk@sam.sdu.dk
Pedersen
K M
KM
D002204:Capitation Fee; D003695:Delivery of Health Care / Q000191:economics / Q000706:statistics & numerical data; D005249:Fees and Charges; D006291:Health Policy; D006295:Health Resources; D006801:Humans; D007348:Insurance, Health / Q000191:economics; D009313:National Health Programs; D017149:Private Sector; D017150:Public Sector; D012456:Salaries and Fringe Benefits; D012537:Scandinavian and Nordic Countries