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Norway's Decentralized, Single-Payer Health System Faces Great Challenges

Magne Nylenna, MD
JAMA. 1995;274(2):120-124. doi:10.1001/jama.1995.03530020038015.
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SOLIDARITY and equality form the ideological basis for the Scandinavian welfare state. In an international context the health care in Norway is characterized by a high level of education, proven medical competence, and equitable distribution of services. The main challenge for the future is an increasing gap between the capacity of the health services and the needs and expectations among patients. Waiting lists and rationing of health services represent significant threats to today's health care system in Norway. More resources and funding are needed to maintain the quality and public support and to avoid deterioration of the system.

Norway—the Way to the North  One of the northernmost countries in the world, Norway straddles the Arctic Circle, where the midnight sun shines during summer and the winters are dark and cold (Figure 1). Some 4.3 million inhabitants are scattered throughout an area of 324 000 km2, of which more than


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