Health Care Analysis

, Volume 7, Issue 4, pp 321–330 | Cite as

Access to Health Care in the Scandinavian Countries: Ethical Aspects

  • Sören Holm
  • Per-Erik LissEmail author
  • Ole Frithjof Norheim


The health care systems are fairly similar in theScandinavian countries. The exact details vary, but inall three countries the system is almost exclusivelypublicly funded through taxation, and most (or all)hospitals are also publicly owned and managed. Thecountries also have a fairly strong primary caresector (even though it varies between the countries),with family physicians to various degrees acting asgatekeepers to specialist services. In Denmark most ofthe GP services are free. For the patient in Norwayand Sweden there are out-of-pocket co-payments for GPconsultations, with upper limits, but consultations forchildren are free. Hospital treatment is free inDenmark while the other countries use a system without-of-pocket co-payment. There is a very strongpublic commitment to access to high quality healthcare for all. Solidarity and equality form theideological basis for the Scandinavian welfare state.Means testing, for instance, has been widely rejectedin the Scandinavian countries on the grounds thatpublic services should not stigmatise any particulargroup. Solidarity also means devoting specialconsideration to the needs of those who have lesschance than others of making their voices heard orexercising their rights. Issues of limited access arenow, however, challenging the thinking about a healthcare system based on solidarity.

access ethics health care system primary health care solidarity 


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  1. Brinch, L. et al. (1993) Prioritizing in Practice. Thinking about it, Wishing it, then doing it. (Norwegian). Tidsskrift for Den Norske Laegeforening 113, 3392–334X.Google Scholar
  2. Forskrift om bidrag til behandling i utlandet og om klagenemd for bidrag til behandling i utlandet. Sosial-og helsedepartementet 1999. Oslo: Sosial-og helsedepartementet.Google Scholar
  3. Forskrift om ventetidsgaranti, Sosial-og helsedepartementet 1997. Oslo: Sosial-og helsedepartementet.Google Scholar
  4. Innsatsstyrt finansiering (ISF) - en orientering om ordningen og tenkningen rundt ordningen. Sosial-og helsedepartementet 1998. Oslo: Sosial-og helsedepartementet.Google Scholar
  5. Nylenna, M., Haug, C. and Bjorndal, A. (1996) High-dose Therapy with Stem Cell Support and Support by a Cabinet Minister. Tidsskrift för Den Norske Laegeforening 116, 2537–2539.Google Scholar
  6. Nylenna, M. (1995) Norway's Decentralized, Single-payer Health System Faces Great Challenges [published erratum appears in JAMA (1995 Sep 20) 274(11), 874]. JAMA 274(2), 120-124.Google Scholar
  7. Piller, prioritering og politikk. NOU 1997: 7. Oslo: Statens forvaltningstjeneste.Google Scholar
  8. Prioritering på ny. Gjennomgang av retningslinjer for prioriteringer innen norsk helsetjeneste. NOU 1997: 18. Oslo: Statens forvaltningstjeneste.Google Scholar
  9. Priorities in Health Care. Final Report by the Swedish Parliamentary Priorities Commission. SOU 1995: 5. Stockholm: Regeringskansliets offsetcentral.Google Scholar
  10. Retningslinjer for prioritering innen den norske helsetjenesten. NOU 1987: 23. Oslo: Universitetsforlaget.Google Scholar

Copyright information

© Kluwer Academic Publishers 1999

Authors and Affiliations

  • Sören Holm
    • 1
  • Per-Erik Liss
    • 2
    Email author
  • Ole Frithjof Norheim
    • 3
  1. 1.Centre for Social Ethics and PolicyUniversity of ManchesterManchester
  2. 2.Department of Health and SocietyUniversity of LinköpingLinköpingSweden (Corresponding author E-mail
  3. 3.Department of Public Health and Primary Health Care, Division for general practiceUniversity of BergenUlriksdal, BergenNorway

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