1、1Organisation and financing of hospital services in Norway 挪威醫院服務的管理和融資In Norway, the financing and provision of hospital services is mainly a public responsibility, financed by income and wealth taxation. But one can also find a significant private contribution in terms of both financing and provis

2、ion, which has become more important in recent years. 在挪威，醫院服務的籌資和供應基本上是一項公共職責，由所得稅和福利稅負擔。但是籌資和供給中的私有資產也擁有重要份額，近年來還不斷增加。The political responsibility and control of hospital services lies with the Ministry of Health and Care Services, i .e. the national health authority is responsible for the financi

3、ng, planning and prioritizing of health services at the national level. 衛生與社會事務部在政治上負責并管理醫院服務，即作為全國的權威負責籌資、指定規劃，并且在國家層面上保證衛生服務的優先性。2Organisation of hospital services 醫院服務的管理The responsibility of providing hospital services is delegated to five Regional Health Authorities (RHA), which are organized a

4、s central governmentally-owned enterprises. The RHA exercises state ownership and has the responsibility for providing services to the population in the health region, within the framework stated by the overall health political goals. 醫院服務的供應職責交由五個地區的衛生機構(RHA)，按照中央政府所有的企業進行管理 RHA實行國有制，在衛生事業的政治目標規定的框

5、架中負責為該地區人口提供衛生服務The responsibilities also cover specialized mental-health services and hospital services to persons with drug-related health problems. 這些職責還包括特別的精神健康服務，以及為患有毒品相關健康問題的人群提供醫院服務The production of hospital services is performed mainly by local Health Authorities (HA) owned by the RHAs or

6、with private, non-profit, hospitals that have a provisional agreement with the RHA. The local HA consists of one or more hospitals. The RHA supplements its own production with purchases from private, for-profit, providers. 地區的衛機構(RHA)擁有的地方衛生局(HA)以及和RHA簽訂臨時協議的私有非營利性醫院醫院服務主要生產具體的醫院服務產品。地方衛生局(HA)擁有一個或更

7、多的醫院。地區衛生局在自己的產品之外，還從私有營利性供應者那里購買。3Financing of hospital services 醫院服務的融資The major elements in the financing of the RHA are: 地區性衛生機構的主要融資因素包括：Activity-based financing; 基于醫院行為的資金In-patient and out-patiens payment schemes. 住院和門診費用Block grants (needs-equalization grants) distributed among the RHAs acco

8、rding to socio-demographic characteristics (e.g. age-composition) of the population. 根據社會-人口特點（如年齡結構）在地區的衛生機構中分配的整筆撥款（需求均分資助） Different ear-marked grants.不同的特殊用途的資金There is also out-of-pocket payment (user fees) for out-patient hospital services (but these finance less than 2 % of total costs). 還有患者

9、自負的門診費用（但是此部分少于總額的2%）No out-of-pocket payments for inpatient hospital services 沒有個人承擔的住院費用RHAs are free to choose their own system of hospital financing. Most RHAs have chosen to ”copy” the national model combining population-based grants with activity-based financing, i.e. giving the local health a

10、uthorities a sort of population responsibility. 地區衛生機構可以自由選擇各自的醫院融資體系。多數地區衛生機構選擇“復制” 國家模式，把基于人口的資金和基于醫院行為的資金結合起來，即賦予地方衛生機構一定程度的人口責任。4Total health care expenditure in Norway Primary and secondary (2004) 2004年挪威初級和二級醫療衛生總支出26 billion USD 260億美元Primary 18.5 billion 初級185億美元secondary 7.5 billion USD 二級7

11、5億美元5800 USD per person 人均5800美元9.9 % of GDP 占GDP的9.9%Public expenditure in % of total expenditure: 85.5 (2003) 公共支出占總支出的85.5% （2003年）Private expenditure in % of total: 14.5 私人支出占總支出的14.5%（2003年）Johnsen p. 325Expenditure by function, Secondary 20042004年二級支出（按不同功能分類）Inpatient and day cases of curativ

12、e care 28.6 % 住院及其每日藥品診療 Outpatient curative 17.7 % 門診治療Services of rehabilitative care 1.4 % 康復治療服務Inpatient long term nursing 15.2 % 長期住院護理Homes based long term nursing care 7.5 % 長期家中護理Clinical laboratory and diagnostics imaging 3.3 % 臨床實驗和透視診斷Patient transport and emergency rescue 2.3 % 病患轉移和急救M

13、edical goods dispensed to patients 13.9 % 患者所用藥品Prevention and health administration 2.8 % 疾病預防和行政Capital formation of health care provider institutions 7.2 % 衛生保健供應機構的資金份額Johnsen p. 386Private supplement 私有的補充部分In later years, the private supplement of hospital services has become increasingly impo

14、rtant. 近些年，私有的醫院服務日趨重要The number of private, for-profit, providers has grown. 私有營利性供應者數目增長The range and scale of activities (out-patient and day surgery) has increased. 活動范圍和規模增長（包括門診和工作日的手術）The public providers are the major purchasers, but there is also privately financed purchases and a private h

15、ealth-insurance market is emerging. 公共供應者仍舊是主要購買者，但是私人融資的購買者和私有健康保險市場正在涌現7 Summary 總結Two separate management and financing systems in health care 在醫療上兩種不同的管理和融資體制Primary health: (Local) Municipality planning, implementation and financing (+ NIS) 初級衛生保健（地方）市政當局的規劃、執行和融資（+NIS）Secondary health: 二級衛生(National) state responsibility and financing （國家）國家職責和融資Health enterprises planning and implementing 衛生企業規劃和執行Primary health care: small out-of-pocket payment (12