How much does inpatient treatment cost in Norway. Norwegian health care system. Comparative analysis of health systems in different countries

75% of the cost of services provided by health services is covered by the national insurance system, the rest
is covered by the consumer himself through direct payments, through the system of additional insurance, and also indirectly, through taxation. When providing long-term medical care not all "health and welfare centers" in Norway provide for their patients good nutrition, offering them only light breakfasts and "daytime sandwiches" with coffee. In addition, they are forced to close for three summer months (44, 84, 90).
Clearly regulated by MS drug care. At acute diseases medicines on the list No. 1 are provided free of charge (all expenses for their purchase are compensated). There is a list of 36 chronic diseases in which completely free or partially paid medicinal treatment. Only medicines approved for use in the country are paid for. Appointment especially expensive drugs controlled by a special committee. In order to receive a "blue prescription" for the course free treatment for a chronically ill group A (children under 16 years old, elderly, over 67 years old), you need to pay 25 NOK, and group B (from 17 to 66 years old) - 50 kroons. The prescription is issued for a period of up to three months, the annual limit per patient is 840 kroons. Exceeding the limit leads to special proceedings (84, 90, 98).
Social insurance reimburses the cost of the first visit to the doctor general practice by 55%, the second - by 70% and only after the third visit the insured receives 100% compensation. Consultation of specialists is paid by the insurance fund at the first visit by 60%, by 70% at the second, etc. (58).

More on the topic 11. Health insurance in Norway:

1. Insurance. Health insurance. Types of health insurance: compulsory and voluntary. Health Insurance Funds
2. 9. Interaction of medical insurance organizations with the regional fund of compulsory medical insurance

Hello everyone, both men and women! As it turned out, men also watch me. Today I will make a rather difficult video for myself, because I wanted to talk about Norway. Why difficult? Because a lot has already been said about Norway, I mean the video of Irina Bergset, which made so much noise on the Internet. By the way, when I was preparing for this video, I found a recording of my friend, Mira, who lives here in Oslo, who also smashes this Norway to smithereens. But I will probably not refute or prove anything, I will just tell you how I live here, in Norway. My personal impressions, my personal observations, my conclusions that I made. And I hope you find it interesting.

You know, I think the main problem that the Russians have here is that they expect something special from the Norwegians. But this nation is not great, it did not have great history, she did not have great literature, she did not have great conquests, this is not an empire. They don't have any famous philosophers. And, in general, this, it seems to me, is the whole problem. Because the Russians, they are waiting for something high, they are waiting for something deep. And when they don't find it, it disappoints them. But, in principle, such simplicity of being is not a sin, and it is quite acceptable, and we must accept the Norwegians as they are.

What do I want to say? Here in this country everything smells of well-being, everything smells of money. Everything that money can buy is bought here, made here. Every centimeter of this country is “licked” here. Here is a stunningly beautiful private sector, and very beautiful private houses, good roads. They are now rebuilding their cities, they are rebuilding old buildings. Everything related to material well-being is just perfect here. But problems begin when you start looking for or wanting something that money cannot buy. Here, especially for the Russians, big problems begin.

This prosperity is Norwegian, it is very strange, because you quickly realize that in these beautiful houses there is some kind of - how to choose the right word - an empty, or something, life. Or you could even say primitive. People do not even somehow live, they just exist. They go to work, they arrange some holidays, they smile. But these smiles mean nothing at all. You understand this very quickly.

The Norwegians themselves understand this, because I study art, and all their art speaks, just screams about it. By the way, they have a very excellent film, Norwegian-Irish, in my opinion, which is called - it is in Russian translation - "Inappropriate Man". And just this person is shown there, who lives this prosperous life, but just goes crazy from this emptiness. There are very good scene, it was filmed here, in the center of Oslo, near the town hall, when Norwegians surround it and say: “Look, it’s so beautiful here, it’s so safe here, such a happy city. What else do you need?" And this “what else do you need”, it just hangs in this Norway, because it seems that everything is there, and there is nothing.

Or, for example, they have such an artist, Pushwagner, here he draws human robots. And he claims that this is the population of Oslo. These robots go to work, these robots line up home, they go to bed on schedule, they get up. If you look at Pushwagner's paintings, you will understand life in Oslo in general. Even take that Munch, look at these, sorry for the expression, faces that he painted when he painted the inhabitants of Oslo, everything becomes clear. In general, the Norwegians themselves admit that something is wrong in this Norway, something is missing here.

Probably the most unpleasant and negative thing that I don’t like in Norway is, of course, disgusting education and disgusting medicine here. There is no education at all. Everyone who knows what Soviet education is, when it is given beyond what you need to know, when you are constantly being pulled somewhere, when this whole system guides you, this whole system gives you knowledge that you may never need but which will shape your thinking. This is not the case in Norway at all. A special horror is here in kindergartens. Because I have my very first education as a teacher-psychologist, and I tried to work here in kindergartens, and, honestly, I was horrified. There is not even an idea that a child should be brought up, that a child should be taught some norms. It's good if they just look after your child if you send him to kindergarten. And by the way, in her video, Mira says that once she came for her sister, and her little sister was lying and drinking from a puddle. And no one needs it at all. This is an ordinary, typical Norwegian garden.

Why did I talk about education? Because I study here myself, I get a second higher education, and I get a profession in the direction of which I have no contact with Norwegian culture at all, I study art and design. Moreover, with an in-depth study of art. And you know, when we had our first project at the university, we had to completely prepare it ourselves, according to the old Soviet habit, I shoveled a bunch of literature, spent all these two months, studied techniques, studied art trends. And when I came to defend him, when I told them something about Velasquez, I told them something about Jot, how he justified art in general. In general, I told them everything, as is customary in our universities, I realized with horror that they did not understand at all what I was talking about. It's not just that the students don't understand, even the teachers don't understand what I'm talking about. Because there are so narrowly specialized specialists sitting there, so she studies the history of fashion, she knows nothing apart from this history of fashion and the history of costume. It is, in principle, not required of her.

Of course, this took some getting used to. Why is it bad? What education is, it pulls you down. And now for the second project, I didn’t really tense up. And in general, all this education that I received in Norway, I didn’t really strain. I didn’t really get anything, I didn’t give anything special, and it’s as if I don’t need to. Here the diploma will be, and it's good. And you know, all this life in Norway, everything is there, and it's good.

Why Norway - Norway is a country with a sparsely populated vast northern territories, where the very provision of medical care becomes a problem. And this is very close to Russia. And the standards of medical care in Norway are very high, 20th place in the WHO list for a northern country is an indicator.

From personal:

Norway in the dashing 90s seemed (and was) an unattainable dream. My friend married a Norwegian who was involved in the oil industry. I tried then to get a job at a drilling rig, but it was hard legally, but I didn’t want to work illegally. Then he suddenly died, leaving her a good house with a piece of wood and savings. I remember she hired Russian sailors in the port to take care of the forest, because according to Norwegian law it was an obligation for her, and she also laid footpaths through the forest to pick mushrooms not in boots ...

In Norway, the health insurance system is universal. The Norwegian health care system is constantly being reformed, in 1974 the whole country was divided into 5 health regions. The system is financed by general tax revenues to the budget: there are no earmarked taxes for health needs in the country. Since 1999, health care spending has increased significantly. Thus, healthcare is the most important factor, causing a high tax burden in Norway - taxes in this country amount to 45% of GDP. Of all the industrialized countries, only Sweden has higher levels of taxation. For stay and treatment in public hospitals(including medicines) no fee is charged. The state develops a unified budget that limits the total amount of health care spending and sets hospitals the cost of fixed assets. Norwegian healthcare employs 400,000 people.

There are three levels of healthcare in Norway: municipal, regional and state.

At the regional level(paid by the state) hospital and advisory assistance is provided.

At the state level highly specialized care is provided, treatment rare diseases, organ transplantation and more.
government pays most the cost of medical services, approximately 95%. Patients pay a small amount, approximately 5%. During pregnancy and childbirth, assistance is provided free of charge. It is estimated that at any given time, 280,000 Norwegians are on "waiting lists" - and this despite the fact that the entire population of the country is 5.1 million people. Waiting time for replacement surgery hip joint averages more than four months, for prostatectomy almost three months, and for hysterectomy more than two months. Approximately 23% of patients admitted to hospital have to wait more than three months for the hospital to admit them.

Solving the problem of the northern territories:

In the north of Norway, 500 thousand people (10% of the population) live in three areas with heavy names, but that's not the point. The main problem of these territories is that the main efforts are spent not on treatment, but on "getting" to the doctor. Therefore, smart Norwegians came up with in the 20s of the 20th century, then in Bergen one of the hospitals practiced doctor's consultations on the radio to consult fishermen (damn, did they already have radio stations on ships then?) - TELEMEDICINE - what is now with a creak and we are trying to make matyuks in Russia. But in Norway, since 1996, the cost of telemedicine has been included in the health budget.

This Scandinavian country is home to just 5 million people and has one of the lowest population densities in Europe. The basic principle of Norwegian medicine is to provide medical care to all residents of the country, regardless of their income and social status, which is why Norway is often called the country of victorious socialism, and Norwegian medical services are famous for their quality and availability.

Peculiarities

The Norwegian healthcare system is constantly evolving and reforming, so the level medical care The population of the country remains one of the highest in the world. There are 4 types in the country medical institutions: outpatient clinics (they employ general practitioners), hospitals, psychiatric hospitals and university clinics that provide high-tech medical care. There are three levels in the healthcare structure: central (state), regional (fylke) and local (municipal).

To central authorities health care include the Ministry of Health and Welfare, the State Board of Health and the Institute of Public Health. The Ministry of Health and Welfare develops the state health policy, provides the legislative framework and health budget planning. The State Board of Health is supervisory authority which controls the norms and quality of medical care. State Institute public health supervises the activities of scientific and preventive institutions. At the state level, high-tech and specialized medical care, treatment of rare diseases, organ transplantation and psychiatric care. State-level health services are provided by ambulances, university clinics, large specialized hospitals, some psychiatric clinics, and drug rehabilitation facilities.

At the regional level, hospital treatment, dental care and consultations of highly specialized specialists (as directed by general practitioners).

At the local level, primary health care is provided by general practitioners and home visits, which are very popular in Norway. Municipalities are responsible for the welfare of patients, diagnostic, curative, rehabilitation and preventive actions. They manage polyclinics, local medical and rehabilitation centers, institutions for the care of the elderly and psychiatric patients, mother and child centers, school health centers and a number of other medical institutions at the municipal level.

Financing

Health care costs in Norway are very high - they amount to 9.4% of GDP, and according to this indicator, Norway ranks 16th among European countries (for comparison: in Russia, health care costs amount to 5.08% of GDP). But in terms of per capita health spending, which is $5426 per year (for comparison: in Russia this figure is $998), Norway ranks third in Europe, behind only Luxembourg and Monaco.

The country's health care is 73% financed from the state budget, 12% from social insurance funds, and the remaining 15% are co-payments of patients who come from the provision of paid medical services. There are no targeted taxes for healthcare needs in the country - funding is provided by state, regional and local authorities at the expense of general taxes, which make up about 50% of the income of working citizens. At the same time, local authorities have the right to impose local taxes in addition to national ones. For healthcare needs, municipalities receive subsidies from the state budget, which depend on the population of the district, insurance compensation from the state health insurance system, as well as funds from the population for paid medical services.

Not only citizens of Norway, but also all residents of the country who live there can use the services of public medical institutions longer than a year. At the same time, EU citizens have the same rights to medical care and reimbursement as Norwegian citizens, and residents of other countries must pay for these services entirely from their own funds.

For all Norwegian citizens, there is a "co-payment ceiling" - the maximum total amount of co-payments for medical services per patient, made during the calendar year. When the patient's co-payments reach this amount, all medical services received by him subsequently are provided to him free of charge. The amount of the “co-payment ceiling” is established by the state annually, while co-payments for a child under the age of 16 are included in the co-payments of one of the parents.

Chronically ill patients who are taxpayers are also eligible for a tax deduction that further reduces drug and medical co-payments.

national insurance

The National Insurance System provides a wide range medical care. State insurance provides the services of general practitioners and narrow specialists, inpatient treatment, full medical care for pregnant women and children under 7 years of age, drug provision for patients with chronic diseases, 100% payment sick leave, payment maternity leave within 42 weeks, disability pension, Spa treatment and a number of other services. Voluntary health insurance is not in demand in Norway, but there are paid medical services in the country: on the basis of co-payment for patients, laboratory tests and radiological studies, are physiotherapeutic and dental services and long-term care for the disabled and the elderly.

All residents of Norway who are Norwegian citizens, as well as Norwegian citizens working abroad, and foreigners working in the country for hire or living in the country for more than a year, must have a national insurance policy. National insurance contributions depend on the amount wages and account for 7.8% of income for employees, 11% of income for the self-employed and 4.7% for pensioners. With a monthly salary over €5356, the percentage of deductions is reduced. Employers also pay contributions to the National Insurance Fund - depending on the region and municipality, such contributions range from 0% to 14%.

Drug supply

Pharmaceutical market in Norway is strictly controlled government bodies. All medicines are subject to mandatory registration with the Norwegian Medical Agency. Medications divided into 4 groups: group A is drugs, group B - drugs, addictive or addiction, group C for other prescription drugs, and group F for over-the-counter drugs. The wholesale and retail price of drugs is not regulated, but the Norwegian Medical Agency sets the maximum possible retail price for each drug. On average, pharmaceutical retail prices in Norway are much lower than in many other European countries.

In law pharmaceuticals can only be sold in pharmacies. All pharmacies in the country are private. Since 2001, anyone can own a pharmacy, with the exception of doctors and pharmaceutical manufacturers. To open a pharmacy, you need to obtain two licenses: the first is a permit to own a pharmacy, the second is a permit to operate a pharmacy. The number of pharmacies and their location is not regulated by law. Pharmacy chains are allowed in the country. VAT on pharmaceuticals is 25%.

Since 2001, the sale of generic drugs has been allowed in Norway, which has served as an impetus for the development of the pharmaceutical market. Now doctors, when prescribing original drugs, are required to inform patients about the availability of generics, if any.

Reimbursement in Norwegian

In Norway, only drugs for the treatment of chronic diseases and for long-term (more than 3 months) treatment of patients with certain diagnoses are reimbursed. Such pharmaceuticals are reimbursed by 62%. Medicines for the treatment of serious infectious diseases(tuberculosis, syphilis, AIDS/HIV) are reimbursed 100%. If the original drug has generics, then only a part of its cost equal to the cost of the generic is subject to reimbursement: if the patient chooses original drug, then he must pay the difference between the cost of the original and the cost of the generic from his own funds.

Figures and facts

Average life expectancy in Norway is 81.5 years.

Norway became the first country in the world to officially include telemedicine tariffs in the health budget.

In June 2015, the Norwegian authorities passed a law that allows children who have reached the age of 7 to change their gender without parental consent, without requiring any medical or psychiatric examination.

In Norway, a system of non-governmental institutions has been created to help drug addicts, where anyone can get a dose of a drug, clothes and a coupon for free food for free.

Scandinavian health care standards in Norway

The Kingdom of Norway is a state in Northern Europe, occupying the western and northern parts of the Scandinavian Peninsula and part of the Arctic archipelago of Svalbard. Norway is a country that can serve as a model for a policy that is reasonable in all respects.
The quality and availability of medical services in Scandinavia, and in Norway in particular, are known all over the world. The Scandinavian countries are often jokingly called "countries of victorious socialism", and there is some truth in this joke. Indeed, the basic principle of Norwegian medicine is to provide medical care to all residents of the country, regardless of their social status and the thickness of the wallet.

The Norwegian healthcare system is constantly evolving and reforming. First state medical institutions were founded here in XVIII century, and specialized clinics and psychiatric hospitals appeared only towards the end XIX century. Today, 420 thousand people work in Norwegian healthcare, the average salary in the industry is about 3.5 thousand euros per month. Long and firmly rooted local self-government continues to develop: regional and local authorities are taking over more and more functions of the central authorities.

Management and system structure
There are three main levels in the structure of health care in Norway, which correspond to the three levels of government: central, regional (19 counties) and local (435 municipalities). To avoid duplication of medical services, the Swedish-Finnish system of inpatient care, in which it was carried out by regional authorities, was recently abolished in the country. The country was divided into five medical-territorial districts, which are governed by the county. Local authorities are responsible for organizing medical care; only rationing and supervision is carried out at the central level. All permanent residents of Norway are covered by state insurance. At the same time, health care in Norway is funded by the state. The government pays most of the cost of medical services - approximately 95%. During pregnancy and childbirth, assistance is provided free of charge.
Central level. The central health authorities are the Ministry of Health and Welfare, the State Institute of Public Health and the State Board of Health. The Ministry is responsible for the development of health policy, its legislative framework and main directions of development, budgeting, planning, organizing an information network. The state coordinates the activities of the Institute of Public Health and some other scientific and preventive institutions. The State Board of Health is an independent professional organization that, together with the health services of the county, supervises and ensures that medical care complies with quality standards and laws. At the national level, highly specialized care is provided (eg, treatment of rare diseases, organ transplantation).
Regional level. At this level, hospital and advisory assistance is provided. AT outpatient departments specialist consultations are provided for patients with referrals from a general practitioner and specialized hospital care is provided in hospitals. In order for highly specialized medical care to be effective and cost-effective, since 1974 the country was divided into five medical-territorial districts, in each of which a district health committee was established. In the early 1990s the state decided to expand their responsibilities: starting in 2000, each district is obliged to submit to the Ministry of Health its long-term health development plan in accordance with the main directions public policy in this domain.
local level. 435 municipalities of the country are entrusted with the financing and organization of primary health care and medical and social services.
There are usually three departments in a municipality: medical assistance, patronage and home care, and social security. To ensure that health and social services meet the needs of the population, in 1986 the municipalities were given the right to determine priority areas in their funding and organization.
This level includes all types of primary care provided by a general practitioner. This includes a medical center, a post-treatment home, and a home for the elderly in need of care. AT medical center there are 1-2 general practitioners, a physiotherapist, nurses and midwives. At the initial visit, the patient is consulted by a general practitioner. Here, patients are monitored and a period of post-treatment of patients by a physiotherapist takes place. The medical center monitors children, pregnant women, and vaccinates. If necessary, the patient is sent to the regional medical institution.

Features of financing medicine
Distinctive features of Norwegian health care are financing mainly through taxes, which are the highest in the world and account for about 50% of the population's income, the predominance of the public sector and a small share of paid medical services. All permanent residents of Norway are provided with medical care. The state also pays them medical vouchers to any resort. Financing is provided by central, regional and local authorities (municipalities have the right to impose local taxes in addition to national ones), as well as the state insurance system.
Local governments receive government funding in proportion to their population. Local health services receive funds from the state budget (general and targeted subsidies), the state insurance system (insurance compensation) and from the population ( paid services). Although the state does not directly influence the distribution of funds, in practice the autonomy of local governments is limited by the standards and financial policies they set.
In 1997, the county's share of health care funding declined to less than 30%, while the share of government spending by the end of the 1990s. increased up to 50%. Since many patients are treated outside their own county, there is a cross payment system: the county where the patient lives reimburses the costs to the county in which this patient was treated. The state insurance system finances healthcare by approximately 17.9% (covers the cost of medicines and transportation of patients, pays for the services of doctors working under contracts private practice). Doctors receive a salary from the municipality, as well as payment from patients, which can be up to 70% of the family doctor's income. If necessary family doctor refers the patient to a specialist. In this case, payment is made at the expense of the health insurance fund.
Introduced in 1980, global budget funding forced some counties and hospitals to narrow their scope due to budget constraints. Long waiting lists for hospitalization led to the adoption in 1997 of the current funding scheme, which takes into account the volume of services provided by the hospital. The main goal of the innovation is to increase the efficiency and profitability of hospitals. Although the introduction new system funding was voluntary, by 1999 all counties had switched to it, with the exception of one.
Voluntary insurance in Norway is poorly developed. The main source of additional financial income is paid medical services. A visit to a specialist in the outpatient department of a hospital costs at least 19 euros. In addition, in such departments, patients pay part of the cost of laboratory and X-ray studies, some medicines. Co-pays apply for treatment by general practitioners, out-of-hospital specialists and psychotherapists, certain medications, and travel costs associated with examinations and treatments. The co-payment for medical services is about 10% of healthcare costs. In the early 1980s the maximum level of expenses of citizens for paid medical services, including medicines, primary and outpatient medical care, has been introduced. Separate groups population and patients with certain diseases are exempted from co-payment.

Levels of care
Primary health care. Municipalities are responsible for primary health care, including prevention and health promotion, diagnostic and medical interventions, rehabilitation and long-term care. The municipal council approves a plan for the development of health care in accordance with the needs of the population living in its territory. Local authorities determine the amount of health care financing themselves, and the list of medical services that they are required to have is established by the Law on Health Care and the Powers of Local Authorities. Each county has an official who oversees these services. There are also seven specialized medical-administrative institutions subordinate to the Ministry of Health that provide expert opinions. Government preventive programs such as early detection breast cancer and cervical cancer, are implemented under the direction of the respective specialized institutions. The leading role in primary health care is played by general practitioners, most of them organized in groups of 2-6 people with assistants, the number of which depends on the funds provided by the municipality. Generally, general practitioners specialize in general or family medicine. Most general practitioners are municipal employees or private practitioners under contract with the municipalities.
In choosing a general practitioner, patients are not limited in any way. The patient has the right to choose a doctor twice a year. Get treated by physiotherapists and manual therapists you can do it without a doctor's referral, but this treatment will cost more because it's not covered by public health insurance. Specialist physicians receive a service fee from the state insurance funds only if the patient is referred to them by a general practitioner. AT recent times requirements for general practitioners have increased. First, the number has been reduced hospital beds and length of hospital stay. Based on this, improving the work of general practitioners has become one of the priorities. To this end, in 1997, official registration of patients admitted by a doctor was introduced throughout the country, and his income began to depend not only on the number of people served, but also on the medical services provided.
Specialized medical care. Since 1969 for the planning, financing and organization of specialized medical services (general hospitals, psychiatric clinics, laboratory and other specialized medical services, dental clinics for adults) correspond to the county. In organization and management inpatient care The county is quite independent. Each of Norway's five health districts has a district hospital providing highly specialized medical care. All county hospitals serve as training bases; four of them belong to the county, the fifth is national. Several hospitals are owned by voluntary organizations, but the status of these hospitals is practically the same as the status of state hospitals. The private practice segment is insignificant. Norwegian laws severely restrict the operation of private hospitals, where most of the laboratory and x-ray examinations are carried out. There are also about 30 private laboratories and other institutions involved in diagnostic studies. Private institutions are funded by public insurance.
Through the strengthening of the role of outpatient care and the development of day hospitals average duration hospitalizations are reduced. The average bed occupancy in Norway is higher than in many other European countries, while the utilization rate of inpatient treatment is relatively low. In the past decade, the most pressing health issue has been waiting lists for inpatient care. This problem was attempted to be solved different ways. Now the situation has improved somewhat.
Part of the territory of Norway, especially the north and the islands located in the North Sea, allocated to the fifth region, have very low density population and relatively weak transport infrastructure. Particular attention in this region is paid to the development of telemedicine, that is, remote methods of consulting and diagnosing using the most modern telecommunication technologies, in particular videoconferencing. People in need of help are transported to the place of medical care by helicopters or airplanes.
Medico-social service. Social services in Norway are provided in accordance with a decentralized model. The state is responsible for policy-making, staff training and the formation of a legal framework, while municipalities are responsible for providing services. The latter mainly receive funds for services through subsidies from the state. For some areas of particular focus, municipalities receive "targeted" grants. These are, for example, services for the elderly or measures to ensure that people with mental disorders could live in their own homes with adapted services, and participate in work and leisure activities.
Examples of social services:
– practical help people who need it due to disability, old age, etc.;
– emergency assistance people and families with complex care needs;
– support for people who need help in organizing leisure activities and establishing contacts with other people;
- Shelter services.
Alcohol and drug treatment services are integral part medical services.
In addition, municipalities are responsible for preventing social problems. Mostly they provide social services independently, however, in some cases, municipalities buy services from private organizations, in particular from many humanitarian and religious organizations regarding the organization of the provision of services for the elderly, disabled, people dependent on alcohol and drugs. In addition, over the past few years, many commercial organizations have begun to offer services such as care for the elderly and disabled, as well as full-time care or day care for people who have complex health care needs.

Timeline of reforms
Reforms in the 1990s were mainly aimed at improving the efficiency and availability of medical care and reducing the queues for hospitalization. In 1993, a list of basic prices for medicines was established (and expanded in 1998). In the late 1990s the scheme of financing hospitals and the conditions of remuneration of private practitioners have changed. In 1998-1999 passed a number of laws, some of them deserve special attention. First, the district health committees were given the responsibility of planning the development of health care in their district. Second, under the Specialty Care Act, mental health services have been merged with other medical services, and the organization of long-term care for patients with mental disorders is entrusted to the municipalities. Thirdly, such patients' rights were legalized, such as the right to choose a hospital, to provide specialist advice no later than 30 working days after receiving a referral from a general practitioner, to consult another doctor. Patients who require long-term complex treatment, are entitled to individual plan medical care, which allows coordinating the actions of different services. In the spring of 2000, a system for registering patients in primary care facilities was introduced. Among other things, this system allowed citizens to change personal doctor and, if desired, seek advice from another general practitioner. The recent reform entailed the unification of the national insurance system and national service employment -