Municipal health and care services
03.02 Health services
Yearly
Municipality, and for Oslo and Bergen: parts of town.
Division for health statistics (330)
Statistikkloven §2.2
Lov om helsetjenesten i kommunene § 6-3 and Lov om sosiale tjenester § 2 - 5
(not relevant)
These statistics are supposed to meet the increasing need for information among the central authorities for planning purposes, supervision and evaluations of the municipalities' health services (overview of the total input of the recourses in the general practitioners services, physiotherapist services, midwife services, school health services, and maternal and child health centre services) and care and nursing services. In addition, the municipalities themselves are in need of comparable figures on county and national level to evaluate their own services.
The Municipal Health Services Act was enacted in 1982 and took effect in 1984. The purpose of the law was to strengthen the primary health services. From 1 January 1998 the law was expanded to include prison health services and county nursing homes. Under the act, the municipalities were given responsibility for board of health activities and user groups such as the mentally retarded and psychiatric patients. Municipal health service statistics provides the health authorities' with data for planning and supervisory purposes. They shall provide knowledge about the staff situation and about delivery of health care in the local health service.
The statistics for the different parts of the municipal health and care service are based on annual data from the municipalities. For the first year, 1984, the data were basically limited to information about staff resources. From 1985 the statistics were expanded to include the maternal and child health centres and school health service. Staff without background as a health professional was included in the statistics for the school health service and maternal and child health centres in 1988 (maternal and child health centres) and 1994 (the school health service).
Since 1995, data on vaccinations in the school health service and maternal and child health centres were removed entirely from the questionnaires. Since then, they have been collected by the Norwegian Board of Health through a individual-based system (SYSVAK). Part of this material is published annually in the Ministry of Health and Social Affairs publication "Styrings- og informasjonssystemet for helse- og sosialtjenesten i kommunene" (Management and Information System for Health and Social Services in the Municipalities).
The official statistics of the public care and nursing services were for the first time collected in one data gathering and publishing routine in 1989. The background for this was the transfer of the responsibility for the nursing homes from the counties to the municipalities. Thus the total responsibility for all these services was transferred to the municipalities, and the administrative distinction between social (municipality services) and health services (county services) was abolished. The statistical basis has undergone major changes since the statistical routine was established. This makes it difficult to follow the developments over time.
The ministry of health and social affairs, the ministry of local government and regional development, the municipalities, research institutes and media.
The official statistics of the municipal health care services and public care and nursing services are based upon annual reports from all municipalities and institutions for the aged and disabled in Norway.
The statistics of the municipal health services is based upon annual dispatch of five questionnaires to all municipalities in Norway. These municipalities deliver electronic questionnaires that are included in the national statistics for the municipal health and care services. From 2002, all municipalities report by the KOSTRA system (Municipality - National authorities - Report).
Five questionnaires are being used for the purpose of collecting data. One handles municipal health care, including all functions of physicians, physiotherapists, midwives and public health nurses. A second questionnaire concerns the home-based services, and a third one for total registration of the man-years within both the home based services and the institutions for the aged. The fourth questionnaire is addressed to every institution for the aged and disabled and concerns information about patients and personnel. Privately run institutions are also included. These are, however, few in numbers and are often supported by the municipalities. The last questionnaire is dedicated activity centres excluding centres especially for the old.
Each municipality is estimated to use about 8 hours to complete the annual reports.
The new data are compared with data from the preceding year and various relative figures. In any case of conspicuous deviation from preceding years, the data basis is further checked and the figures are corrected as far as possible. Besides these controls, there are ordinary logical and validity controls intending to secure the logical relation between the items in the complemented questionnaires. In spite of an extensive revision of data some reservations must be taken concerning the figures presented on municipal level.
Upon the release of final figures, municipalities failing to give data will be included with figures from the preceding year.
Man-year
These data are intended to embrace all kinds of activities within the home based services and the institutions, and are not only restricted to nursing and care functions. The data also contain administration and management personnel and as far as the institutions are concerned, kitchen and cleaning functions etc. The personnel are registered on the basis of their formal education by December 31st. The figures are reported in man-years, which means that the total numbers of part-time employees are converted into number of full time employees. Thus the total number of man-years is based on the assumption of stability among the personnel during the year. Employees without the specified education are recorded in collective groups.
Man-years - positions
For personnel, the recording unit is hours per week, and applies to hours set for those with permanent full-time or part-time positions. The number of hours per week is recalculated into man-years (full-time positions) by dividing the number of contract working hours per week. In practice this means that we have divided by 36 hours for physiotherapists and 37.5 hours for the other occupational groups.
Organisation
Organisation means the forms of association the individual physicians and physiotherapists have with the municipality. Municipalities offer practitioners four possible forms of association. The two most common forms are fixed salary and contract.
Physicians and physiotherapists with fixed salaries
Physicians and physiotherapists with fixed salaries are municipal employees, in municipal medical officer or physiotherapist positions advertised by the municipality. These positions may be full or part-time. The municipalities cover all expenses of the positions, but the National Insurance scheme provides fixed grants to the municipalities per position. The duties of these fixed-salary physicians and physiotherapists are set by municipal instructions.
Physicians and physiotherapists with municipal contracts
Physicians and physiotherapists with municipal contracts are basically private practising physicians and physiotherapists who sign an agreement with the municipality or borough. The provisions of this agreement are based on an agreement between the Norwegian Association of Local Authorities, Ministry of Health and Social Affairs and the physicians' and physiotherapists' organizations. The agreement implies that all physicians are obliged to participate in the medical duty service and municipal responsibilities such as care of the elderly and preventive medicine. How much the individual doctor is to perform these duties and the opening hours of the curative practice are defined in the specific agreements between the individual practitioner and the municipality/borough. The basis of the income of physicians and physiotherapists with municipal agreements is National Insurance reimbursements, patient co-payments and a fixed amount (operating grant) from the municipality as compensation for the agreement. Physicians and physiotherapists with combinations of fixed salary part-time positions and part-time contract practice are regarded as practitioners with a municipal contract.
Physicians and physiotherapists without municipal contracts
There are also practitioners with private practices who do not have a contract with the municipality. For the individual patient, it is of no financial significance if you go to a mandatory practitioner, doctor with fixed salary or doctor with a municipal contract. Physicians without a municipal contract may, with certain limitations, take as high a co-payment as the patient is willing to pay.
Following changes in sections 5-4, 5-7 and 5-8 of the National Insurance Act of 1 July 1998, national insurance reimbursements are no longer to be paid to private practising health professionals who do not have an operating agreement with the municipality or county. Exceptions have been made for general practitioners pending the introduction of the regular GP scheme.
Mandatory practitioners
Mandatory practitioners also make up an important part of the medical and physiotherapy services in many municipalities. Mandatory practitioners are medical graduates who are serving their obligatory service in general practice in order to earn the right to be licensed.
Vacant authorised posts/ positions
Authorised posts or fixed-salary positions that are vacant at December 31st due to leave, illness or other reasons, are regarded as filled if the absence is less than four months, otherwise it is regarded as vacant.
Overtime
From the statistical year 1994, data on man-years worked by physicians also include hours worked under extended working time agreements pursuant to the central union federation special agreement between the Norwegian Association of Local Authorities and the Norwegian Medical Association. This agreement permits, for up to one year at a time, the signing of an agreement on extended working hours beyond 37.5 hours per week. Overtime work beyond this is not included.
Users of home based services
The figures cover all users of home help and home nursing or both services that were registered as active users at the end of the year. In general every person receiving services is regarded as one user, with one exception; households consisting of two or more persons receiving help are regarded as one user.
Home nursing is regulated by the Act of health services in the municipalities that prescribes professional nurse services. Home help is regulated by the Act of social services in the municipalities (of 13 December 1991) and is part of the term "practical assistance" that covers all kinds of help to the tasks of daily-life household given persons in need of such help because of old age or various handicaps.
Institutions for the aged
These are defined as a group of buildings where parts of the floorage are shared between residents, the household is common and care personnel are present 24 hours a day. This definition embraces all kinds of institutions falling under the two laws mentioned above and are as follows: nursing homes, old peoples homes, combined nursing and old peoples homes and in addition various municipal dwellings with full-time services.
Non-response
In the case of non-response from either municipalities or institutions the questionnaires are completed with information from the previous year.
Another source of error is connected with the fact that the delivery of health care is extremely diverse, so the form does not always fit all municipalities. A lack of correspondence between the registrations, and the actual situation of which the form was meant to survey may consequently occur.
Sources of error can apply to many parts of the statistics, as described below:
Man-years of physicians with operating agreements
According to the instructions the figures shall show the number of hours per week on which the agreement with the municipality is based. Sometimes the hours actually worked by the doctor are entered, even though they exceed the hours on which the agreement is based.
Man-years of fixed-salary physicians
The instructions state that overtime is not to be included. Some municipalities have nevertheless included "overtime". This has been removed insofar as the municipalities have been informed that such work is included.
Physicians and physiotherapists without municipal agreement
Work performed by physicians and physiotherapists without agreements shall be reported to the medical consultant/chief municipal medical officer. Experience shows that municipalities and boroughs do not have a full overview of these operations. The labour input of practitioners without an agreement may therefore be somewhat underestimated.
Breakdown into areas of activity
It may happen that the distribution of man-years in the various areas of activity is not given for physicians, physiotherapists and auxiliaries. When this is suspected, the municipality is contacted for update.
Man-years
In the basic material from the municipalities the amount of work is given in hours per week. Recalculation to man-years is undertaken at publication. The general recalculation rule - 37.5 hours per week - is therefore observed for all groups except physiotherapists, whom hours should be divided by 36. There seems, however, to be differences among the municipalities as to the hours of a full-time position in the various occupational groups.
The statistical basis has undergone major changes since the statistical routine was established, but the Statistics Norway is able to present time-series for the most important health care variables back to 1987, and for nursing and care back to 1991.
The statistics of the municipal health services is highly correlated to the nursing and care statistics, and the two statistics are published together from 2003.
The web address is http://www.ssb.no/helsetjko_en/.
The statistics is published twice a year, preliminary figures are published in June and yearly figures in March the succeeding year.
Norwegian (Nynorsk), English
Official statistics of Norway, Nursing and Care statistics and Municipal Health Services, was published yearly/each second year. From 2003, these publications are replaced by a common Municipal Health and Care services. Some figures are also published yearly in "Health Statistics in the Nordic Countries by NOMESCO and in "Social protection in the Nordic Countries" by NOSOSCO.
2003 © Statistics Norway