Norwegian patients with chronic pain conditions that can be managed with reasonable cost/benefit now have a legally binding right to treatment in Norway

The national health care system in Norway benefits from a higher percentage of the BNP than most other nations in Europe. In spite of long distances in thinly populated areas, poor road and railway systems, and a lot of foul weather conditions, our national health care system takes well care of those with acute and serious diseases or trauma.

However, it has been apparent for decades that the Norwegian health care system is less than perfect for those with chronic health problems, that are not directly lifethreatening but often reduce health related quality of life. Twice the government has developed rules for priority setting (Norsk Offentlig Utredning, 1987, Norsk Offentlig Utredning, 1997) in which it was clearly stated that those suffering from burdensome chronic health conditions should be given high priority. This resulted in a law passed by the Parliament, the Patients’ rights law of 1999.

In spite of this legal imperative to give priority to those suffering chronic diseases, health care expenditure has continued to go mainly to acute diseases, to save “life and limbs”, leaving mostly small leftovers of resources for chronic diseases.

During the last 4 years the Department of Health has instructed the government-owned hospitals to make sure that patients suffering from chronic pain get better care by giving priority to pain clinics and ensuring collaboration between specialist care and primary care.

In three of the five main health regions in Norway there has been some improvement, whereas in the biggest region in the south-east of Norway where half of the population live, nothing has happened. Even worse, the systems for pricing and reimbursing services at the pain clinics have been changed so that incomes from outpatients at pain clinics have decreased by about 50%. This has made any expansion of pain clinic services impossible. This development is contrary to what health care policy makers have intended for the last two decades (Norsk Offentlig Utredning, 1987, Norsk Offentlig Utredning, 1997).

New hope for more and better care for patients with chronic pain conditions 

The Ministry of Health and Care Services and The Directorate of Health and the Regional Health Governments appointed national task forces within 32 specialized fields of medicine with mandates to propose national guidelines for how to give priority to patients who are referred from primary care to specialist care in the hospitals. A task force comprising doctors from pain clinics in the five main health regions in Norway, a general practitioner and two representatives from the chronic pain patient society in Norway, proposed guidelines for chronic pain conditions. The draft was submitted for open hearing to various types of health care providers and societies. The adjusted version was scrutinized by experts and lawyers at the Department and Directorate of Health. The final version of the guidelines was published in June 2009. The guidelines are being implemented from September 2009.

The paper by Walseth Hara and Borchgrevink (Walseth Hara, 2010) in this issue of the Scandinavian Journal of Pain describes the background and the results of this process. We publish this report of the guidelines for giving legally binding priority to patients with severe chronic pain conditions because it is a new approach and a serious attempt at improving management of this major health care problem (Breivik et al., 2006, Breivik et al., 2009). I agree with Walseth Hara and Borchgrevink (Walseth Hara, 2010) that this is one forceful way of signaling that a much neglected group of suffering patients need better health care. We have reasonable hope that this will come true. Time will show.