Specialist health service

Specialist health service --includes somatic and psychiatric hospitals and institutions, institutions related to drug abuse, ambulance service and private specialists with operating agreements.

General (somatic) hospitals are "normal" hospitals, i.e. not psychiatric hospitals. Day-cases are planned admittances without the patient staying overnight. The treatment given is more comprehensive than outpatient treatment.

Outpatient consultations include consultations and treatment carried out in hospitals without the patient being admitted.

Mental health care
Psychiatric health care for adults covers treatment of patients aged 18 and up. Patients under 18 are treated in psychiatric health care for children and adolescents.

Ambulance
In accordance with "Definisjonskatalog for AMK-/LV-sentraler" the definition of an ambulance is as follows:

"Ground-, air- or sea vehicles constructed/built for and used for transporting ill or hurt persons, with personnel, facilitated and equipped for treatment ahead of and during the transport."

Government mandate

Private institutions with government mandate function as a part of the Public Health system. The government make plans for how these institutions may operate and these institutions are responsible for providing specialist health services to inhabitants in specific geografical areas. There are 12 private institutions with government mandate: Stiftelsen Betanien Hospital Skien, Voss DPS NKS Bjørkeli AS, Haugesund Sanitetsforenings Revmatismesykehus AS, Lovisenberg diakonale sykehus AS, NKS Jæren Distriktspsykiatriske senter AS, Diakonhjemmet sykehus AS, NKS Olaviken Alderspsykiatriske senter AS, Stiftelsen Betanien Bergen, Martina Hansens Hospital AS, Haraldsplass diakonale sykehus AS, Solli sykehus og Revmatismesykehuset AS.

Operating agreement
An operating agreement is an agreement entered into by physicians and HE, and concerns operations and private practice. The services delivered by institutions with operating agreements are de facto part of the ordinary provided health care in the respective health regions.

Additionally, HE (or RHE) might purchase health care services from privately owned enterprises. Those contracts are often more short-term based than an operating agreement. The services purchased contribute to the general health care provided by HE and RHE.

Expenditure eksl. revenues
Expenditure includes expenses on wages and social benefits, expenses on equipment and maintenance, other current expenses and transfer expenses. Public grants is not included. Interest, principal repayment, financing transactions such as funds, charging of accounting losses/profits as expenses and coverage of previous years' losses, are not included. Refunded wages from national insurance for paid sick leave are corrected.

Revenues
Revenues include sales and leasing revenues and transfers. This corresponds to items 300-399, 570, 571, 579 and 583 in the regulations for the health enterprises. Financial transactions such as funds, and recording of surplus in the balance sheet are not included.

Depreciation
Depreciation in total includes depreciation of commercial buildings and other real estate, means of transport, medical technical equipment, machines, other equipment and furniture, ICT-equipment (Information and Communication technology-equipment), immaterial properties and write-down of fixed assets and immaterial properties.

Man-years are the number of full time employees and part-time employees converted to full-time equivalents at 31 December of the statistical year. Man-years cover the agreed working hours. Overtime is not included.

Bed capacity at the institutions

This is the number of accessible beds in the institution as of 31 December each year. Beds that are temporarily closed (e.g., during public holidays, etc.) are included.

Bed-days

Number of days a patient remains in hospital

Outpatient treatment
In somatic hospitals an outpatient treatment is: Examination/treatment and/or medical advice administered in or by a hospital. Usually, a physician should be present at such consultations. Consultations related to admitted patients, telephone consultations, lab tests and x-ray examination, are not included.

Outpatient consultations include consultations carried out in outpatient clinics or in psychiatric institutions, giving reimbursement from the state.

Ambulances operative parts of the day may denote vehicles operative between 8 a.m. and 4 p.m., or in another period of the day.

Ambulances in 24-hour readiness are vehicles that are operative 24 hours a day.

Other ambulances are vehicles that are not included in the daily operations. These are standby ambulances and supplementary ambulances.

Specialist physicians are placed in various classes of subsidy . This is done subsequent to local negotiations between Health Enterprises and the physicians, with basis in the specialist need for housing, technical equipment and personnel. Subsidy is provided according to the following scale:

Class Amount per year (per 01.07.2009)

1 NOK 700 000

2 NOK 813 200

3 NOK 1 042 500

Population for this statistics is defined by Classification of Standard Industrial Classification (SIC 2007).

Name: Specialist health service
Topic: Health

Division for Health, care and social statistics

Statistics are presented on national level, per helath region and per Heath enterprises.

Annual

The statistics are reported to OEDE, Eurostat, WHO and NOMESCO

Microdata, information about population and data are saved as textfiles.

The purpose of this statistics is to provide information on capacity, activity, personnel and economy within the Specialist health services.

2.1.1. Main trends
Up to and including the operating year 2001 the counties were responsible for the Specialist Health Service. The counties owned most of the hospitals and institutions included in this statistics, and entered in to operating agreements with private hospitals, institutions and specialists. In this period the sector went through administrative changes.

From January 1.st 2002 the central government took over responsibility for Specialist Health Service. The new organizational structure was a Health Enterprise model with 5 Regional Health Enterprises (RHE), being the owners of subsidiary Health Enterprises (HE). This includes a transition from an administrative organization to an enterprise organization. The responsibility for the population of a specific geographical area lies with the RHE the area belongs to. The specialist health service is produced by the HEs, private hospitals, institutions and specialists.

From January 1.st 2004 the regional health enterprises took over responsibility for multidisciplinary specialised substance abuse institutions from the counties. These institutions are now either owned by the regional health enterprises themselves or governed through operating agreements.

Organization - changes in the Health Enterprises from 2002 to 2005

Between 2002 and 2005 several changes has taken place in organisation of the Health Enterprises. The total number of Health Enterprises has decreased, and every Health Enterprise now includes several more institutions.

The statistics are used by the Ministry of Health and Care services, the Directorate of health and social affaires, the National Board of Health, the Health Enterprises, organizations, researchers, students and more. According to the Specialist Health Service Act, the Health Enterprises are under an obligation to offer the population health services on specialist level. In connection with that, statistics are used to monitor the development in capacity, activity and personnel resources in the regions.

In addition, the Norwegian Directorate of Health uses the statistics as data source for their Samdata publications.

No external users have access to the statistics and analyses before they are published and accessible simultaneously for all users on Statistics Norway at 8 am. Prior to this, a minimum of three months' advance notice is given in the Overview of planned releases and events.

Emplyees in Specialist health services is part of the overall statistics of Health care personel.

Accounting information is included in General government revenue and expenditure

OECD has developed a system for the health accounts ("A system of Health Accounts", OECD 2000) based on a common framework that will ensure optimum comparability of data over time and between countries. The accounts cover all expenses for health purposes, both private and public, which are spent on consumption and investments in health services. The expenses are classified according to function (purpose), provider and financing source. Statistics from the specialist health service accounts are included as basic data in the compilation of the more extensive health accounts. See Health Accounts.

Special Health Service Act of 2 July 1999, Section 61 § 5-6, and Statistics Act of 21 June 2019, Section 32 §10-1.

Not relevant

The statistics cover Regional health enterprises (RHE), Health enterprises (HE) and private hospitals and institutions. General hospitals, rehabilitation institutions, institutions in mental health care for adults and for children and adolescents, ambulance service, operating agreements with private specialists and clinical psychologists and multidisciplinary specialised substance abuse institutions are included.

Population for this statistics is defined by Classification of Standard Industrial Classification (SIC 2007). All Regional Health Enterprises (RHE) and Health Enterprises with subordinate local units are included. Private enterprises and local units which have an operating argreement with RHE are included.

Electronic questionnaires are used for reporting on capasity (beds).

Accounts are reported as flat text files.

Personnel data (employees, full time equivalents) is based on administrative registers, and the joint reporting solution called "a-ordningen". A-ordningen is a coordinated digital collection of data on employment, income and tax deductions to the Tax Administration, the Norwegian Labour and Welfare Organization and Statistics Norway.

Activity data (bed-days, discharges, day treatment, out patient consutations) are collected by the Norwegian Patient Register, administered by the The Norwegian Directorate of Health.

Data are collected via electronic schemes and electronic account files. Schemes are accessible on the Internet from January. Response deadline for activity is February 1.st for HE/RHE, and private institutions. Response deadline for accounts is April 1.st for HE/RHE and private institutions

Statistics Norway performs automatic sum controls of the data material. In addition, the data are compared with information from previous years, and with other sources (data on activity, personnel and patients). Institutions are contacted in the event of missing data or discrepancies in the data.

Contracted man-years adjusted for long term leaves

The number of full-time jobs and part-time jobs calculated as full-time equivalents adjusted for doctor-certified sickness absence and maternity leave.

Not relevant

Data is presented on aggregated level, in order not to identify persons and private enterprises. Data for governmental enterprises (RHE/HE) are presented, jf. Statistical act 2019 §7-3.

The length of time series that is relevant to produce can vary, with some variables dating far back in time. The greatest break was when the hospital reform was introduced in 2002. Prior to this, the specialist health service was a county municipal responsibility. The statistics are therefore broken down into different regional levels before and after the reform. Up to 2001, the statistics were presented at county level, while from 2002, health regions and health enterprises are divided into the relevant regions.

New service areas are gradually being added to the specialist health service. The most important expansion was in 2004, when multidisciplinary specialist treatment for substance abuse was transferred to the state via the regional health enterprises.

From 2004 also the air ambulance service is included.

When comparing total figures for the specialist health service, these expansions of the regional health enterprises' responsibility will explain various changes in overall sizes.

The main souce for identifiing units is Statistics Norway's Business register. Errors will occur if the register has deficiencies. In cooperation with the enterprises Statistics Norway try to identify and correct such sampling errors.

Electronic controlls aim to reduce risk of misunderstandings and typing errors. Data is controlled at macro level by Statistics Norway. Controlls are based on established statistical method and "European Statistics Code of Practice".

Not relevant.