Norway's Initial Report

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233. The Health and Care Services Act stresses that the purpose of the Act is to prevent, treat and facilitate coping with illness, injury, suffering and disabilities. Similarly, one major objective of the Specialist Health Service Act is to counter illness, disease, injury, suffering and disability. These provisions are of significance for interpreting and applying the contents of the other provisions of the Act to specific cases. The Patients’ Rights Act has its own provisions concerning patients' and users' right to information. This Act states that users shall have the information necessary to provide sufficient insight into the services offered and to enable them to protect their rights. It is also stressed that the information must be adapted to the recipient's individual circumstances, such as age, maturity, experience and cultural and language background.

Mental health

234. The Government has given high priority to the goal of strengthening the health services available to persons with mental disorders. The municipal health services and specialist health service are both to be strengthened in this area. Following the Opptrappingsplanen for psykisk helse [Escalation Plan for Mental Health] (1999–2008), the mental health services have undergone major changes. At the end of the plan period, more than twice as many people were receiving treatment for mental disorders as in 1998. This increase took place both in municipalities and in the specialist health service, and has continued in subsequent years. Most people now get help locally, close to their place of residence. In line with the escalation plan guidelines, the large, closed institutions have gradually been dismantled, while at the same time some 75 district psychiatric centres have been established. The centres provide the majority of the services in the psychiatric part of the specialist health service. Most patients are treated through the outpatient and ambulant services, and according to their own wishes. The transition from hospital to district psychiatric centres and from inpatient to outpatient and external services parallels developments in most other countries and complies with the recommendations of the World Health Organization (WHO) and the EU. The district psychiatric centres need to be strengthened further, to ensure ready availability around the clock, fulfil competency requirements, and as far as possible achieve equal services for all, irrespective of place of residence.
235. Programmes to increase municipal mental health competence have been initiated to strengthen service provision at municipal level. Measures include recruiting more municipal psychologists and offering grants for ongoing professional development of municipal personnel. Providing competent, accessible services in the municipalities increases the possibility of offering early and better help, and reduces the need for institutionalisation in the specialist health service, including the need to use compulsory detention. The services offered to persons with severe mental illness who are unable to use ordinary services are strengthened through an extension of the work involving outreach treatment teams and mutually binding cooperation between the municipal and specialist health services.
236. In pace with the measures to strengthen the mental health services offered in the municipalities, there has been a steady increase in man-years for psychiatric nurses and persons with further training in mental health care; see KOSTRA (Municipality-State-Reporting), administered by Statistics Norway). See Article 31 for more details.

Self-assessment of health

237. Figures from the Survey on Living Conditions (see also Article 31) show that persons with disabilities have far poorer self-assessed health than the population generally. Forty-five per cent of persons with impaired mobility regard their state of health as poor. The proportion among persons with disabilities generally is 37 per cent. This indicates that a far larger share of persons with disabilities have health problems that create obstacles and challenges in various spheres of their lives. Just under one in ten with disabilities state that they have an unmet need for medical services, while the corresponding figure for the general population is only 2 per cent. This indicates that the major health challenges that persons with disabilities report are not being adequately met by the healthcare service. One in ten persons with disabilities report that they have poor dental health. The corresponding figure for the general population is about one in twenty. Persons with other types of disability also have a higher degree of psychological problems than the population in general. Eighteen per cent of persons with disabilities aged between 20 and 66 reported in 2012 that they had an unmet need for psychiatric health services. The corresponding figure for the general population was 6 per cent. This may indicate that persons with disabilities encounter larger barriers in contacting psychiatric health services than others.
238. Apart from the general prohibition on discrimination against persons with disabilities in Article 98 of the Constitution and the Anti-Discrimination and Accessibility Act, there are no rules in Norwegian law that specifically regulate the issue of non-discrimination of persons with disabilities in connection with taking out insurance, including health insurance. This issue will have to be resolved according to the general rules in the Insurance Contracts Act. In principle, insurance companies are supposed to make general risk considerations the basis for their assessment of whether an insurance contract should be entered into and for what premium, and the companies undertake to use insurance conditions that are proportionate to the risk being assumed. When the insurance company decides whether it should take on a personal insurance and assesses the risk, the company is required to base it on the state of health of the insured at the time of application.
239. This point of departure is modified somewhat by the fact that the Insurance Contracts Act imposes a partial duty to contract on insurance companies. The insurance companies' partial duty to contract regulates when the companies can reject an application for insurance. The provision stipulates that a company cannot without just cause deny anyone insurance cover on the ordinary terms it offers the general public. Circumstances that constitute a special risk shall be deemed just cause for denial, provided that there is a reasonable connection between the special risk and the rejection of the application. The provision further establishes that factors to which it is prohibited, under provisions in or regulations to an act, to attach weight when performing risk assessments in insurance, cannot constitute just cause. The same applies to information that the company, under provisions in or regulations to an act, is precluded from requesting from the policyholder or the insured.
240. In parallel with the introduction of a rule of partial duty to contract, important rules were adopted that restrict access by insurance companies to health information. The premise is that the company can request information that may have a bearing on its assessment of risk. However, the company is precluded from asking for health information going back more than ten years, nor can health information that has been unlawfully gathered or left undeleted be invoked by the insurance company.
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