Health Care in Norway: Part 1

“The reason: Norwegians stopped taking so many drugs.

“Twenty-five years ago, Norwegians were also losing their lives to this bacteria. But Norway’s public health system fought back with an aggressive program that made it the most infection-free country in the world. A key part of that program was cutting back severely on the use of antibiotics.

“Now a spate of new studies from around the world prove that Norway’s model can be replicated with extraordinary success, and public health experts are saying these deaths–19,000 in the U.S. each year alone, more than from AIDS–are unnecessary.

“‘It’s a very sad situation that in some places so many are dying from this, because we have shown here in Norway that Methicillin-resistant Staphylococcus aureus (MRSA) can be controlled, and with not too much effort’,said Jan Hendrik-Binder, Oslo’s MRSA medical adviser. ‘But you have to take it seriously, you have to give it attention, and you must not give up. . . . ‘

“Norway’s model is surprisingly straightforward.

“– Norwegian doctors prescribe fewer antibiotics than any other country, so people do not have a chance to develop resistance to them.”

Many antibiotics simply are not available.

When Dr. John Birger Haug opens the dispensary at Aker hospital, one sees “a small room lined with boxes of pills, bottles of syrups and tubes of ointment. What’s here? Medicines considered obsolete in many developed countries. What’s not? Some of the newest, most expensive antibiotics, which aren’t even registered for use in Norway, ‘because if we have them here, doctors will use them,’ he says. . . .

“Norway responded swiftly to initial MRSA outbreaks in the 1980s by cutting antibiotic use. Thus while they got ahead of the infection, the rest of the world fell behind.

“In Norway, MRSA has accounted for less than 1 percent of staph infections for years. That compares to 80 percent in Japan, the world leader in MRSA; 44 percent in Israel; and 38 percent in Greece.

“In the U.S., cases have soared and MRSA cost $6 billion last year. Rates have gone up from 2 percent in 1974 to 63 percent in 2004”

Could the Norwegian solution work here? Yes—if patient safety came first in U.S. hospitals.

Why am I so sure?

“In 2001, the CDC approached a Veterans Affairs hospital in Pittsburgh about conducting a small test program. It started in one unit, and within four years, the entire hospital was screening everyone who came through the door for MRSA. The result: an 80 percent decrease in MRSA infections. The program has now been expanded to all 153 VA hospitals, resulting in a 50 percent drop in MRSA bloodstream infections, said Dr. Robert Muder, chief of infectious diseases at the VA Pittsburgh Healthcare System.

“It’s kind of a no-brainer,’” he said. ‘You save people pain, you save people the work of taking care of them, you save money, you save lives and you can export what you learn to other hospital-acquired infections.’”

It should come as no surprise that the VA, the least “corporate” sector of U.S. health care, has adopted the Norway model. VA docs don’t take gifts or consulting fees from Pharma. The VA itself has an evidence-based formulary. Unlike Medicare, it does negotiate for discounts on drugs—and achieves substantial savings.The VA isn’t competing with other hospitals. It doesn’t worry whether “consumers” will go elsewhere. It worries about what is best for “patients.”

Although it may seem a “no-brainer,’ the Norway solution has not been widely adopted in rest of the U.S. health care system. AP reports: “Dr. John Jernigan at the U.S. Centers for Disease Control and Prevention said they incorporate some of Norway’s solutions in varying degrees, and his agency ‘requires hospitals to move the needle, to show improvement, and if they don’t show improvement they need to do more.’”

And if they don’t?

“Nobody is accountable to our recommendations,’” Jernigan told AP, “but I assume hospitals and institutions are interested in doing the right thing.’”

Of course U.S. hospitals shouldn’t be asked to follow safety guidelines. That would constitute government intervention in U.S. health care. We pride ourselves on our laissez-faire approach to medicine, letting each hospital set its own priorities. In Norway, apparently public health is a priority. In the U.S. power resides with the hospital lobby.

Moreover, U.S. patients would not be satisfied with a hospital where the floors are “streaked and scratched” and dust is visible on the blood pressure monitor. They would rather die of an MRSA infection in a seemingly immaculate private room with view.