Entitlement to essential healthcare from the specialist health service

You must have a referral in order to receive healthcare from the specialist health service

The municipal health service and the specialist health service will work together to provide you with the healthcare you need. If you fall ill, you will normally go to your GP first. If you have a physical or mental condition which requires more specialised healthcare than the municipal health and care services can provide, your GP will refer you to the specialist health service.

The referral must be sent to a treatment centre that is authorised to assess whether you are entitled to healthcare from the specialist health service.

Virtually all public sector and some private treatment centres also have such authorisation.

When the specialist health service receives your referral, it will have 10 working days to assess whether you need healthcare in the form of either medical investigations or treatment from the specialist health service. The outcome of this assessment will determine whether or not you are entitled to healthcare from the specialist health service.

You will not need a referral in an emergency when you need immediate healthcare.

Assessment of entitlement to healthcare

Whether or not you need healthcare from the specialist health service is a medical question. The treatment centre that receives your referral will assess this question. The decision itself will be made by a health professional, normally a specialist doctor.

The decision will be based on:

• the information provided in the referral
• a specific, individual assessment of your health condition, based on the information given in the referral
• national guidelines and recommendations prepared by the Norwegian Directorate of Health

The assessment may have one of two outcomes:

• You are entitled to healthcare from the specialist health service
  You will be offered assessment and/or treatment at a hospital or by a specialist. At the same time, you will be given a binding deadline for the start of your healthcare.
• Rejection: You are not entitled to healthcare from the specialist health service
  The assessment concluded that you do not need to undergo medical investigations or be treated by the specialist health service. This will normally mean that your GP or other areas of the health service will be able to treat you satisfactorily.

The specialist health service will be obliged to assess your referral within 10 working days of receiving the referral. The response must be given in writing. If serious illness is suspected, the assessment must be carried out sooner.

Conditions for entitlement to healthcare

A number of conditions must be met in order for you to be entitled to essential healthcare from the specialist health service:• You must need healthcare from the specialist health service.

• It is expected that you will benefit from the healthcare.
• The cost of the healthcare is in reasonable proportion to the expected benefits of the healthcare.
• The healthcare falls within the framework of the services that the specialist health service is responsible for providing and funding.

Right to assessment of referral within 10 working days

The specialist health service must respond to your referral within 10 working days of receiving the referral. If serious illness is suspected, the assessment must be carried out sooner.

What is the specialist health service responsible for?

The specialist health service is an umbrella term for the types of health services that are not provided by the municipal health and care services. The specialist health service is responsible for diagnosing, treating and following up patients with acute, severe and chronic medical conditions and health issues.

For example, the specialist health service includes

• hospitals
• district psychiatric centres
• training and rehabilitation institutions
• institutions for the multi-disciplinary specialist treatment of substance abuse
• pre-hospital services
• privately practising specialists
• laboratory and x-ray services

What is included in the specialist health service may change over time, due both to medical advances and changes in the organisation of the health services.

Clinical trials and experimental treatment

Hospitals may offer you the chance to participate in clinical trials. Such treatments have not been used as part of the ordinary treatment programme. However, you will not be entitled to receive this type of treatment, which is known as experimental treatment or clinical trials.

Healthcare abroad

You may be entitled to claim either some or all of your expenses for healthcare that you have received in another EEA country. You may also be entitled to reimbursement for your expenses for healthcare received abroad if you are entitled to essential healthcare which is not available in Norway, or if the healthcare abroad has been documented as being more effective than the corresponding healthcare provided by the public sector in Norway.

Right to treatment abroad

Is the healthcare you need not available in Norway, or has healthcare abroad been shown to be more effective than the corresponding healthcare that is available from the public healthcare service in Norway? If you are a patient who is entitled to essential healthcare from the specialist health service, the office for treatment abroad in the health region in which you live, can consider if you are you may be entitled to treatment abroad.

Illustration: Morten Rakke / Helfo

If your application is rejected, you can request that you be re-assessed

If your referral is rejected on the grounds that you are not entitled to healthcare from the specialist health service, you can ask your GP whether there are any grounds for requesting a re-assessment of your health condition at another treatment centre. You can choose which treatment centre your GP should send the new referral to, but the treatment centre must be authorised to assess referrals.

You can request a re-assessment at another treatment centre if:

• you disagree with the deadline you have been given for the start of your healthcare
• you disagree with the assessment or the severity of your condition
• you disagree with the proposed treatment program

You can only request a re-assessment for the same condition on one occasion.

If you believe that your patient rights would be breached by the re-assessment, you can appeal to the County Governor (statsforvalteren.no). The County Governor can review all aspects of the case.

Entitlement to re-assessment

If you disagree with the specialist health service's assessment of your referral, you can request that the referral be re-assessed.