Provision of rehabilitation care has a long tradition in Norway. The approach to rehabilitation has evolved from a narrow (medical) focus on restoring lost functions to a more comprehensive approach incorporating nonmedical (e.g. social, economic) factors and involving comprehensive cooperation between several sectors and areas of care. In May 2018 the amendment of the “Regulation for habilitation/rehabilitation, individual plan and co-ordinator” changed the definition of habilitation and rehabilitation and centred it more on the patient. According to this regulation, rehabilitation (and habilitation) should be based on the life situation and goals of the individual patient who has or is at risk of impaired physical, mental, cognitive or social ability and give them the opportunity to achieve optimal functional ability, sense of life achievement, independence and participation in education and work, on a personal and societal level. It should comprise targeted processes in a range of settings, with cooperation between patients, next of kin and service providers. Processes should be coordinated, continuous and knowledge-based.
Rehabilitation is provided at both primary (physiotherapy, occupational therapy, etc.) and secondary (specialized rehabilitation) levels. As in other countries, Norway has in the last two decades also developed some intermediate rehabilitation services based on shared care between specialized and primary health care.
Primary care rehabilitation is provided in the community – in patients’ homes, schools and institutions run by the municipalities (e.g. nursing homes). Services are provided by medical doctors, physiotherapists, nurses and midwives. Primary care rehabilitation is available for somatic as well as psychiatric patients and can be accessed through a referral from a primary care physician.
Secondary rehabilitation services are provided in hospitals in dedicated rehabilitation departments or other units, such as rheumatology or neurology departments. Rehabilitation, especially postoperative rehabilitation, may also be provided in private rehabilitation institutions contracted by the RHAs; this is free of charge if the patient is referred by a GP or a hospital. Rehabilitation services for patients with specific conditions are also available in specialist hospitals (e.g. children’s hospitals treating pulmonary conditions, asthma and allergy) and competence centres (e.g. competence centres for rare diseases). Since 2017 patients have been able to choose to receive rehabilitation services outside their RHA, but most patients (97%) receive rehabilitation within their own RHA. The exception is the Northern Norway RHA, where the respective share is 92%.
Municipalities as well as RHAs are jointly responsible for coordinating rehabilitation services. This is done through designated “coordination units”. The units facilitate cooperation between health care providers and the NAV and its local offices and user organizations. Coordination activities include registration of rehabilitation needs; designing and following individual holistic (ensuring interdisciplinary approaches) rehabilitation plans; and initiating, administering and monitoring multidisciplinary rehabilitation teams, which constitute the core of cooperation between different service providers.
In 2017, 54 000 patients received rehabilitation services from the specialist health service and 14 000 patients received rehabilitation in the municipalities (Norwegian Directorate of Health, 2018d). Institutional rehabilitation within the municipalities is usually provided to older patients (85% of patients in 2017 were aged 70+) (Mørk et al., 2018). In 2017 over 27 870 patients received rehabilitation care in hospitals, nearly 50% of them as outpatients or day-care patients (Norwegian Directorate of Health, 2018d). Almost as many patients (27 393) received treatment in private institutions (mainly in an inpatient setting). The average length of stay was about three weeks.
According to the Action plan for habilitation and rehabilitation for 2017–2019, there are several challenges within the rehabilitation sector (Norwegian Ministry of Health and Care Services, 2017b). The key challenges are: ensuring sufficient resources to allow the maintenance of an adequate capacity of rehabilitation care; development of individual rehabilitation programmes in a way that provides equitable access to services; ensuring sufficient cross-sectoral cooperation and coordination across administrative levels and professional groups; and eliciting the active participation of users.