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Header logo - Riksrevisjonen circle pattern

Document 3:10 (2025–2026) / Published Coordination of health services for the elderly

Many patients who could have been treated in the municipalities are instead being treated in hospitals.

Short background

  • As early as 2033, the number of people over 80 years of age will have increased by 50 percent compared to 2024.
  • To ensure sustainable health and care services in the future, we depend on better coordination and that more services are provided at the lowest possible level of care.

Overall assessment

The national policy instruments administered by the Ministry of Health and Care Services, which are intended to ensure that treatment takes place at the appropriate level, have not functioned well enough. The National Audit Office of Norway (NAO) considers this to be objectionable.

Conclusions

  • Hospitals will become overburdened in the future unless healthcare services are delivered at the lowest appropriate level of care to a greater extent than today.
  • Elderly people in municipalities that host hospitals use specialist health services more than elderly people in municipalities without hospitals.
  • In many cases, specialist health services treat patients who should instead have received care from municipal health and care services.
  • Poor coordination means that many patients do not receive continuous and coherent services.
  • Management in the health services pay too little attention to known weaknesses in coordination.
  • The governance by the Ministry of Health and Care Services does not ensure good coordination or sufficient information on whether the instruments for coordination have worked.

Recommendations

We recommend that the Ministry of Health and Care Services ensures:

  • that central government policy instruments are designed in such a way that they promote patient pathways at the lowest effective level of care. This includes ensuring appropriate use of municipal emergency bed capacity (KAD) and out-of-hours services, proper follow-up of general practitioners’ referral practices, and improved coordination regarding patients ready for discharge. It also includes assessing the incentives for municipalities to receive patients who are ready for discharge.
  • better management data on coordination that can contribute to improving patient pathways in the services. This includes data that managers in municipalities and hospitals can use to develop good patient pathways and assess whether patients are treated at the appropriate level, such as data on referral practices.
  • that the regional health authorities fulfil their responsibility to facilitate necessary cooperation with municipalities in providing services.

The Ministry of Health and Care Services should, through its governance, ask the Norwegian Directorate of Health to investigate why residents in many municipalities hosting hospitals are more frequently treated in hospitals than residents in municipalities without hospitals.

The Ministry of Health and Care Services should, through its governance, ask the regional health authorities to:

  • follow up on differences in residents’ use of hospitals across the municipalities within the catchment areas of the health trusts and hospitals,
  • give greater attention in long-term planning to how characteristics of municipal health and care services—such as capacity and organisation—affect the use of specialist health services.
  • The Ministry of Health and Care Services should, in cooperation with KS (the Norwegian Association of Local and Regional Authorities), help ensure that specialist health services and municipalities make greater use of the health partnerships to collaborate on planning and developing services from a longer-term perspective.
Kategorier: Health