Health Care Reform in Norway: The End of the “Profession State”?

From the early nineteenth century until about 1980, a close relationship developed in Norway between the state and the medical profession. Medicine became integrated into the state at all levels of government, and the profession assumed important roles in initiating and formulating health policy. Another, and perhaps also causally related, development has been that health policyand most strikingly during postwar expansiontended to be formulated and implemented in its own policy sector, with few links to other parts of the welfare state. Important elements of the “profession state” in Norway have thus been professional integration with the state and institutional isolation from other policy sectors. Health reforms of the 1980s and 1990s brought changes in institutional relations: Other professions have replaced physicians as experts at central and local levels, and health policy making has become more politicized and integrated into welfare state policies. Thus there are clear indications that the profession state is waning.