Norsk
1. The situation so far
After NPE was introduced in 1988, the private insurance companies continued to cover some policies for the health sector, initially those outside the NPE order, ie private hospitals and clinics, and various types of self-employed people such as private physicians and physiotherapists. But those covered by the NPE also needed liability insurance, as the order did not cover all types of claims for which health personnel could be responsible.
In general, these policies were based on the common law of damages, but for some private clinics that had patients referred by the public health sector, the insurance covered patient claims under the same conditions as NPE.
When the NPE order was assessed at the end of the nineties, it was proposed that private companies should also be included. The proposal was that they should insured by the private insurance companies, but that claims handling should be undertaken by NPE.
It was also proposed that there should be no limit to the insurance sum on liability insurance, which would make calculation of premiums difficult, and reinsurance cover almost impossible.
In addition, it was proposed to move the boundary between the public and private health sectors, so that large groups who had previously been private were transferred to the public health sector . This would reduce the market for liability insurance for private health personnel by more than 50%, and make it of little commercial interest for companies to offer such insurance.
The new boundary between private and public health companies would also create problems in terms of the framework of regulations under which a claim would be handled. What happens in the case of a patient on a waiting list who is sent for treatment in a private institution, and receives a ‘private’ operation in addition to his ‘public’ operation, when there is a claim against the anaesthesia which is common to both parts of the operation? Claims that involve ‘waiting list operations’ would be covered under the public order, while the others would be covered by private insurance.
All this led to all the major insurance companies in Norway deciding not to be offer liability insurance for the private health sector under the new rules as proposed.
2. New rules from 1.1.2009
After many lengthy discussions between the insurance sector and the political authorities, the solution was that NPE should cover all health sectors in Norway, both public and private. The rules came into effect from 1.1.2009 and meant that private health personnel no longer need to have liability insurance for the claims covered by NPE.
These new rules mean that the Patient Claims Act, and thus the connection to NPE, applies to claims caused:
a) in an institution during specialist or municipal health treatment,
b) during transport by ambulance, or
c) by health personnel who carry out medical activities in relation to public authorisation or license, persons who act on their behalf, persons who have the right to carry out work as temporary health personnel in Norway without Norwegian authorisation, license, or specialist approval, or other persons specified in the regulations.
The authority for the requirement for authorisation is based in the Health Personnel Act, Section 48, which covers the following groups of health personnel:
This list is exhaustive, so that those not included cannot be authorised, and so cannot under any circumstances be covered by the NPE order.
The intention of the Patient Claims Act was that all patient claims should be handled under the same regulatory framework irrespective of the health sector in which the claim arose. Under the circumstances, it was only right to extend the public order to cover both public and private health sectors.
All patient claims now come under the public order, no matter whether they are against the private or public health sectors. So the same regulatory framework applies to all patient claims, whether they involve the private or the public health sectors, and the need for liability insurance for patient claims no longer exists.
Marit Nøkleby
