Week 64: The perverse incentives of the Norwegian health care system

Written by Lars Haakon Soraas

Week 64 in the war on cancer has passed. Here are the highlights:

  • Dyanne has been in pretty good shape all week. A bit tired on some days, quite dry hands (probably a side effect and result of cold weather). The rash on arms and legs is getting better. It is no longer itching, but still visible.
  • She went to Frankfurt for a new vaccine injection. She did not get nivolumab due to the rash.

On Thursday this week, I was in Bergen and held a presentation at a seminar about re-purposing of drugs.  My talk was focused on the perverse incentives that exist in the health care system in Norway. These incentives mean that great opportunities for drug repurposing are not pursued by our leading hospitals and researchers. Furthermore, the targets for our hospitals, which are set by our dear Minister of Health, Bent Høie, also means that hospitals don’t have any incentives to try to save the lives of “terminally” ill patients.

As a matter of fact, the incentives are stacked up in way so that the best outcome for our public hospitals is that Dyanne dies “on time” after receiving the standard treatment. It is a sick and broken system, probably beyond repair. I have, unfortunately, come to believe it will probably be easier to cure lung cancer than to fix the health care system. Needless to say, we have long ago realized that this system will only play a very minor role in our efforts to try to make sure Dyanne can see her grandchildren in some 20-30 years.

For anyone interested, the presentation can be found here.  Here are a couple of the slides from the presentation.



Based on our experience with the Norwegian health care system, my advice to any newly diagnosed “terminal” cancer patients is that they must understand that the public hospitals in Norway have no incentives to save their lives. Furthermore, as they have never really tried to save the lives of terminally ill cancer patients, they also have limited competence in this area. Patients who want to try to survive a “terminal” diagnosis, basically have to fend for themselves by trying to find private doctors or doctors outside Norway who are willing to help. It is sad, but it is a fact. And the saddest part is that most patients don’t seem to realize this before it is too late.

With that, have a great Sunday night everyone!

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