The core of the Nordic health care system is not empty

  • Carl Hampus Lyttkens Department of Economics, Lund university, Sweden
  • Terkel Christiansen University of Southern Denmark
  • Unto Häkkinen Centre for Health and Social Economics, National Institute for Health and Welfare, Helsinki
  • Oddvar Kaarboe University of Oslo
  • Matt Sutton University of Manchester
  • Anna Welander Department of Economics, Lund university
Keywords: Nordic health care system, embedded, trust, quality, efficiency, institutions


The Nordic countries are well-known for their welfare states. A very important feature of the welfare state is that it aims at easy and equal access to adequate health care for the entire population. For many years, the Nordic systems were automatically viewed as very similar, and they were placed in the same group when the OECD classified health care systems around the world. However, close inspection soon reveals that there are important differences between the health care systems of Denmark, Finland, Iceland, Norway and Sweden. Consequently, it is perhaps no surprise that the Nordic countries fell into three different categories when the OECD revised its classification a few years ago. In this paper, we revisit this issue and argue that the most important similarity across the Nordic countries is the institutional context in which the health care sector is embedded. Nordic health care exists in a high-trust, high-taxation setting of small open economies. With this background, we find a set of important similarities in the manner in which health care is organized and financed in the Nordic countries. To evaluate the performance of the Nordic health care system, we compare a few health quality indicators in the Nordic countries with those of five non-Nordic similarly small open European economies with the same level of income. Overall, the Nordic countries seem to be performing relatively well. Whether they will continue to do so will depend to a large extent on whether the welfare state will continue to reform itself as it has in the past.

Published: April 2016.