What about legal protection?
The Norwegian Healthcare Investigation Board (Ukom) recently documented how the nonattendance fee is unequally applied between hospitals as well as internally within each hospital (3). The report shows that many hospitals lack procedures for collecting the fee, while those that have written procedures do not necessarily coordinate between them. Many hospital employees report on the challenges of deciding who is to be subject to the fee, and call for national guidelines. These findings must be seen in light of the wording of the regulations, which say that the fee can be imposed (2), and the hospitals have been instructed to apply discretionary judgement (3).
The nonattendance fee is unequally applied between hospitals as well as internally within each hospital
When a fee is demanded from a patient, nor is this an individual decision in the sense of the Public Administration Act. Thus, the patient has no formal rights to appeal against the fee to an appeals board. On the other hand, if the nonattendance fee is to function as an individual decision, the scheme will require more administrative and economic resources, as the authorities themselves have pointed out (4). Concern that the use of nonattendance fees in the health services will require a lot of administrative effort has also been voiced in other countries (5, 6). This notwithstanding, formal rights of appeal and predictable frameworks for the exercise of discretionary judgement appear to be fundamental for the patients' legal protection when faced with the nonattendance fee in the specialist health services.
The patient has no formal rights to appeal against the fee to an appeals board
While the nonattendance fee in 2009 was equal to the user fee that applies to everybody, from 2023 onwards it will amount to four times the user fee. Only patients in mental health care and addiction therapy will continue to pay a fee equal to the user fee. Although the fee is defined in terms of the user fee, it does not count towards the basis for the exemption card.
When the fees and the economic consequences of failing to attend an appointment in the specialist health services increase, there are reasons to rethink whether the patients' right to appeal should be made a reality. Clarifying the grounds on which the patients can be freed from paying the nonattendance fee could be one step in this direction.