mipex health strand · the country became a sovereign state under the danish crown in 1918, and...

MIPEX

HEALTH STRAND

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©IOM

MIPEX Health Strand Country Report Iceland

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MIGRANT INTEGRATION POLICY INDEX HEALTH STRAND

Country Report Iceland

Country Experts: Bjarney Friðriksdóttir and Guðrún Pétursdóttir

General coordination: Prof. David Ingleby Editing: IOM MHD RO Brussels Formatting: Jordi Noguera Mons (IOM) Proofreading: DJ Caso Developed within the framework of the IOM Project “Fostering Health Provision for Migrants, the Roma and other Vulnerable Groups” (EQUI-HEALTH). Co-funded by the European Commission’s Directorate for Health and Food Safety (DG SANTE) and IOM.


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This document was produced with the financial contribution of the European Commission’s Directorate General for

Health, Food Safety (SANTE), through the Consumers, Health, Agriculture, and Food Executive Agency (CHAFEA)

and IOM. Opinions expressed herein are those of the authors and do not necessary reflect the views of the

European Commission or IOM. The sole responsibility for this publication therefore lies with the authors, and the

European Commission and IOM are not responsible for any use that may be made of the information contained

therein.

The designations employed and the presentation of the material throughout the paper do not imply the expression

of any opinion whatsoever on the part of the IOM concerning the legal status of any country, territory, city or area,

or of its authorities, or concerning its frontiers or boundaries.

IOM is committed to the principle that humane and orderly migration benefits migrants and society. As an

intergovernmental body, IOM acts with its partners in the international community to: assist in meeting the

operational challenges of migration; advance understanding of migration issues; encourage social and economic

development through migration; and uphold the human dignity and well-being of migrants.

International Organization for Migration Regional Office for the European Economic Area (EEA), the EU and NATO

40 Rue Montoyer

1000 Brussels

Belgium

Tel.: +32 (0) 2 287 70 00

Fax: +32 (0) 2 287 70 06

Email: [email protected]

Internet: http://www.eea.iom.int / http://equi-health.eea.iom.int

mailto:[email protected]

http://www.eea.iom.int/

http://equi-health.eea.iom.int/


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TABLE OF CONTENTS

1. COUNTRY DATA ...................................................................................................................... 5

2. MIGRATION BACKGROUND .................................................................................................... 6

3. HEALTH SYSTEM ..................................................................................................................... 8

4. USE OF DETENTION ................................................................................................................ 9

5. ENTITLEMENT TO HEALTH SERVICES .................................................................................... 10

A. Legal migrants ............................................................................................................... 10

B. Asylum seekers .............................................................................................................. 11

C. Undocumented migrants .............................................................................................. 12

6. POLICIES TO FACILITATE ACCESS .......................................................................................... 13

7. RESPONSIVE HEALTH SERVICES ............................................................................................ 15

8. MEASURES TO ACHIEVE CHANGE......................................................................................... 17

CONCLUSIONS .......................................................................................................................... 19

BIBLIOGRAPHY .......................................................................................................................... 20


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READER’S GUIDE TO THE REPORT

This report was produced within the framework of the IOM’s EQUI-HEALTH project, in collaboration with

Cost Action IS1103 ADAPT and the Migrant Policy Group (MPG). Full details of the research and its

methodology are contained in Sections I and II of the Summary Report, which can be downloaded from the

IOM website at http://bit.ly/2g0GlRd. It is recommended to consult this report for clarification of the exact

meaning of the concepts used.

Sections 5–8 are based on data from the MIPEX Health strand questionnaire, which covers 23 topics, in 10 of

which multiple indicators are averaged. Each indicator is rated on a 3-point Likert scale as follows:

0 no policies to achieve equity

50 policies at a specified intermediate level of equity

100 equitable or near-equitable policies.

‘Equity’ between migrants and nationals means that migrants are not disadvantaged with respect to

nationals. This usually requires equal treatment, but where migrants have different needs it means that

special measures should be taken for them. Scores relate to policies adopted (though not necessarily

implemented) by 31st December 2014. However, some later developments may be mentioned in the text.

To generate the symbols indicating a country’s ranking within the whole sample, the countries were first

ranked and then divided into five roughly equal groups (low score – below average – average – above

average – high). It should be remembered that these are relative, not absolute scores.

The background information in sections 1-4 was compiled with the help of the following sources. Where

additional sources have been used, they are mentioned in footnotes or references. It should be noted that

the information in WHO and Eurostat databases is subject to revision from time to time, and may also differ

slightly from that given by national sources.

Section Key indicators Text

1. Country data

Eurostat CIA World Factbooks, BBC News (http://news.bbc.co.uk), national sources

2. Migration background

Eurostat, Eurobarometer (http://bit.ly/2grTjIF)

Eurostat, national sources

3. Health system

WHO Global Health Expenditure Database1 (http://bit.ly/1zZWnuN)

Health in Transition (HiT) country reports (http://bit.ly/2ePh3VJ), WHO Global Health Expenditure database

4. Use of detention

National sources, Global Detention Project (http://bit.ly/29lXgf0), Asylum Information Database (http://bit.ly/1EpevVN)

These reports are being written for the 34 countries in the EQUI-HEALTH sample, i.e. all EU28 countries, the

European Free Trade Area (EFTA) countries Iceland, Norway and Switzerland, and three ‘neighbour’

countries – Bosnia-Herzegovina, FYR Macedonia and Turkey.

All internet links were working at the time of publication.

1 For the definition of these indicators please see p. 21 of the WHO document General statistical procedures at http://bit.ly/2lXd8JS

http://bit.ly/2g0GlRd

http://news.bbc.co.uk/

http://bit.ly/2grTjIF

http://bit.ly/1zZWnuN

http://bit.ly/2ePh3VJ

http://bit.ly/29lXgf0

http://bit.ly/1EpevVN

http://bit.ly/2lXd8JS


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1. COUNTRY DATA

KEY INDICATORS RANKING

Population (2014) 325.671 🌑◯◯◯◯

GDP per capita (2014) [EU mean = 100] 121 🌑🌑🌑🌑◯

Accession to the European Union N/A

Geography: Iceland is a 103.000 sq. km island in Northern Europe, located between the Greenland Sea

and the North Atlantic Ocean, northwest of the United Kingdom. The terrain is composed of an

expansive plateau combined with mountain peaks and ice fields, and the coast is deeply dented by bays

and fiords. There are active volcanos and geysers. The main city is the capital Reykjavik, where more

than 50% of the total Islandic population of 331.918 live. The population density is extremely low at

3,2/km2; 94,1% of the population lives in urban settings.

Historical Background: Settled by Norwegians and Celts during the late 9th and 10th centuries, Iceland

boasts the world's oldest functioning legislative assembly, the Althingi, established in 930. After 1262

Iceland was ruled by Norway, coming under Danish rule in 1523. The country became a sovereign state

under the Danish Crown in 1918, and fully independent in 1944.

Political Background: Iceland is a constitutional republic divided in eight regions. The country is a

member of the Schengen border-free travel zone and of the European Free Trade Association (EFTA). In

2009 the government applied for membership of the EU, but because of increasing public criticism the

application was withdrawn in 2015.

Economic background: Before the 20th century, Iceland was one of the poorest countries in Europe;

currently it is one of the most highly developed. Immediately prior to the economic crisis of 2008 the

country was ranked first in the United Nations' Human Development Index. Up to that point, Iceland had

achieved high growth, low unemployment, a low level of violence and a remarkably even distribution of

income. The banking system failed catastrophically in 2008 and In October of that year, the government

took over control of all three of the country's major banks and secured over €10 billion in loans from the

IMF and other countries to stabilize its currency and financial sector. Twenty-six bankers subsequently

received prison sentences for their pre-crisis activities.2

The economy depends heavily on the fishing industry, which provides 40% of export earnings (12% of

GDP) and employs nearly 5% of the work force. Over the last decade, Iceland's economy has been

diversifying into manufacturing and service industries (software production, biotechnology, and

tourism). Iceland’s economy was hard hit by the crisis, but started recovering in 2010.3

2 http://bit.ly/2olA8QF 3 http://www.bbc.com/news/world-europe-17385009

https://fr.wikipedia.org/wiki/Reykjavik

http://bit.ly/2olA8QF

http://www.bbc.com/news/world-europe-17385009


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2. MIGRATION BACKGROUND

KEY INDICATORS (2014) RANKING

Foreign-born population as percentage of total population 11,4 🌑🌑🌑◯◯

Percentage non-EU/EFTA migrants among foreign-born population

32 🌑◯◯◯◯

Foreigners as percentage of total population 7,0 🌑🌑🌑◯◯

Non-EU/EFTA citizens as percentage of non-national population

18 🌑◯◯◯◯

Inhabitants per asylum applicant (more = lower ranking) 1.916 🌑🌑🌑◯◯

Percentage of positive asylum decisions at first instance 25 🌑◯◯◯◯

Positive attitude towards immigration of people from outside the EU (Question QA11.2, Eurobarometer)

N/A

Average MIPEX score for other strands (MIPEX, 2015) 46 🌑🌑🌑◯◯

The following graph shows how the percentage of migrants in the Icelandic population has increased

since 1990. From 2000 to the beginning of the economic crisis in 2008 numbers increased rapidly, after

which the rate of increase slowed down.

Figure 1. Migrants in Iceland as percentage of the population, 1990-2015 (data from UN DESA)

Figure 2 shows the migrants’ main countries of origin. The fact that there is a lower percentage of

foreigners than foreign-born persons indicates that a number of migrants become naturalised. As in

most countries, this concerns mainly non-EU/EFTA citizens (third-country nationals).


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Figure 2. Foreign-born population of Iceland in 2014 by country of birth (Eurostat)

Recovery after the crisis has been rapid, and Iceland’s GDP grew by 7,2% in 2016 against an EU average

of 1,9%. As unemployment is low (3,2% in 2016), demand for overseas workers is high.4

Iceland may seem a remote destination for asylum seekers, but relative to its population it receives an

average number of applications. Fig. 3 shows how numbers have increased since 2008.5

Figure 3. Total number of asylum applications per year since 2008 (Eurostat)

4 http://icelandmag.visir.is/article/too-many-jobs-iceland-needs-least-7000-new-foreign-workers-next-couple-years 5 No separate figures are available for first-time applications.

http://icelandmag.visir.is/article/too-many-jobs-iceland-needs-least-7000-new-foreign-workers-next-couple-years


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3. HEALTH SYSTEM

KEY INDICATORS (2013) RANKING

Total health expenditure per person (adjusted for purchasing power, in euros)

2.824 🌑🌑🌑🌑◯

Health expenditure as percentage of GDP 9,1 🌑🌑🌑◯◯

Percentage of health financing from government National health system (NHS) / social health insurance (SHI) 80 NHS

Percentage of health financing from out-of-pocket payments (higher percentage = lower ranking)

18 🌑🌑🌑◯◯

Score on Euro Health Consumer Index (ECHI, 2014) 818 🌑🌑🌑🌑🌑

Overall score on MIPEX Health strand (2015) 40 🌑🌑◯◯◯

According to Sigurgeirsdóttir et al. (2014), Iceland’s small but high-quality health system is government

financed and centrally organised. The State both pays for and provides most services, though an

increasing number of service providers are privately owned. All legal residents of Iceland, regardless of

nationality, are covered by the state system of health insurance, provided they have lived in the country

for at least six months. During this period newcomers have to be covered by private health insurance,

which normally excludes pre-existing conditions.

In 2013, 49% of the funding for the health system came from general taxation and 32% from social

security premiums, paid by employers and self-employed persons. Out-of-pocket payments (cost-

sharing) accounted for 18%. The latter consist of both co-payment (fixed charges) and co-insurance

(proportional charges); they apply to primary care visits, outpatient care and pharmaceuticals, as well as

some other services. There is an annual maximum payment ceiling for OOP payments; when that limit is

reached, a discount certificate can be issued that entitles the holder to lower charges (ibid.: 64).

However, these certificates are poorly publicised and the application procedure is cumbersome, so that

only about half of those eligible acquire them in practice.

Iceland is divided into seven health districts, each district having a central health institution which is

responsible for organizing and coordinating health services within that district. There are two large

hospitals in Iceland, National University Hospital in the capital Reykjavík and Akureyri Hospital located in

Akureyri (the largest municipality in the north of the country). In the other five health districts hospital

services, if available, are operated along with basic health care services. Regardless of the division into

health districts, everyone has the right to seek health services at any location.

As regards policy making and provision of services, the board of each health district is responsible for

healthcare services provision within the district, and operates under the authority of the Ministry of

Welfare, which is ultimately responsible for the administration of health services in the country. The

Ministry of Welfare is the main actor in developing policy on health care services, and the Directorate of

Health serves as an advisory institution to the Ministry and the government concerning health issues.


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4. USE OF DETENTION

Immigration detention in Iceland is regulated by the Act on Foreigners6 which lays down standards and

procedures for detention. In accordance with the article 29 of the Act, foreigners may be placed in

police custody for up to 24 hours when it is considered necessary for the verification of their identity.

Police custody can be followed by detention for a maximum period of 12 weeks, based on judicial

decision. Article 33 of the same Act establishes detention in order to enforce a removal order for a

maximum of six weeks (CoE 2013).

On 1st January 2017 a revised version of this Act (Law no. 80/2016) entered into force. The most

significant change relevant to this report regards detention of asylum seekers who enter the country

with false identification documents. In accordance with Article 32 of the new law, those seeking

international protection cannot be punished on the basis of Article 116 (h) for entering with false

identification documents, if they can prove they are coming directly from a State where they have

reason to fear persecution or if they are stateless and cannot obtain citizenship.

Facilities

Persons detained under articles 29 and 33 are accommodated in prison together with other inmates.

Currently, the Icelandic Prison Service operates six prisons, generally with a low level of security (ibid.).

The European Committee for the Prevention of Torture and Inhuman and Degrading Treatment or

Punishment (CPT) noted already in 1999 and 2006 that detaining migrants along with other inmates was

not optimal and that it was “preferable to accommodate them in a centre specifically designed for that

purpose, offering material conditions and a regime appropriate to the their legal status, and staffed by

suitably qualified personnel.” During the visit of a CPT delegation in 2012 (ibid.: 13), Icelandic authorities

affirmed that a dedicated facility with an open reception centre and a closed wing was going to be built.

This appears in 2017 not to have been done.

Conditions

In 2012, the CPT delegation found immigration detention conditions and safeguards generally

satisfactory. However, some shortcomings in health care provision were noted, particularly regarding

mental health (ibid.: 25).

6 Act On Foreigners No. 96 /2002


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5. ENTITLEMENT TO HEALTH SERVICES

Score 61 Ranking 🌑🌑🌑◯◯

A. Legal migrants

Inclusion in health system and services covered

Legal migrants are not covered in the national health insurance scheme for the first six months of

residence: the Act on Health Insurance7 defines a health insured person as a person who has been

residing in Iceland resident for a minimum of six months before health insurance benefits are requested.

Newcomers are required to take out private health insurance with a minimum coverage of 2 million ISK

(about €17.000) during the first six months.8 The costs for various types of health services are set forth

in a regulation issued by the Ministry of Welfare, which is regularly updated and published on the

website of the Icelandic Health Insurance along with guidelines on the cost of health care.

Several types of health care, such as treatment for long-term illness and for childbirth, are not covered

by the private health insurance available to migrants during the first six months of residence. A person

from a country outside the European Economic Area has to provide a health certificate in order to

obtain a residence permit.9 Applicants for residence permit have to undergo examination for infectious

diseases upon arrival in Iceland, unless they have a valid health certificate issued within the last three

months. (This test is only mandatory for migrants from Central and South America, Asia, Africa, and non-

EEA European countries; those coming from the USA, Canada, Australia, New Zealand, Switzerland, and

Israel are exempt. The examination includes testing for HIV, hepatitis B, tuberculosis, and sexually

transmitted diseases. In practice, lack of coverage can mean that treatment for diseases detected during

the examination has to be delayed until they have resided in the country for six months and have

become regularly insured.

Special exemptions

According to article 15 of regulation No. 1088/2014 on health services for persons who are not health

insured in Iceland, prisoners of foreign origin and victims of human trafficking are entitled to emergency

health care in accordance with Article 1 of the regulation. This stipulates that public health services are

obliged to provide everyone who does not have health insurance in Iceland with emergency care due to

a sudden illness or an accident. If prisoners of foreign origin and victims of human trafficking are not

able to pay for the cost of emergency health care, the cost will fall on the service provider.

Barriers to obtaining entitlement

None.

7 Article 10 of the Act on Health Insurance No. 112/2008. 8 Article 43 of the Regulation on Foreigners No. 53/2003. 9 Regulation no. 053/2003 on residence permits.


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B. Asylum seekers


Like legal migrants, asylum seekers are not covered by the healthcare risk sharing system until they have

resided in Iceland for at least six months. Reportedly, the practice of the Directorate of Immigration is to

register asylum seekers as residents after a one month stay in the country, which enables them to gain

access to the health care system six months later. This is however neither an official policy nor

prescribed by law. Asylum seekers’ access to health care is formally governed by a contract between the

Directorate of Immigration and the municipality in which they reside. Currently, the Directorate of

Immigration has a contract with two municipalities, Reykjavík and Reykjanesbær, to host and service

asylum seekers while their claim for asylum is under consideration. This includes providing them with

housing free of charge, finances for necessities such as food and clothing, and paying health care

expenses on their behalf.

Section III of the contract between the Directorate of Immigration and the municipalities outlines

healthcare access and medication costs. It stipulates the following:

Included in the daily fee paid to the service partner (the welfare sections of the municipalities listed

above) by the Directorate of Immigration is “a health check upon arrival, general health services for the

asylum seeker and cost of related medicines, as well as prenatal and postnatal care if needed. The

service partner shall immediately ensure that pregnant women get access to prenatal care. Asylum

seekers shall also be provided with the opportunity to seek treatment by a social worker, psychiatrists,

or psychologist with respect to, for example, post traumatic syndrome or other difficulties they may

have experienced.“ Health services other than those listed above are not included in the daily fee,

except if they are determined to be medically necessary by a doctor consulted by the Directorate of

Immigration. Furthermore, health care costs for emergency services for asylum seekers are paid in

accordance with the regulation on health services for those who do not have health insurance.10

Childbirth and hospital emergencies are covered; migrants are themselves responsible for any other

health care costs or medicines.

Asylum seekers who obtain a work permit after they arrive in Iceland and are permitted to work while

their claim is under consideration are not included in this arrangement. For asylum seekers in this

category, there are the same requirements as for legal migrants, i.e. they have to purchase health

insurance during the first six months of residence with a minimum 2 million ISK coverage. They become

health insured after having resided in Iceland for six months, but have to purchase health insurance

from the time they start working if they have been resident for less than six months. After six months of

residence, they become insured by the national health insurance in accordance with the Act on Health

insurance.11

Asylum seekers whose claim is under consideration are, with very limited exceptions, not subject to

detention. Asylum seekers who present falsified documents upon arrival in Iceland are however without

exception sentenced to a 15-30 day prison term to be served immediately.12 The number of asylum

10 The current regulation in force is No. 1088/2014. 11 Article 10 of the Act on Health Insurance No. 112/2008. 12 Based on Article 57 (h) of the Act on Foreigners No. 96/2002.


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seekers imprisoned on this basis annually is between 25 and 50 persons. During imprisonment, they

have the right to emergency health care due to a sudden illness or accident in accordance with the

regulation on health services for persons who are not health insured in Iceland.13

Special exemptions

As for legal migrants.


Coverage for asylum seekers, other than basic health care outlined in paragraph 3 of the Annex below, is

subject to clinical judgments about “necessary” and “emergency” care.

C. Undocumented migrants


Undocumented migrants are not covered by the regular state health insurance system. Nevertheless,

they are entitled to receive emergency health care in case of sudden illness or accident, based on the

regulation on health services for the uninsured.14 They are expected to pay for the emergency care

provided, but if they are unable to do so, the cost will fall on the service provider. Undocumented

migrants cannot purchase private health insurance.

The only vulnerable groups that are granted special entitlements to health services by law are prisoners

of foreign origin and victims of human trafficking, but this entitlement is limited to emergency health

care in case of sudden illness or accident. According to the regulation on health services for persons who

are not health insured in Iceland15, prisoners of foreign origin and victims of human trafficking are

entitled to emergency health care in accordance with the Act on Health Services, which stipulates that

public health services are obligated to provide everyone who does not have health insurance in Iceland

with emergency care due to a sudden illness or an accident.16 If prisoners of foreign origin or victims of

human trafficking are not able to pay for the emergency health care, the cost will fall on the service

provider.

Special exemptions

As for legal migrants.


To be eligible for treatment a UDM must be classified as an “emergency” case, which involves a

discretionary decision by medical staff. To be exempted from payment they must be unable to pay

themselves.

13 Article 15 of Regulation No. 1088/2014, on health services for persons who are not health insured in Iceland. 14 Ibid. 15 Ibid. 16 Article 1 of the Act on Health Services No. 40/2007.


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6. POLICIES TO FACILITATE ACCESS

Score 80 Ranking 🌑🌑🌑🌑🌑

Information for service providers about migrants' entitlements

Information for service providers about migrants’ entitlements to health services is not systematically

disseminated by the Ministry of Welfare or the Directorate of Health. In fact, no comprehensive

information materials regarding this have been produced for service providers.

Information for migrants concerning entitlements and use of health services

Information for migrants concerning entitlements and use of health services has been produced by the

Multicultural and Information Centre in Ísafjörður, which has a mandate from the Ministry of Welfare to

serve the whole country, on its website (available in 8 languages)17 and in booklets entitled First Steps in

Iceland (with separate editions for citizens of EEA and EFTA Member States and Third Country

Nationals).18 The booklets include a chapter on health, which is mostly focused on access to the health

services and practical information, but also includes limited information on legal entitlements to

healthcare. The booklets (available in Icelandic, English, Polish, Lithuanian, Latvian, Spanish, Russian,

Thai, and Vietnamese) are primarily for legal migrants, but provide some basic practical information that

can also benefit asylum seekers and undocumented migrants.

Health education and health promotion for migrants

The Directorate of Health has produced booklets on various subjects that target health education and

health promotion; they are available on its website19 and in printed form. Subjects covered include the

use of alcohol and narcotics during pregnancy, effects of smoking tobacco, dental health, mental health,

HIV and AIDS, and influenza. Most of these booklets are available in Icelandic, Albanian, Arabic, English,

Lithuanian, Polish, Russian, Serbo-Croat, Spanish, Thai, and Vietnamese. In addition, the Capital Area

Health Services have compiled an information package for expecting parents in both Icelandic and

English. The information is sent by email or given out during clinic visits. It contains information on

perinatal health services, hospital stays, pregnancy and follow-up, breastfeeding and the new-born

child.

Provision of ‘cultural mediators’ or ‘patient navigators’ to facilitate access for migrants

Formal facilitation of access to health services for migrants by cultural mediators’ or ‘patient navigators’

is not provided by law or policy at the national level. However, the Multicultural and Information Centre,

the Human Rights Office of Reykjavík Municipality and the International Office in Akureyri employ

consultants for persons of foreign origin who act as ´patient navigators´ to facilitate migrant healthcare

access. Their services are available for legal migrants as well as other groups. Asylum seekers are

formally entitled to receive this facilitation assistance from consultants working for the public social

service agencies in the municipality where they reside.

17 http://www.mcc.is/english/health/ 18 https://eng.velferdarraduneyti.is/newsinenglish/nr/33055 19 http://www.landlaeknir.is/english/general-information/

http://www.mcc.is/english/health/

https://eng.velferdarraduneyti.is/newsinenglish/nr/33055

http://www.landlaeknir.is/english/general-information/


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Is there an obligation to report undocumented migrants?

Icelandic law does not oblige health care workers to report undocumented migrants who seek health

care. The Act on Health Care Professionals stipulates that health care professionals are bound by

confidentiality regarding all patient personal information.20

Are there any sanctions against helping undocumented migrants?

There are no sanctions against healthcare professionals or organisations assisting undocumented

migrants with access to health care. The Act on Foreigners,21 which provides for sanctions for assisting

undocumented migrants to come to, or stay in the country does not cover health care workers.

20 Article 17 of the Act on health care professionals No. 34/2012. 21 The Act on Foreigners No. 96/2002.


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7. RESPONSIVE HEALTH SERVICES

Score 21 Ranking 🌑🌑🌑◯◯

Interpretation services

Icelandic law requires that qualified interpretation services are provided free of charge to patients with

inadequate proficiency in the Icelandic language.22 The law does not specify which methods must be

used for interpretation, but in practice face-to-face and telephone interpretation are the methods most

commonly used. Those are also the two methods recommended in the common guidelines of the

institutions that provide interpretation services to health care institutions.

Requirement for 'culturally competent' or 'diversity-sensitive' services

There are no standards or guidelines in use by health service institutions that require 'culturally

competent' or 'diversity-sensitive' services, or that require health services to take into account individual

and family characteristics, experiences, and situations, and/or mandate respect for different beliefs,

religion, culture, competence in intercultural communication. The only material that could be identified

related to this topic is a booklet titled Cultures Meet: The influence of religion, culture and heritage on

interaction and treatment within the health services, which was published by the Directorate of Health

in 2001. This booklet is first and foremost informational, and so does not constitute mandatory

guidelines for health care providers.

Training and education of health service staff

There are no policies in force that support training and education of health service personnel in

providing services responsive to the needs of migrants.

Involvement of migrants

No policies on the involvement of migrants in information provision, service design and delivery of

health services were identified at individual health care institutions or through the Ministry of Welfare

and the Directorate of Health.

Encouraging diversity in the health service workforce

As regards encouraging diversity in the health service workforce, none of the leading health care

institutions in the capital area of Reykjavik and in the North of Iceland reported having such a policy in

place. The two largest hospitals, National University Hospital and Akureyri Hospital do, however, have a

policy to assist non-native health care professionals seeking employment by formally recognising their

previous qualifications and by helping them to improve their Icelandic. In the Parliamentary Resolution

on an action plan on immigrant issues for 2016-2019 (adopted 20th September 2016), one of the stated

goals23 is to increase the number of immigrants working in public service institutions, including health

care institutions. The draft action plan calls for a working group tasked with making recommendations

on strategies to increase the number of immigrants working in public services institutions to be set up.

22 Article 5 of the Act on the Rights of Patients no. 74/1997. 23 Parliamentary Resolution on an action plan on immigrant issues for 2016-2019, point D.1.


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Development of capacity and methods

No policies were found concerning the development of capacity, diagnostic procedures, and treatment

methods to take more account of variations in the sociocultural background of patients.


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8. MEASURES TO ACHIEVE CHANGE

Score 0 Ranking 🌑◯◯◯◯

Data collection

There is no systematic collection of data on migrant health in Iceland. The Act on the Health Registry

stipulates which personal information shall be registered for a health care user. Migrant status, country

of origin, or ethnicity are however not among the background information registered.24 The Directorate

of Health conducted a comprehensive survey on the health and welfare of Icelanders in 2007 and 2012.

Explicit prerequisites to participate in the survey was Icelandic citizenship (or permanent residence), and

ability to speak Icelandic. Migrant status, country of origin and ethnicity were not among the several

background questions asked in the survey.

Support for research

No research on the topics of occurrence of health problems among migrant or ethnic minority groups,

issues concerning service provision for migrants/ethnic minorities, evaluation of methods for reducing

inequalities in health/healthcare affecting migrants, or health care affecting migrants and/or ethnic

minorities has been funded by the Council on Immigrants of the Ministry of Welfare, the Directorate of

Health, the Icelandic Centre for Research, or the Research Centre of the University of Iceland in the past

five years. The few migrant health research projects identified were master’s theses papers written by

graduate students in nursing; all of them focus on pregnancy and child birth services for women of

origins other than Icelandic.

"Health in all policies" approach

Migrant or ethnic minority health is not a priority for service provider organisations and health agencies.

None of the main health service institutions or the Ministry of Welfare reported implementing measures

or having policies in place that pay special attention to migrant or ethnic minority health. A few

individual initiatives were reported with respect to pre- and postnatal care within the health care

services in the capital area of Reykjavik.

Whole organisation approach

No policies or measures in any sector that pay attention to impact on migrant or ethnic minority health

could be identified through the Ministry of Welfare or the Directorate of Health.

Leadership by government

The purpose of the Act on Immigrant Issues is, among other things, to mainstream migrant interests into

all public policy making, administration, and public services.25 However, no policy measures or activities

have so far been undertaken by the Ministry of Welfare to implement the law as regards health services. The Action Plan for the Directorate of Health 2016–201726 contains no reference to migrants.

24Article 6 of the Act on the Health Registry No. 55/2009. 25Article 1 of the Act on Immigrant Issues No. 116/2012. 26 http://bit.ly/2nql4Ah

http://bit.ly/2nql4Ah


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Involvement of stakeholders

There is no policy in place to involve migrants as stakeholders in the design of migrant health policies or

policy making on health services according to the Ministry of Welfare and the Multicultural and

Information Centre. The Minister of Welfare plans to submit to the Parliament a Parliamentary

Resolution on an action plan on immigrant issues for 2015-2019 based on the above mentioned law by

end of March 2015. In the draft of the action plan, health services and health care are referred to with

regards to three action points. The first is an action point27 which aims to facilitate immigrants’ access to

public services and to increase the cultural competences of public service employees. It calls for a

working group to be set up to prepare a plan to provide education to employees of state and municipal

institutions and host courses on cultural competences in all regions of the country - in particular for

social workers, nurses, teachers, and police officers. The second is action point that refers to health

services28 and provides that health care providers shall take part in a working group tasked with

providing education to women of foreign origin who have been victims of domestic violence. The aim of

the education activities is to strengthen the support network of the women and to reduce domestic

violence. The third is an action point related to health care, and was already discussed in under

Responsive health services above.29

Migrants’ contribution to health policymaking

See previous topic.

27 Draft Parliamentary Resolution on an action plan on immigrant issues for 2015-2019, point A.4. 28 Draft Parliamentary Resolution on an action plan on immigrant issues for 2015-2019, point B.7. 29 Draft Parliamentary Resolution on an action plan on immigrant issues for 2015-2019, point D.1.


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CONCLUSIONS

Migration is of increasing importance in Iceland, and despite the fact that the island’s population is so

small, measures are needed to ensure their integration into society, including the development of

inclusive and responsive health services. For legal migrants, entitlement to health care coverage is good

after six month’s residence in Iceland, but during that period private health insurance must be taken out

(which usually excludes pre-existing conditions) and health care charges are higher. At the same time,

the migrant is paying through taxes for regular coverage, making the inequity even greater. Asylum

seekers are legally subject to the same limitation, but its effects are mitigated by other regulations.

Undocumented migrants are only entitled to emergency care in cases of sudden illness or accidents, for

which the service provider pays if the migrant cannot.

Information for migrants on entitlements, the use of health services and health promotion is very good,

so that altogether Iceland ranks 6th in the EQUI-HEALTH sample for ‘access’. Nevertheless, the limitation

of coverage to emergency care still plays a large role in legislation on entitlements. Recent research has

shown that such restrictions can be a false economy; for example, a recent study in Germany

(Bozorgmehr & Razum 2015) showed that delaying asylum seekers’ access to full health care coverage

actually increased costs in the long run rather than reducing them – quite apart from the human-rights

objections to this practice.

Although Iceland’s health system copes well with language barriers, little or no allowance is made for

any other kinds of diversity. The notion of ‘cultural competence’ is not recognised, though there are

signs of increasing interest. At present, there are hardly any measures to promote improvements in

health services for migrants, with the result that Iceland scores below average on ‘quality’. A similar

contrast is found in France, where access to services is good but there is very little willingness to adapt

them to diversity – in strong contrast to the UK, where such adaptations have been developed over

decades, but access for migrants is very poor.

Considering that the increase in immigration to Iceland is fairly recent and numbers are small, Iceland is

making reasonable efforts to accommodate the newcomers. However, critical re-evaluation of existing

policies would seem to be a good investment for the future.


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BIBLIOGRAPHY

Bozorgmehr, K., & Razum, O. (2015 ) Effect of Restricting Access to Health Care on Health Expenditures

among Asylum-Seekers and Refugees: A Quasi-Experimental Study in Germany, 1994–2013. PLoS

ONE 10(7), e0131483. doi: 10.1371/journal.pone.0131483

CoE (2013) Report to the Icelandic Government on the Visit of Iceland carried out by the European

Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment

(CTP), September 2012. Strasbourg: Council of Europe. http://bit.ly/2mTzRas

Sigurgeirsdóttir S, Waagfjörð J, Maresso A. (2014) Iceland: Health system review. Health Systems in

Transition 16(6):1–182.

http://bit.ly/2mTzRas


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International Organization for Migration

Regional Office for the European Economic Area (EEA), the EU and NATO

40 Rue Montoyer—1000 Brussels—Belgium—http://www.eea.iom.int

Tel.: +32 (0) 2 287 70 00— [email protected]

http://www.eea.iom.int/

mailto:[email protected]

mipex health strand · the country became a sovereign state under the danish crown in 1918, and...

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