Overview of the Icelandic

Health Care System

7th Nordic Casemix Conference:

Building Bridges

19-20 May 2016

Anna Lilja Gunnarsdóttir

Permanent Secretary

Ministry of Welfare

General information on Iceland

• Iceland is 103,000 square km in area –

• The coastline is 4,970 km in length

• Inhabitants 334.300 (1. April 2016)

• Most built-up areas are around the coastline

• Over 60% living in and around Reykjavik

• Independence in 1918

• Establishment of the republic in 1944

• Parliamentary democracy

• Two administrative levels; local and national

• 74 municipalities

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Eyjafjallajökull 2010

Holuhraun – Bárðarbunga sept 2014

The Icelandic Health Care System

• Founded on values similar to those of other Nordic countries.

• Easy and equal access to good health care services for all citizens.

• Health centers providing primary care are located throughout the

country and are sometimes run jointly with small hospitals or health

institutions.

• Specialized hospital services are provided at Landspítali University

Hospital in Reykjavik and Akureyri Hospital and a few other

hospitals and healthcare facilities.

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Health services » Main objective of the Health Services Act No 40/2007

...all people of Iceland shall have access to the most optimum health service that can

be provided at any time

» The service

Universal health care system

Paid for by taxes (80 - 85%)

Administrated by Ministry of Welfare.

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Health services » Health care Regions (7)

» Main hospitals (2)

» Regional Hospitals (6)

» Health Institutions (8)

» Primary Health Care Centers (approx. 60)

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Health Care Regions 2014

Primary Health Care Centers 2014

Acute beds 2014

3 2

3 8

4

677

142

44

2

15

15 7 3

23

3

15

30

33

Surgery 24/7 2015

Deliveries 2013 Total 4.480

138

3293

303

91

36

3

63

397 2

59

In homes 95

Ambulances in Iceland 2014

Reserv

The Air Ambulance over Akureyri

Helicopters are important in Iceland

Medical doctors part of helicopter crew

Health and Social Indicators

• Life expectancy at birth in Iceland is among the highest in the world

at 83.7 years for females and 80.5 years for males.

• Infant mortality is the lowest in the world at 1.3 per 1000 live births.

• Maternal mortality is the lowest in the world at 3 deaths per 100.000

live births.

• Fertility rate slightly declining - 1,9 births per woman in 2014 – 2,3

births per woman in 1990.

• Still favorable demographics – relatively young population

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Health and Social Indicators

• Euro Health Consumer Index 2015 ranks Iceland in 8th place out of 35

countries: Patients have good rights and are well informed. Waiting time

for services is relatively short and the results of treatment one of the best

in Europe.

• Good results in the prevention of smoking. In 2013, 11,4% of adults in

Iceland smoked daily, compared with 19,7% in the OECD countries on

average.

• In 2013, 22,2% of the population in Iceland aged 15 years and over was

obese. This is higher than the OECD average of 19%.

• Participation in the National vaccination program for children in Iceland is

about 91% which is acceptable.

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Health and Social Indicators

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• In general, Icelanders are more satisfied with their lives than the

OECD average. When asked to rate their general satisfaction with

life on a scale from 0 to 10, Icelanders give it a 7,5 grade, one of

the highest scores in the OECD, where average life satisfaction is

6,6.

• The total health expenditure in Iceland in 2014 amounted to 176

billion ISK, 8.8% of GDP which is lower than the other Nordic

countries except Finand.

• Of the total health expenditure in 2014: 55.7% was spent on in-

patient care, 27% on out-patient care and 15% on medical goods

dispensed to out-patients. The remaining part or 2.3% went to

health administration and other health categories.

Landspitali - The National University Hospital of Iceland

The Financial Crisis hit Iceland hard

» In 2008, the Icelandic banking system collapsed – economic

recession and a severe currency crisis followed

» The Emergency Act set and capital controls imposed to prevent

further depreciation of the currency

» Sharp decline in GDP and rising unemployment

» Financial support from IMF and neighbouring countries

» Public debt and Interest expense as a % of GDP soared

» Severe cut in public expenditure

» Social protection system kept in place

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Public expenditure on health care and GDP

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130

135

140

145

150

155

160

165

170

1.900

1.950

2.000

2.050

2.100

2.150

2.200

2.250

2.300

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

GDP (IKR bn) Public expenditure on health care (IKR bn)

High unemployment following the crisis

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Public expenditure on health care, education and social protection

120

140

160

180

200

220

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

IKR bn

Public expenditure on Education Public expenditure on health care

Public expenditure on social protection

Health expenditure cuts

AUS

AUT

BEL

CAN CHS

CZE

DNK

EST

FIN

FRA

DEU

GRE

HUN

ICE

IRL

ISR

ITA

JAP

KOR

MEX

NLD

NZ

NOR

POL

PRT

SVK

SVNESP

SWE

CHE

GBR

USA

-15

-10

-50

5

% c

ha

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e in

an

nu

al h

ea

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pe

nd

ing

gro

wth

(p

re a

nd

po

st 2

00

9)

-8 -6 -4 -2 0% change in annual GDP growth (pre and post 2008)

Cuts in GDP and health expenditure growth

AUS

AUT

BEL

CAN

CHS

CZE

DNK

EST

FIN

FRA

DEU

GRE

HUN

ICE

IRL

ISR

ITA

JAP

KOR

MEX

NLD

NZ

NOR

OECD

POL

PRT

SVK

SVNESP

SWE

CHE

GBR

USA

-15

-10

-50

5

% c

ha

ng

e in

an

nu

al h

ea

lth s

pe

nd

ing

gro

wth

(p

re a

nd

po

st 2

00

9)

2 4 6 8 10 12% annual health expenditure growth (2000-2009)

Pre and post crisis health expenditure growth

Health and Social Indicators

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• The employment rate is very high in Iceland. In 2015 the average

OECD employment rate was 66,2 % of the working age population,

while it was 84.7 % in Iceland.

• Iceland has the highest labor force participation rate of women among

the OECD countries, the rate being 79.6 percent, and the second

highest among men, being 83.7 percent.

• Low unemployment rate in Iceland, in 2014 it was 5,1% compared to

the OECD average of 7,5%. In March 2015 unemployment in Iceland

was 3,8% and 2,5% in March 2016.

• Retirement age in Iceland is 67 years, which is mirrored in high labor

market participation rates for workers aged between 60 and 69, the

highest observed in the OECD.

Landspitali - The National University Hospital of Iceland

Financing

» There is fixed budget in all hospitals – in 2017 Landspitali will be

financed based on DRG – Akureyri hospital will follow in 2018 – the

goal is to finance all regional hospitals based on similar principals in

the future.

» The budget is also fixed in primary care – new financing system for

primary care in Reykjavik and surrounding area 2017 based on

ACG. The goal is to use that model in all primary care centers all

around the country.

» Fee for service is used for financing outpatient private practice and

that model will be evaluated later.

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New reimbursement model in primary care

» The model is based on the reimbursement model from Västra

Götaland in Sweden

» Objectives

One reimbursement model for all primary care centers

More equal division of budget

• Reflecting patients of the primary care center

Transparency in reimbursements

The same requirements for the operation of primary care

whether it is publicly or privately run

Defined quality control and follow-up

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New reimbursement model in primary care

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» The model

2%

Age and sex ACG casemix Other rules Socioeconomic factorsCoverage

Quality indicators

Special

missions Visits

41,1% 41,1% 7,4% 0,4% 3% 4% 1% 2%

Visits from

other areas

VERA Age and sex All ICD-10

diagnoses

School-nursing,

Interpretation

services,

Psychological care

Seven factors Visits in primary

care/some other

outpatient

healthcare

Eight indicators

90,0% 8,0%

Nýr Landspítali

Takk fyrir - Thank you

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