Sóttvarnir Centre for Health Security and Infectious Disease Control

The Icelandic Health Care System

- Communicable Disease Control and Hepatitis Surveillance -

Thorolfur Gudnason MD

Chief of National Vaccination Program

22.3.2012

Sóttvarnir Centre for Health Security and Infectious Disease Control

Sóttvarnir Centre for Health Security and Infectious Disease Control

Vital statistics (2011)

• Population 319.000 0-9 y 14% 10-19 y 14% 20-64 y 60% 65+ 12 %

• Total fertility rate 2.2

• Life expectancy men 79.9 yrs women 83.6 yrs

• Perinatal mortality rate 2.7

Sóttvarnir Centre for Health Security and Infectious Disease Control

Economy of Iceland (2010)

• Iceland's GDP per capita ranked 13th of EU countries

• More than half of Iceland's GNP comes from communications, trade, and service industries and tourism

• Less dependent on fishing than before

• Aluminum smelting and ferrosilicon production is important

• Unemployment 7.6%

Sóttvarnir Centre for Health Security and Infectious Disease Control

The Icelandic health care system

• Hospitals owned and run by the state – No payment by patients

• Primary care delivered from HCC, run by the state – Minimal payments by patients

• Specialists outside hospitals are private practitioners paid by the patients and the state

• Comprehensive

• Financed by taxation and by patients

• Most nursing homes and rehab. clinics are private

• Dentists are private practitioners

Sóttvarnir Centre for Health Security and Infectious Disease Control

Reykjavík: 38 Health Care Centres H2 (At least 2 doctors) 18 Health Care Centres H1 (One doctor) 28 Health Care Centre H 0 (affiliated to H1 or H2)

Health Care Centres 58 HCCs

Sóttvarnir Centre for Health Security and Infectious Disease Control

Hospitals • Landspitali University Hospital, Reykjavik

– 1000 beds

• Akureyri – 200 beds

• Akranes – 75 beds

• 17 other small institutions around the country

– 600 beds all together

Sóttvarnir Centre for Health Security and Infectious Disease Control

Real health care expenditure 2010 (% of GDP)

0 5 10 15 20

USAHollandFrance

germanyDenmark

SwitzerlandCanadaAustria

belgiumNew Zealand

PortugalSweden

UKIcelandGreeceNorway

ItalySpain

IrelandFinland

AustraliaJapan

LuxembourgS-Korea

OECD

Sóttvarnir Centre for Health Security and Infectious Disease Control

Health care expenditure 1980 – 2010 % of GDP

0,0

1,0

2,0

3,0

4,0

5,0

6,0

7,0

8,0

9,0

10,0

11,0

1980

1981

1982

1983

1984

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1987

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1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

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2007

2008

2009

2010

% o

f GD

P

Total health care expenditure Governmental sector Private sector

Sóttvarnir Centre for Health Security and Infectious Disease Control

Communicable Disease Control

• Ministry of Health and Welfare

• The National Committee on Communicable Diseases

• Center for Health Security and Infectious Disease Control – Chief Epidemiologist

Sóttvarnir Centre for Health Security and Infectious Disease Control

The National Committee on Communicable Diseases

• Advisory body – policy making – Appointed by the Minister of Health and Welfare – Creates policy on measures against

communicable diseases – Advises on measures against communicable

diseases

Sóttvarnir Centre for Health Security and Infectious Disease Control

Center for Health Security and Infectious Disease Control

• Chief Epidemiologist – Surveillance and monitoring

• Communicable diseases, radio-nuclear substances, chemical agents and unexpected events.

• Keeps registers of communicable diseases, national vaccinations and antimicrobial consumption.

– Response • Acts on the responsibility of the Minister of Health. • Coordinates official and public measures against communicable

diseases and other health threats. • Supervises and organizes communicable disease control, prevention

and immunizations. • Provides information and advice to health care workers and the public.

Sóttvarnir Centre for Health Security and Infectious Disease Control

The reporting system

• Notifiable Diseases – Communicable diseases, diseases caused by toxic chemicals and

radio-nuclear substances – No personal identifiers. – Aggregate numbers

• Reportable Diseases – Communicable diseases, diseases caused by toxic chemicals and

radio-nuclear substances – Personal identifiers.

• Central Registers – Reportable diseases – Notifiable diseases – National Vaccinations (personal identifiers) – Antibiotic prescriptions (no personal identifiers)

Sóttvarnir Centre for Health Security and Infectious Disease Control

Hepatitis Surveillance

• Reportable Diseases – Hepatitis A – Hepatitis B – Hepatitis C – (hepatitis D and E)

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Reporting on Reportable diseases

Chief Epidemiologist

Health Care Centres

Hospitals

Private doctors

Laboratories

Sóttvarnir Centre for Health Security and Infectious Disease Control

Hepatitis Surveillance

• Passive surveillance (acute/chronic)

• Active surveillance (chronic)

Sóttvarnir Centre for Health Security and Infectious Disease Control

Hepatitis Surveillance

• Passive surveillance –Disease reporting

• Hepatitis A (acute) • Hepatitis B (acute/chronic) • Hepatitis C (acute/chronic) • (hepatitis D and E)

Sóttvarnir Centre for Health Security and Infectious Disease Control

Hepatitis Surveillance

• Active surveillance (chronic) – Hepatitis B

• Immigrants • Pregnancy • Blood donors • Drug abusers

– Hepatitis C • Blood donors • Drug abusers • Immigrant children • Pregnancy

Sóttvarnir Centre for Health Security and Infectious Disease Control