Iceland Health Profile

The first Icelandic medical doctor was appointed by the Danish
king in 1760. He was Icelandic by nationality and educated in Denmark.
His residency was at Seltjarnarnes, close to the town of Reykjavík (which
later became the capital of Iceland). His official title was Landlaeknir, which
means national physician, a title still held by the country’s Medical Director
of Health. According to this first doctor’s job description, he was to practise
medicine and teach at least young men to practise medicine, as well
as teaching midwives. He as well established the first pharmacy, which he
ran during the first years until a pharmacist established himself at the same
place. Iceland at that time had approximately 30 000 inhabitants. The
country was large, horses were the only form of transport on land, the
country was mountainous and none of the rivers had bridges. Bearing this
in mind and the fact that he had mostly ineffectual medicines, primitive
instruments, a rudimentary knowledge of the epidemiology and
pathogenesis of diseases and a low salary, it is not surprising that he also
went fishing to help earn his living. In 1766 additional doctors were
appointed as a medical officer for the western part of the country and
for the north. A fourth medical officer was appointed in 1772. In
1850, there were eight medical districts in the country. In 1875, the number
was 20, and at the turn of the century 42. In 1904, there was doctor
for each 1750 inhabitants. By the time when Iceland gained its
independence in 1944, there were 50 medical districts. Only a few of them
had additional than doctor.
The first hospital in Iceland, not counting leprosy hospitals, was established
in Reykjavík in 1866 with 14 beds. It was considered inconvenient that the
major ballroom in Reykjavík was on the floor below. This supply of beds was
far beyond the request, reflecting both a country unaccustomed to such services
and a lack of the ability to pay for them, rather than a lack of need. The next
hospital was erected in the town of Akureyri in the northern district in 1873. A
hospital has been there ever since. In 1874, there were 30 hospital beds in the
whole of the country, or per 2400 inhabitants. A medical school, established
in 1876, became part of the University of Iceland when the latter was established
in 1911. In 1944 there were about 50 “hospitals” with 1300 beds, but most of
the hospitals outside Reykjavík were actually nursing homes with a few beds
for active medical treatment. In Reykjavík, the major hospitals in the 20th
century were St. Joseph’s Hospital, established in 1902 by Catholic
missionaries; Landspítali, established as a university clinic in 1930; and the Reykjavík Municipal Hospital, established in 1967. The gradual merger
of these three hospitals into large national-owned university hospital,
Landspítali University Hospital, is described in later sections. The first
psychiatric hospital, Kleppur, was established in the outskirts of Reykjavík
in 1907, and it later became an integrated part of Landspítali.

Health status
Health records are well kept in Iceland and sometimes date back as far as a
century or additional. Health care statistics have been published annually since
1896.
Today, Icelanders enjoy good health status as measured by conventional
indicators, such as life expectancy, number of disability-free years and
self-reported health and quality of life. Life expectancy, as already
mentioned, is part the highest in the world. Perinatal mortality during
1996–2000 was 5.7 deaths per 1000 births, and infant mortality was as
low as 3.5 deaths in the first year of life per 1000 live births, a figure
part the lowest in the world. Maternal mortality is virtually nonexistent.
Lifestyle factors
The nutritional price of food in Iceland improved significantly during the last
century, and it now comes closer in most respects to the targets set by the
Icelandic Nutrition Council. Surveys in 1990 and 2002 show a decrease in the
daily intake of fat, mainly due to less consumption of margarine and nonskimmed
milk, and an increase in consumption of fruits (39%) and vegetables
(15%). There is a clear social gradient, with those who have better education
or higher incomes eating additional vegetables. On the negative side, it should be
mentioned that the country’s consumption of fish per person has diminished
by 43% during this period and is now only slightly above a lot of other European
nations. Icelanders as well have the doubtful honour of holding the world record
in the consumption of sugar per capita. It has increased steadily during
recent decades, especially the consumption of sugar from soft drinks.
Obesity is an increasing problem in Iceland, especially part children.

The major challenges for the Icelandic health care system can be summarized as follows.

• The role of amount types of health care facilities and institutions needs to be additional clearly defined.
• The relationships between general practice and specialist care must be clarified. It is often stated on behalf of the health authorities that primary care should provide patients with their first contact with the health services. It is as well declared that people should have the right to go directly to the service providers of their choice. These aims may appear irreconcilable. It has not recommended that a GP referral should be required in order to consult a specialist, as has been tried in the past. The preferred situation would be a system with higher financial rewards for the specialist and lower co-payments for the patient when the patient is referred by a GP.

• The dissatisfaction of GPs with their position in the health care system is of the issues that has to be addressed further, especially if any kind of referral system is to be considered. Recruitment of new qualified
GPs has been slow, leading to vacant posts, a heavier burden on the remaining GPs and longer waiting times for patient appointments. GPs want to be paid on equal footing with other specialists and have additional to say about their working conditions. Recent changes – allowing GPs to choose between payment schedules, a privately run health care centre and training in general practice within the country – seem to be
steps in the right direction.
• There are now at any time approximately 150 long-remain patients at the university hospital blocking expensive beds. Well equipped nursing homes are needed for these patients, releasing the resources of the
university hospital.
• Outpatient care in hospitals needs to be strengthened. The current situation, in which even patients coming for follow-up after hospital care are seen by specialists in their private practices, is not acceptable.
If not for other reasons, the teaching of medical students and other health care practitioners require such follow-ups to be a routine hospital activity. Out-of-pocket payment for short remain within hospitals should be considered.
• Almost amount hospitals overspend and rely upon being reimbursed later. There is no incentive in this system for hospitals to be cost-effective. There are positive ongoing experiments with a diagnosis-related group (DRG) system in some departments of the university hospitals, and they will be used in large parts of the hospital sector in near next. There are some hopes that this system will make the hospitals additional efficient and reduce waiting lists. Health policy has not been high on the political schedule in Iceland until recently. However, this has been changing, and health care will certainly play a bigger role on the political schedule in the years approaching. The financing and organization of the health services will certainly be debated, but so will basic policy, such as equality of access, prioritization of services when the possibilities for treatment and care outweigh the funds available, the role of private practitioners and institutions in the provision of services, and the importance of patient choice and whether patients should be able to buy the care they want if they pay the whole cost.