Reykjavík Grapevine - 05.12.2014, Qupperneq 19

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The Reykjavík Grapevine
Issue 18 — 2014
Prescription drugs used to be either
completely, partially or not at all cov-
ered by the insurance system, some-
times arbitrarily. On May 4, 2013, a
new system was implemented, which
was meant to be simpler and more just
than the old one. The new arrangement
entails three payment steps, where pa-
tients must progress from paying the
full price of medication, to 15% and
then 7.5%. Once the total costs reach a
certain cap, patients can request a med-
ical exemption licence that sees their
medication fully subsidized. The sys-
tem resets every year, making patients
go through the three steps again.
Medical professionals have noted
that the system is not without fault—Dr.
Ólafur Baldursson, PhD, Chief Medi-
cal Executive of LSH, notes that “the
system is not working the way it was
meant to, and there has been very nega-
tive feedback from patients,” as the
chronically ill, who previously did not
have to pay for prescriptions, now find
themselves burdened with a hefty an-
nual fee.
Ólafur G. Skúlason, chair of the Ice-
landic Nurses’ Association, says that
the increased cost of care for patients
in recent years is an unacceptable de-
velopment in a welfare society. “Why
people with cancer have to pay such
exorbitant fees for their treatment is
beyond me,” he says. “We should be
able to find ways for patients to get the
care they need without having to worry
about their families’ livelihood.”
Ólafur says he also worries about
how costly seeking medical help has
become for fringe groups, such as those
suffering from mental illness, people
on benefits, pensioners, and the home-
less—he feels society needs to do more
to address their situation and ensure
they can lead decent lives. “We need
to do more to resemble the other Nor-
dic welfare models, securing the funds
needed to run a powerful and modern
healthcare system.”
Retired 82-year-old GP Dr. Haukur
S. Magnússon echoes Ólafur’s senti-
ments that a fundamental change in
how patients receive care has occurred
in Iceland. “I had to buy medicine the
other day, and it cost me 17,000 ISK,”
he says. “I can pay that amount out of
pocket, but I’m not sure everyone else
can.”
Haukur became a doctor in 1961
and worked full time until 2003, after
which he’s continued working shifts in
clinics out in the countryside and at the
Grund nursery home. Over the course
of his career, Haukur saw leaps and
bounds in medical science, with more
precise x-ray machines becoming avail-
able, the introduction of endoscopy, an-
gioplasty, keyhole surgery, CAT scans
and MRIs, and numerous medicines
that made short work of diseases that
had previously required major surgery.
Much like the managing director of
the Primary Health Care of the Capital
Area, Oddur Steinarsson, Haukur wor-
ries that there are currently far too few
GPs in Iceland. Oddur estimates that
an additional 70-80 more doctors are
required nationwide to meet primary
care requirements. In the meanwhile,
Haukur notes that patients often seek
expensive treatment from specialists
for problems that a GP could easily tend
to. “Just the other week, a grandchild of
mine went to a dermatologist who per-
formed a three minute examination for
which he charged 7,000 ISK.”
Following the economic collapse of
2008, the Icelandic State’s debts sky-
rocketed, reaching 126% of the coun-
try’s GDP in 2011. At the same time,
State revenue sources ground to a halt,
and property devalued. The consumer
price index shows price levels on con-
sumer goods increased by a whopping
18.6% from 2008 to 2009, and strict
capital controls were put in place to stop
funds from funnelling out of the coun-
try. In a desperate attempt to avoid na-
tional bankruptcy, the State underwent
hefty austerity measures, and called in
the IMF.
Although these facts are readily
available, a myth persists to this day that
Iceland simply let its banks fail, jailed
those responsible for the collapse and
took a moral stance that the rest of Eu-
rope should aspire to. Take for instance
a Guardian interview with healthcare
specialist Dr. David Stuckler, where he
claims that “recessions can hurt, but
austerity kills,” before going on to praise
the Icelandic State for taking the neces-
sary steps to protect its people. He cites
research showing that more than five
million US citizens had lost access to
healthcare, and 10,000 British families
had been pushed into homelessness fol-
lowing housing benefit cuts, whereas
Iceland suffered “no noticeable impact
on suicide rates or other health prob-
lems.”
David’s estimation is, unfortunately,
overly optimistic. In fact, Iceland's al-
ready strained healthcare system un-
derwent several bloody budget cuts
in the aftermath of the 2008 collapse.
In the years preceding the crash, the
healthcare system, and LSH in particu-
lar, had suffered numerous cost-cutting
procedures, leaving it with little fat to
trim when the State implemented its
emergency procedures.
Emergency measures
Looking simply at the amount of ISK
on LSH’s budget shows that half a
billion extra ISK went towards the
hospital’s budget in 2009, compared
to 2007. However, due to the severely
deflated ISK, this actually amounted
to a hefty reduction in funds, going
from the equivalent of $520 million in
2007 to the equivalent of $274 million
in 2009.
The emergency measures included
lowering or freezing hospital staff
wages, delaying repairs and mainte-
nance, and cutting the equivalent of
400-500 full-time positions at LSH.
Ögmundur Jónason, of the Left-Green
party, served as Minister of Health
in the aftermath of the collapse, and
oversaw the aforementioned auster-
ity measures. Ögmundur tells me that
these measures were meant as a short-
term fix, and that the budget was sup-
posed to be drastically improved once
the economy stabilised.
“People realised at the time that
the State had very little funds to work
with,” he says, “and that we were doing
the best we could with what we had.
We had no choice but to downsize.” In
an effort to shield the welfare system,
Ögmundur says the government tried
to focus on cutting other programmes,
such as infrastructure investments by
85%, and road administration by 50%.
Ögmundur says he regrets that his
government wasn’t able to do more,
and is convinced that the healthcare
sector shouldered too much of the
burden. He also expresses anger to-
wards the current government, which
he says is not doing enough to revital-
ise the vulnerable aspects of Icelan-
dic welfare society while toying with
ideas of further privatisation.
No privatisation
Taking over from Ögmundur, Kristján
Þór Júlíusson assumed the position of
Minister of Healthcare on behalf of the
Independence Party in 2013. Kristján
tells me that by the time he took office,
the healthcare sector had undergone
cuts to the amount of 30 billion ISK.
When asked to assess his predeces-
sor’s work, Kristján declined to com-
ment, stating that he is not interested in
finding fault with those who came be-
fore him. “It’s easy to sit on a high horse
and criticise the decisions of others,” he
tells me, “and things could always have
been prioritised differently.” He also
insists that the Icelandic healthcare sys-
tem will not be privatised on his watch,
although he says he’s open to private
enterprises operating in service of the
public sector.
Catching up
Kristján notes that nations who operate
a similar healthcare system to Iceland,
spend on average 1.8-4% of their health-
care budget on medical equipment,
whereas only 0.6% of LSH’s budget was
used for that purpose in 2013. To stem
the tide, Kristján Þór’s ministry has laid
out a four-year budget of medical equip-
ment maintenance amounting to 5.5
billion ISK for LSH and 800 million for
Akureyri Hospital. “We envision that
we can catch up to where we should be
after four years,” he says.
His ministry also runs a project
called Betri heilbrigðisþjónusta 2013-
2017 (“A Better Healthcare Service 2013-
2017”), which has the aim of streamlin-
ing the healthcare sector, for instance
by directing patients more efficiently
between hospitals, healthcare clinics
and independent healthcare operators.
Following loud protests inside and
outside of Alþingi in response to the
government’s 2015 budget proposal, the
second draft of the bill included an ad-
ditional billion ISK for LSH’s budget,
250 million to healthcare clinics and 150
million for the Icelandic Health Insur-
ance institute to further subsidise pre-
scription drugs. If passed in its proposed
form, it will mark the greatest amount
of ISK allocated to the hospital, ever,
which could in turn reinforce some of
the healthcare system’s infrastructure.
Following a round of unsuccessful nego-
tiations, doctors in Iceland commenced
their first ever strike in late October. In
the wake of the banking crisis, so as to
share the burden, doctors not only ac-
cepted a 5% wage cut, but also ceased
seeking pay raises with as much fervour
as before. As a result, their wages now
lag far behind other public sector pro-
fessions and the consumer price index.
Compensation in the Icelandic health-
care sector is no longer competitive with
those in our neighbouring countries,
both in terms of salaries and holiday al-
lowances.
Now that the economy is purport-
edly in better shape, doctors are asking
that their wages reflect the six years of
unpaid academic study that their profes-
sion requires, and the amount of respon-
sibility that the job entails. At present,
doctors who specialize abroad also face
a hefty wage cut upon returning to the
island—experts have expressed seri-
ous concern that Iceland will soon face
a shortage of medical specialists if their
salaries don’t start reflecting what com-
parable positions in neighbouring coun-
tries yield.
The Icelandic Medical Association’s
motion to strike received near unani-
mous member support, with 96% voting
to engage in strike actions in an early
October ballot. Since no agreement has
been reached, plans are afoot to engage
in further and harsher strike actions in
2015.
Primum non nocere
The strike sees departments scaling
down their efforts (albeit with good no-
tice), making research, surgeries and ap-
pointments grind down to a halt. How-
ever, those who need immediate medical
attention do receive it, and there is a
clear emphasis on not risking patients’
safety, as was apparent in the case of
Sebastian Andrzej Golab. Vísir reports
that Sebastian was stabbed through the
heart on November 23, mid-strike, and
suffered cardiac arrest upon arrival at
the hospital. Following an emergency
surgery, he has fortunately made a mi-
raculous recovery.
All manner of non-essential opera-
tions and procedures, however, are be-
ing delayed. This leaves an estimated
540 people awaiting minor surgery;
with a further 100 people awaiting spe-
cialised surgeries such as cornea trans-
plants and coronary angioplasty; 800 in-
dividual tests, such as blood tests, X-rays
and CAT scans; and an estimated 2,041
outpatient appointments.
Minister of Finance Bjarni Bene-
diktsson has said that the doctors’ de-
mands are unreasonable and will, if
met, result in a slippery slope, where
other professions will ask for similarly
unattainable raises. While Minister of
Health Kristján Þór is not on the nego-
tiating team, he has expressed sympa-
thy for the doctors’ cause. “Their wages
have fallen behind in a very competitive
market,” he says, “but I believe the strike
will only be solved if both parties reach a
compromise.”
Remarking on the strike, Prime Min-
ister Sigmundur Davíð Gunnlaugsson
echoed the position of Business Iceland
(a service and lobby group for Icelandic
businesses), calling for a national recon-
ciliation on pay raises. Polls by Capacent-
Gallup and MMR show that the gener-
ally populist PM has positioned himself
on the wrong side of popular opinion
in this regard, as both indicate that an
overwhelming majority of the nation
supports the doctors’ demands (finding
majorities of 80% and 70%, respective-
ly).
The voice on the ground
Dr. Íris Ösp Vésteinsdóttir, chair of the
Icelandic Association Of Junior Doctors,
says she was shocked when the strike
went forward in October. “I had dif-
ficulties falling asleep the night before
the strike commenced, because I was
convinced I’d hear them announce on
the news that a compromise had been
reached,” she says. “But, the negotiators
didn’t so much as call us with a new to-
ken offer.”
Íris says that the problem started in
2008, when doctors were asked to re-
frain from seeking pay raises, so as to
keep the system going. Ever since, the
base salary has remained low, but doc-
tors have had the possibility of raising
their wages by working overtime shifts
on evenings and weekends. The younger
generation of doctors, however, is not
particularly interested in employing
such measures to attain a fair salary, Íris
remarks.
The hospitals continue running as
usual during the strike, says Íris, with
critical patients receiving the care they
need. But, everything happens at a slow-
er pace, with longer waiting periods.
A case in point would be that of
24-year-old football player Mist Ed-
vardsdóttir. RÚV reports that Mist, who
has stage three lymphoma, caught a
serious infection while undergoing im-
munosuppressive treatment, but had to
wait a full fifteen hours to be treated.
Íris fears what might happen if the
strike isn’t soon resolved. “Since the eco-
nomic crisis started, healthcare profes-
sionals have been driven hard for a long
time, and now they are tired and want
something in return.” If the healthcare
system continues deteriorating as it has
been, Íris believes Iceland will become
less appealing to move back to for young
people who have studied abroad, as well
as educated medical professionals.
Prescribing Trouble
Down To
The Bone
The Icelandic healthcare system,
post-austerity
May Day Mayday
The Doctor’s Union suffers a
medical emergency
Continues on P.20