Tuesday, July 19, 2011

Is MD equity walking out the door in Iceland?

After all that Iceland has been through because of the financial crisis, who needs this? An assertion emerges from Reykjavik that the health care system is on the verge of "imminent collapse." Here are excerpts:

The medical director for the Primary Healthcare of the Capital Area is deeply concerned with a growing problem in Icelandic clinics; the number of postgraduates expected to return from specialist training abroad has declined after recent cutbacks in the healthcare system.

“We might lose a generation of physicians,” Lúdvík Gunnarsson.

Gunnarsson told Morgunbladid the situation in healthcare clinics around the country is poor and specialist positions are understaffed. He continued to say that “an imminent collapse of the healthcare system is impending and it cannot survive further cuts.”

This follows an earlier report about a 40 percent cut in health care funding in the 2011 budget.

Back in 2007, I was giving a talk at Iceland's Landspítali University Hospital in Reykjavík, and I asked my host how the annual budget for health care was established by that country's parliament. I reported the answer in this blog post:

[T]he parliament uses, as a rough guide, a desire to maintain overall health care costs at a certain percentage -- 10 or 11% -- of GNP.

I pursued the question further. Is this percentage based on a quantified assessment of the actual health care needs of the public, i.e., is it driven by public demand (e.g., a growing aging population)? No. Does it take into account the government's expectation for certain quantifiable levels of service quality, medical quality, or operational efficiency of hospitals and other parts of the system? No.

In essence, this appropriation by the parliament is a politically derived decision, just as it would be for any appropriation for a program of important national priority, and it therefore competes with other worthy national programs for resources.

The current cuts emerge because of the financial collapse of internet bank Icesave and its owner, Landsbanki, in 2008, leading to a huge impact on the country and the government.

It is hard to know from here if the current public statements are an exaggeration or a proper warning, but they are indicative of the description I provided above. They reflect the fact, though, that Iceland's approach to medical education subjects the country to a particular risk. While MDs receive their basic training in-country, they go abroad for advanced training. If they think that the market for their newly acquired skills is not sufficiently remunerative back home, they have the option of staying abroad. As we say in other professional fields, your "equity" can always choose to walk out the door.

1 comment:

Anonymous said...

I imagine Iceland is in a fairly unique situation due to its geographic isolation of sorts. It would be interesting to compare rate of MD emigration to rate of emigration of any Icelander who goes abroad for advanced education.
And, of course, the US has skewed patterns of international physician migration for years, due to the vastly higher incomes here than elsewhere. It will be interesting to see what happens as that situation changes.....