From Iceland — The Cost of Cancer

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Month 1: A diagnosis

In the wake of the holidays one year ago, after far too many baked good, chocolates, wine, assorted festive meats and accompanying sauces, and just about everything else one might binge on during the merriest of seasons, my husband and I had a running gag. One of us would ask, “So, what did you get for Christmas?” To which the other would deadpan, “Fat. I got fat for Christmas.” Say what you will, but it cracked us up.

This year I got cancer.

How’s that for a punch line?

On New Year’s Eve there is a one-hour pause in the pre-midnight explosions of fireworks and the country falls silent as a staggering majority of Icelanders gathers in front of their television sets to watch the Áramótaskaup, a sketch comedy show that serves to summarize and make light of the top news and political events of the previous year.

This year’s “Skaup” was heavy on references to the country’s failing healthcare system and the lengthy (though very recently resolved) doctor’s strike that has created a backlog of 700 surgeries, 800 CT scans and x-rays, and some 3000 outpatient treatments.

In one scene, a nurse is working her way down a waiting list of patients to inform them that they are next in line for treatment. But, oh, they’ve all died in the meanwhile.

In another skit, a woman sits across a desk from two doctors and is told she has cancer. The treatment will be too expensive, so she opts to just die. But it’s not all bad news… the doctors are mightily thrilled to be moving on to new, high-paid jobs in Norway the next day!

Is the situation really so dire? Just how costly is it to have cancer in Iceland?

Just two and a half weeks (as of print date) into my experience with the C-word and my running tally is 22,742 krónur. That brings me up to the point when I was told, “You have cancer.”

The exorbitant services I’ve sought for this cost?

Three visits to my general practitioner.
One ultrasound.
One Fine Needle Aspiration (a biopsy).

As I’m new to this cancer rodeo, I can’t say that I know what lies ahead of me. As with most institutions, it seems that each piece of the puzzle is only aware of what is happening within its own borders thus far and cannot hint at what its adjacent piece may look like. I do know that surgery is in my near future, meaning time off work, and— skipping over any other treatments I may undergo before I get the stamp of “cancer-free”—prescription medications to be taken every single day for the rest of my life.

I have thyroid cancer, so while it is presumed at this point that my treatment will be straightforward—at least according to the pieces of the puzzle I’ve been given thus far—it also means a lifetime of hormone replacement therapy. An expensive lifetime.

Doesn’t Iceland have a universal healthcare system? It does, indeed, and that healthcare system subsidizes the full cost of hospital stays, and partial costs of visits to general practitioners and specialists. There is also a prescription drug payment system in place—revamped in May 2013—that sees patients paying for their prescription in three stages. In a cycle that resets each year, patients are required to pay the full price of their prescriptions until a certain cap is met, at which point the prescriptions are subsidized 85% and, finally, 92.5%.

For patients like those with cancer, or other long-term or chronic illness, this equates to a prohibitively high annual expense in addition to ongoing specialist costs.

With my own cancer putting me just 20K in the hole to date, it hasn’t been too hard a financial punch. But I’m still waiting for the punchline.

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