From Iceland — Prescribing Trouble: Iceland's Social Insurance Explained

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Julia Staples

Prescription drugs used to be either completely, partially or not at all covered by the insurance system, sometimes 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 patients 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 medical exemption licence that sees their medication fully subsidized. The system 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 Medical Executive of the National University Hospital of Iceland (LSH), notes that “the system is not working the way it was meant to, and there has been very negative feedback from patients,” as the chronically ill, who previously did not have to pay for prescriptions, now find themselves burdened with a hefty annual fee.

Ólafur G. Skúlason, chair of the Icelandic Nurses’ Association, says that the increased cost of care for patients in recent years is an unacceptable development 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 homeless—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 Nordic welfare models, securing the funds needed to run a powerful and modern healthcare system.”

Dr. Haukur S. Magnússon, photo by Julia Staples

Retired 82-year-old GP Dr. Haukur S. Magnússon echoes Ólafur’s sentiments 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 available, the introduction of endoscopy, angioplasty, keyhole surgery, CAT scans and MRIs, and numerous medicines that made short work of diseases that had previously required major surgery.

“When I was a young man, people were operated on for stomach ulcers,” he says, “a part of their stomach would be removed, and they wouldn’t live very good lives after that. Then in the ‘80s, they developed these drugs that cure people in a relatively short amount of time.”

Much like the managing director of the Primary Health Care of the Capital Area, Oddur Steinarsson, Haukur worries 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 performed a three minute examination for which he charged 7,000 ISK.”

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This article is a part of our feature on the country’s healthcare system, Squeezing Blood From A Turnip: Iceland’s Universal Healthcare At Risk. You may be interested in also reading:

Iceland’s Healthcare System: How Does It Work?