Palliative Care Services to be Expanded in South Iceland

The Minister for Health Svandís Svavarsdóttir has decided to grant funding to establish four rooms dedicated to palliative and end-of-life care to be managed by the Health Care Institution of South Iceland, RÚV reports. The new facilities and services are expected to cost ISK 43 million a year [$313,411; €263,007].

The Health Care Institution of South Iceland (HSU) serves roughly 20,000 people in the region and operates eight health care clinics, a hospital with 62 sickbeds in Selfoss, and health care service for the prison Litla Hraun. The institution’s new palliative care team will oversee treatment for patients nearing the end of their lives and will also support nurses and doctors working at the local health clinic and nursing homes.

The establishment of palliative care facilities outside of the capital area and around the country is in accordance with the government’s 2018 – 2030 healthcare policy, which aims to provide ‘the right care in the right place.’ The idea is that rural residents should not have to travel to the capital for vital health care services, not least palliative and end-of-life care. According to a working group focused on the future of palliative care in Iceland, this will not only better serve rural patients at the end of their lives and their families, but will also ease some of the pressure currently put on the National University Hospital’s ER.

Alþingi Legalizes Safe Injection Sites

Alþingi Icelandic parliament

Alþingi has passed a bill which will make it legal for municipalities around the country to open safe injection sites (SIS) for intravenous drug users, Vísir reports. Heiða Björg Hilmisdóttir, chair of the City of Reykjavík’s Welfare Committee, has praised the bill as a step in the right direction and believes that in Reykjavík, such a facility would do the greatest good if opened downtown. According to the SIS bill, around 700 people use intravenous drugs in Iceland each year. It’s estimated that somewhere between 25 and 40 people would use the Reykjavík SIS initially.

Safe injection sites (also referred to as overdose prevention centres, supervised injection facilities, or drug consumption rooms) are facilities where individuals over the age of 18 can use intravenous drugs in a safe environment, under the supervision of healthcare professionals and without fear of arrest or legal repercussions. They are intended to provide sterile injection supplies, provide healthcare guidance, referrals to rehabilitation and social services, and monitor for overdose, thus decreasing overdose-related expense and pressures on the healthcare system, increasing the likeliness of users seeking treatment and social aid, and reducing behaviours that put users at risk of contracting HIV and Hepatitis C, such as needle sharing.

“This is a really good step,” remarked Heiða Björg on the passing of the new bill, “but we would have liked to maybe see the report more clearly indicate that there would be low-cost healthcare services there [at the SIS]—that it would be a health clinic.”

Heiða Björg also believes that the government should bear the financial burden of healthcare services in safe injection facilities, not the local municipalities that open them. “It really isn’t fair to completely pass the ball to the municipalities,” she continued. “There needs to be a guarantee of funding for such operations.” The Minister of Health has yet to fully outline what services SISs will offer.

Heiða Björg says the city is prepared to help identify a suitable location for an SIS in Reykjavík but thinks that it’s clear that such a facility needs to be centrally located. “I think most professionals agree that it would be preferable for it to be somewhere central, where people are coming and going. We’ve really been looking at downtown.”

Wherever it’s located, the Reykjavík SIS will likely not open until next year. “If I tell it exactly like it is, then I think that this will take at least a year—based on my experience, for instance, finding [housing] for people who have been, or currently are, homeless. I think we have to just give this time but we are ready to get this done quickly and correctly if the funds for the project are guaranteed,” she concluded.

Out-of-Pocket Payments of Patients to be Lowered

Minister of Health Svandís Svavarsdóttir

Minister of Health Svandís Svavarsdóttir has introduced an ISK 3.5 billion ($28.6 million / €25.8 million) plan to lower the out-of-pocket healthcare payments of patients in Iceland, Vísir reports. The plan is to reduce the payment participation of patients so that payments account for less than 15% of current spending on health. 

Emulating the Nordic Countries

In a press conference yesterday, Minister of Health Svandís Svavarsdóttir introduced plans to lower the payment participation of patients in Iceland.

“First of all, because that’s what patients in the Nordic countries pay, and we want to emulate the Nordic system. Furthermore, the World Health Organisation has identified that figure as a kind of threshold of pain; when out-of-pocket payments account for more than 15% of spending on health, patients begin to forgo healthcare services for economic reasons,” Svandís stated. 

A higher percentage of patients in Iceland has had to forgo medical service for financial reasons compared to the other Nordic countries, especially in terms of dental healthcare.

In 2016, 8% of Icelanders reported that they could not afford dental care. Among the lowest-income bracket that number was almost 15%. In the other Nordic countries, the figures are closer to 5-10%. 

Increased Subsidies

The Minister of Health plans on increasing dental subsidies to pensioners from 50% to 75%. Pharmaceutical subsidies and subsidies for specified assistive technology will also be increased. Rules regarding travel costs will be loosened.

Facility fees at healthcare centres will also be lowered from ISK 1,200 ($9.80 / €8.90) to ISK 700 ($5.70 / €5.20) as of January 1, 2020. The fees will be completely abolished as of January 1, 2021. 

In an interview with Vísir, Óskar Reykdalsson, CEO of the Healthcare Clinic in the Greater Reykjavík Area, stated that the new legislation would guarantee everyone primary healthcare regardless of income. 

“Those of us who interact with patients know that some of them forgo tests or visits to the clinic due to financial reasons. The abolition of facility fees means that this will no longer be the case,” Óskar stated.

Article updated 18:22