New reimbursement model in Icelandic primary care in 2017: first-year comparison of public and private primary care

Abstract

Objective

To analyze and compare the effect of a new reimbursement model (based on a modified version of the Swedish free choice reform) on private and public primary care in Iceland during its first year of use.

Design

Descriptive comparison based on official data from the Ministry of Welfare, Directorate of Health, and the Icelandic Health Insurance on payments in the Icelandic primary care system.

Setting

Primary care system operating in the Reykjavik capital area. Public primary care has dominated the Icelandic health sector. Both public and private primary care is financed by public taxation.

Subjects

Fifteen public and four private primary care centers in the capital region.

Main outcome measures

Different indexes used in the reimbursement model and public vs. private primary care costs.

Results

No statistically significant cost differences were found between public and private primary care centers regarding total reimbursements, reimbursements per GP, number of registered patients, or per visit. Two indexes covered over 80% of reimbursements in the model.

Conclusion

The cost for Icelandic taxpayers was equal in numerous indexes between public and private primary care centers. Only public centers got reimbursements for the care need index, which considers a patient's social needs, strengths, and weaknesses.

KEY POINTS

• The Icelandic primary care system underwent a reform in 2017 to improve availability and quality. A new reimbursement model was introduced, and two new private centers opened following a tender.

• Two out of 14 indexes cover over 80% of total reimbursements from the new model.

• Only 5 primary care centers, all publicly driven, got reimbursement for the care need index, which is a social deprivation index.

• Reimbursement systems should mirror the policies of health authorities and empower the workforce.

Keywords:

• Primary care
• healthcare financing
• primary care choice reform
• incentives
• reimbursement model

Acknowledgments

The authors would like to thank Gylfi Ólafsson for his valuable comments.

Disclosure statement

The authors reported no potential conflict of interest.

Additional information

Funding

The Science Fund of Icelandic GPs funded this research. The funding body had no role in the study's design, analysis, interpretation of data, or writing of the manuscript.