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

Figures & data

Table 1. List of indexes that represent reimbursement to primary care centers and proportional distribution of payments in 2017 and 2018 from each index.

Type of index	What the index stands for
^aCost index	Represents age, gender, and number of communications to a center.
2017: 41.1	An average individual has a cost index of 1.0.
2018: 40.9
^a,bACG	ACG is based on two indexes: a weight index estimated with each person's disease burden in accordance with ICD-10 and a demand index that is standardized by dividing the weight index of each center with the average weight index from all centers.
2017: 41.1
2018: 40.9
^a,cCare need index	CNI consists of the following seven demographical variables which vary in expense: 1) Proportion of individuals that are over age 65 and live alone; 2) Proportion of individuals who are recipient of disability benefits; 3) Proportion of individuals born abroad; 4) Proportion of unemployed individuals; 5) Proportion of single parents; 6) Proportion of new residents who are not Icelandic; 7) Proportion of children under age 5.
2017: 0.4
2018: 0.4
Quality index	How well centers serve a total of nine public health factors, e.g. indicators of diabetes; heart and pulmonary diseases; annual review of prescriptions for patients over age 70; smoking, blood pressure and BMI in risk groups; vaccinations; use of antibiotics.
2017: 4.8
2018: 4.1
Other indexes	Payments for service to primary schools, interpretation, psychologists, and prescriptions for exercise.
2017: 12.6
2018: 13.6

^aTop two indexes explain about 82% of payments to centers both in 2017 and 2018; ^bACG: adjusted clinical group. ^cOnly 5 centers (all public) got paid for the Care Need Index [22].

Table 2. Reimbursement to primary care centers in 2018, reported in thousands of Icelandic krona^a [21].

	Public		Private
	n = 15		n = 4		T-test
	Mean	SD	Mean	SD	P-value
Cost index^b	158,626^a	31,214	157,599	52,071	0.975
Adjusted clinical group (ACG)	154,068	33,243	181,108	58,837	0.497
Quality index	4,645	1,267	5,293	1,284	0.471
Care need index (CNI)	2,074	3,696	0	0	–
Other indexes^c	1,326	27,804	0,463	13,149	0.934
Total reimbursement	330,146	67,573	348,633	112,807	0.802
Reimbursement per GP	40,075	7,001	38,191	11,106	0.763
Reimbursement per registered patient	28,043	1,843	29,644	2,317	0.270
Reimbursement per visit	12,116	1,151	11,684	1,121	0.526

^aTo convert to euros, divide by ISK 139.4 which was the currency exchange rate on 1st December 2018, i.e. cost index of ISK 158,626,000 is then 1,137,919 euros; ^bThe index is standardized for different numbers of patients; ^cSchool nursing, physical therapy, psychologists, interpreters, medication review, special income, payment to after-hour care.

Figure 1. Reimbursements in 2018 for (a) GPs at each center, (b) all registered patients at a center, and (c) patient visits. The dark color is for public centers and dots represent private centers.

Figure 2. Increase in number of patients and diagnosis from 2017 to 2018 [Icelandic health insurance, personal communication, 27 January 2021].

Ministry of Welfare (Velferðarráðunaeytið). The primary health care in Reykjavik capital area - Financing model (Heilsugsaela á höfuðborgarsvaeðinu-Fjármögnunarlíkan, útgáfa 2.0). Ministry of Welfare; 2017. Available from https://www.sjukra.is/media/heilsugaeslur/Fjarmognunarkerfi-hofudborgarsvaedid-utgafa-2.0_Loka.pdf.

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