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.