On Icelandic doctors

My friends and family here in Iceland were very enthusiastic about me going to the krabbameinsfélag for an exam. I was really impressed how easy it was to get an appointment--booked online even! And when I got there this afternoon, the efficiency continued: they have a well oiled operation in place there, all very organized with computers asking questions and keyed lockers to keep one's personal belongings in. Then when it came time to see the doctor, well, that lasted all of 2 minutes. And I paid 3420 kroner. So I was overall a little disappointed. When I mentioned to the front desk clerks that I was wondering if it was possible to actually get an appointment where I could speak to a doctor, I was given a variety of phone numbers. None of the ones I called had appointments within the next 6 weeks.

In the United States, when I want a doctor's appointment, I can usually get it within a week of calling, though sometimes I have had to wait 10 days or so. The highest co-pay I have ever had to pay at the doctor's office was $10 dollars.

I am not trying to make any grand point. I am just saying.

Comments

Keli said…
6 vikur er náttúrulega langur tími og þetta dæmi er ekkert einsdæmi á Íslandi. Ég vildi hinsvegar segja að ég og fjölskyldan höfum búið í Bandaríkjunum nú í 2 ár, okkar co-pay er $25 eða $35 (hjá sérfræðing). Svo er allskyns furðulegheit sem maður hefur lent í, eða samtstarfsfólk lent í, svo á heildina litið er ég mun sáttari með heilbrigðisþjónustuna á Íslandi en hérna í USA.
Lissy said…
Hi Keli,

Well actually, a reporter from Pressan called me after I posted this, and when I was speaking to her, I did recall the two years during which I did not have insurance through my employer, and had to pay $85 a month to Blue Cross. Still the co-pay for most procedures was $5.

There are weird things about the US system, of course, lots of preventative measures that should be covered but aren't.

But I was used to that system. And I miss it.

One of the big jokes in the US is how long a doctor's appointment takes; between waiting in the waiting room, filling out the paperwork, having a nurse examine you, then having the doctor come in, then usually the nurse again for follow up, I mean no doctor appointment takes less than 45 minutes. Here in Iceland you are in and out in no time flat, like I am just picking up a pizza or something.
Hulda Sif said…
I once went to the ER in a hospital in the States and after insurances had paid their part I still had to pay $3000! I can't say I thought that was cheap!
Jon said…
Covering myself through BCBS was $330 per month with $5000 deductible. This month my employer picks up my coverage so it only costs me $120 per month with $3000 deductible. There is a $40 co-pay. The wait for a physical is about a month. Just sayin'.
Lissy said…
I am and have always been a very lucky person. Knock on wood. So I suppose it is possible I have also just been lucky with my health care plans and providers.

But I am not really talking about how much it costs or how long the wait is. What I am noticing, in terms of a genuine difference, is the approach and attitude. I cannot imagine in the US being given the sort of news I was given last Friday without at the very same moment being given a referral to the right and proper doctor for follow up care. Rather, the idea here is that I paid the doctor for certain information, and they gave me the information I asked for. They had no ownership or involvement in what I did with that information. It was just mine to do something about or not do something about. It was my problem, is my problem, to figure out what to do with this information.

My aunt here in Iceland, who has lupus, spends what amounts to a full time job, just managing her health issues. Though she is assigned to a state doctor, that doctor is not managing her case for her. She is managing her case.

The Icelandic system is much more capitalistic, fend-for-yourself, than the American system. That is my feeling.

I do not mind paying more if I am getting more. I mind paying more and getting less.
Jon said…
Attitude and approaches to care would be a very interesting study! There is always room for betterment in any system. Cultural differences also have a bearing on how patients are treated and treated. Hmmm...
Thordis said…
Well when you got to leitarstöðin you are not really seeing a doctor in a sense. So it really is not comparable to the US system/or seeing a regular doctor. Leitarstöðin is really just a factory, they do these tests and that is it. It will never be like the experience of seeing a doctor and it is not meant to be like that.

That is why most Icelandic women use their own ob-gyn.

I have SO much to say about the American system. Having worked in it for 6 years, three years full time (Kaiser permanente). The PCP system is great, but it is only great if you have a good job that supports the whole thing. If you get fired, get your insurance through your husband´s job you are kinda screwed if something happens. I had patients quit treatment every month because they lost their job, left an abusive marriage (and therefore lost there insurance) etc. It was always heartbreaking to go through that with them and then just say good-bye. I have countless stories like that.

Some had great coverage that really was not that great when the cancer hit etc. And don´t get me started on the pre-existing conditions. Jeez! I have countless stories about that as well. I once treated a women for post-partum depression who 8 months later contacted me and begged me to remove the diagnosis from her files. She had always been healthy, recovered well from the depression but when it came time to renew the insurance they turned her down. Another one could not transfer to Kaiser because she had a history of acne and yeast infections.

But anyway, I can talk about this forever.... and just realized that I wrote in english... sorry :-) I don´t know why I keep doing that :=)
Lissy said…
Yes, Thordis, good point, but I did indeed have a doctor's appointment four days before this skoðan, so I am also talking about that appointment when I say it was very short, expensive, and not very helpful!

But I think there are a lot of people here in Iceland, like yourself, that understand the Icelandic system a lot better than I do, and I think it works very well for many Icelanders. I just have not figured it out yet, as I said. I am used to the US system.
MamaOlive said…
Your post (and comments) reminded me of a lot of the experiences we had in Iceland. People were generally friendly and willing to help, but we had to know the right questions to ask. Each specific question got a specific answer, with no additional information forthcoming. It was hard to get used to.
Thordis said…
yebb, I know. Then there are a lot of Icelanders who do not want to see any fault with the Icelandic system. I dont want to be that person, I want to stay critical because there is a lot to be done, we need to aim for perfection when it comes to this because we know it will never happen. If you know what I mean.

What I like about the Icelandic system is that I can have a baby with an emergency C without paying a dime, my mom went through cancer treatment and did not pay anything. I only pay my co-pays (ok higher taxes but that is a totally another conversation :) and even the co-pays are limited per year.

I can do all this above with or without a job. I can follow my dream and open up my own practice with a pre-existing condition and still be covered. This would not happen in the US. A lot of people are stuck at their jobs because of the coverage.

But the price I pay for this is the waitlist issue, which is never an issue in a emergency. But I am willing to do that because you learn how to deal with it.

I would work on getting your own PCP, getting your own OB-Gyn and only use leitarstöðin for the mammograms when the time comes.

I guess some people are just lucky when it comes to co-ordination. My mom´s oncologist does all of that for my mom and works with her pcp.
Lissy said…
I have not been to a single procedure in Iceland where I did not have to pay a pretty sizeable little chunk of change. When I went in for my blood test, I was told there was "some little fee" - it was 2500 ISK.

A blood test my doctor ordered would not cost me a single penny in the US unless I had a really crappy insurance plan.
Hildur said…
Hi Lizzy.
A few years ago my mother was taken very seriously ill. She spent 8 weeks in intensive care, the entire time she was there she had 3 doctors who were responsible for her care, and countless others (heart surgeons, infection specialists, kidney specialists etc) who took part when needed. In addition she had one or two nurses who were only looking after her 24 hours a day. She did not make it,and the day she died half the staff of the ICU,who had spent the previous 8 weeks doing SO MUCH MORE than their work were in tears. They asked for our permission to do a cost assessment of her stay (something that is usually not done) as they had never had anyone that sick for that lenght of time in the ICU. The result was that it was just under one million krónur per day for her care, for 8 weeks. At the time she got sick my mother was working part time, project based - and would certainly not have been eligable for insurance. The two lessons I learned about the health health care system in Iceland from that experience is that there that if you have to wait, it is because you can afford to wait, and that I can´t imagine living in a society where my part time employed mother would not have been given the chance to beat her disease. I agree with Thordís, the system is not perfect and there is a lot of room for improvement, but personally I feel happy to know that my system to improve is the Icelandic one rather than what they have in the US.
Lissy said…
Hi Hildur and thanks for sharing your story. I am sure the emotional commitment of the staff made a huge difference in how your family coped with your mother's death. When my brother died, I know my parents felt a lack of sympathy from the ICU staff at the hospital in Alabama where he had been for 2 weeks.

But I would like to say that my brother was unemployed at the time, and he did indeed get admitted to the finest liver research hospital in the American southeast. The doctor's there tried everything they could, identified and treated a serious kidney infection and pneumonia with top end antibiotics, oxygen, dialisys, everything. In fact my parents felt they may have been trying too much at once for how frail his health was.

Previous to that, my brother had received continuous care from a very caring staff at a hospital closer to our home in Southern California.

My brother, unemployed, was covered by Medi-cal, the California state run insurance, which is a good plan that covers not only emergency but also routine health issues. He did not pay for his care, and nor did my parents.

The ironic thing about the US system is that people with full time jobs and unemployed people both have decent plans to cover their health needs. People who are partially employed, like your mother, have fallen between the cracks, and that is the gap the Obama health plan is meant to fill. Once one is covered by a health plan, the US system works rather smoothly.

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