Download Iceland: The health care systems and communicable disease control

The Icelandic Health Care System
- Communicable Disease Control and Hepatitis
Surveillance -
Thorolfur Gudnason MD
Chief of National Vaccination Program
22.3.2012
Sóttvarnir
Centre for Health Security and Infectious Disease Control
Sóttvarnir
Centre for Health Security and Infectious Disease Control
Vital statistics (2011)
• Population




319.000
0-9 y
10-19 y
20-64 y
65+
14%
14%
60%
12 %
• Total fertility rate
2.2
• Life expectancy
men
women
79.9 yrs
83.6 yrs
• Perinatal mortality rate
2.7
Sóttvarnir
Centre for Health Security and Infectious Disease Control
Economy of Iceland (2010)
• Iceland's GDP per capita ranked 13th of EU
countries
• More than half of Iceland's GNP comes from
communications, trade, and service industries
and tourism
• Less dependent on fishing than before
• Aluminum smelting and ferrosilicon
production is important
• Unemployment 7.6%
Sóttvarnir
Centre for Health Security and Infectious Disease Control
The Icelandic health care system
• Hospitals owned and run by the state
– No payment by patients
• Primary care delivered from HCC, run by the state
– Minimal payments by patients
• Specialists outside hospitals are private practitioners
paid by the patients and the state
• Comprehensive
• Financed by taxation and by patients
• Most nursing homes and rehab. clinics are private
• Dentists are private practitioners
Sóttvarnir
Centre for Health Security and Infectious Disease Control
Health Care Centres
58 HCCs
Reykjavík:
38 Health Care Centres H2
(At least 2 doctors)
18 Health Care Centres H1
(One doctor)
28 Health Care Centre H 0
(affiliated to H1 or H2)
Sóttvarnir
Centre for Health Security and Infectious Disease Control
Hospitals
• Landspitali University Hospital, Reykjavik
– 1000 beds
• Akureyri
– 200 beds
• Akranes
– 75 beds
• 17 other small institutions around the
country
– 600 beds all togetherSóttvarnir
Centre for Health Security and Infectious Disease Control
Real health care expenditure 2010 (% of GDP)
USA
Holland
France
germany
Denmark
Switzerland
Canada
Austria
belgium
New Zealand
Portugal
Sweden
UK
Iceland
Greece
Norway
Italy
Spain
Ireland
Finland
Australia
Japan
Luxembourg
S-Korea
0
OECD
5
10
15
20
Sóttvarnir
Centre for Health Security and Infectious Disease Control
Health care expenditure 1980 – 2010
% of GDP
11,0
10,0
9,0
7,0
6,0
5,0
4,0
3,0
2,0
1,0
0,0
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
% of GDP
8,0
Total health care expenditure
Governmental sector
Private sector
Sóttvarnir
Centre for Health Security and Infectious Disease Control
Communicable Disease Control
• Ministry of Health and Welfare
• The National Committee on Communicable
Diseases
• Center for Health Security and Infectious Disease
Control
– Chief Epidemiologist
Sóttvarnir
Centre for Health Security and Infectious Disease Control
The National Committee on Communicable Diseases
• Advisory body – policy making
– Appointed by the Minister of Health and Welfare
– Creates policy on measures against
communicable diseases
– Advises on measures against communicable
diseases
Sóttvarnir
Centre for Health Security and Infectious Disease Control
Center for Health Security and Infectious Disease Control
• Chief Epidemiologist
– Surveillance and monitoring
• Communicable diseases, radio-nuclear substances, chemical agents
and unexpected events.
• Keeps registers of communicable diseases, national vaccinations and
antimicrobial consumption.
– Response
• Acts on the responsibility of the Minister of Health.
• Coordinates official and public measures against communicable
diseases and other health threats.
• Supervises and organizes communicable disease control, prevention
and immunizations.
• Provides information and advice to health care workers and the public.
Sóttvarnir
Centre for Health Security and Infectious Disease Control
The reporting system
• Notifiable Diseases
– Communicable diseases, diseases caused by toxic chemicals and
radio-nuclear substances
– No personal identifiers.
– Aggregate numbers
• Reportable Diseases
– Communicable diseases, diseases caused by toxic chemicals and
radio-nuclear substances
– Personal identifiers.
• Central Registers
–
–
–
–
Reportable diseases
Notifiable diseases
National Vaccinations (personal identifiers)
Antibiotic prescriptions (no personal identifiers)
Sóttvarnir
Centre for Health Security and Infectious Disease Control
Hepatitis Surveillance
• Reportable Diseases
– Hepatitis A
– Hepatitis B
– Hepatitis C
– (hepatitis D and E)
Sóttvarnir
Centre for Health Security and Infectious Disease Control
Reporting on Reportable diseases
Chief Epidemiologist
Health Care Centres
Laboratories
Hospitals
Private doctors
Sóttvarnir
Centre for Health Security and Infectious Disease Control
Hepatitis Surveillance
• Passive surveillance (acute/chronic)
• Active surveillance (chronic)
Sóttvarnir
Centre for Health Security and Infectious Disease Control
Hepatitis Surveillance
• Passive surveillance
–Disease reporting
• Hepatitis A (acute)
• Hepatitis B (acute/chronic)
• Hepatitis C (acute/chronic)
• (hepatitis D and E)
Sóttvarnir
Centre for Health Security and Infectious Disease Control
Hepatitis Surveillance
• Active surveillance (chronic)
– Hepatitis B
•
•
•
•
Immigrants
Pregnancy
Blood donors
Drug abusers
– Hepatitis C
•
•
•
•
Blood donors
Drug abusers
Immigrant children
Sóttvarnir
Pregnancy
Centre for Health Security and Infectious Disease Control
Sóttvarnir
Centre for Health Security and Infectious Disease Control