Programme no. 254-P
Quality Improvement
Clinical practice comparison between GPs in Iceland and Norway: A qualitative study
Hedinn Sigurdsson*1, Sunna Gestsdottir2, Kristjan Gudmundsson3, Sigridur Halldorsdottir4
1Glaesibaer Primary Health Care Centre, Reykjavik, Iceland,Reykjavik,Iceland, 2Centre of Sport and Health Sciences, School of Education, University of Iceland,Reykjavik,Iceland, 3Reykjalundur Rehabilitation Centre, Reykjavik, Iceland ,Reykjavik,Iceland, 4School of Health Sciences, University of Akureyri,Akureyri,Iceland
* = Presenting author
Objectives: The purpose was to explore the experience of Icelandic GPs who have worked in Norway and Iceland. We compared different work environments, efficiency, and organization of the different primary health care systems in these two neighbouring countries.
Background: According to GPs there is a need for paradigm shift in the Icelandic primary health care system.
Results: Analysis of interviews elicited four main themes. 1) The mixed public-private health care system; 2) Tug of war between doctors and nurses; 3) Specialists working as GPs; 4) Out-of-hours service overconsumption. What characterizes the Icelandic health care system outside of hospitals is the high patient access to the specialists’ service without referrals from GPs and an incomplete patient registration system, compared to the gatekeeping list system in Norway. Most of the Icelandic GPs are public employees on fixed salaries, unlike their Norwegian colleges who work in privately owned practices. Factors such as quality of care, service efficiency, continuity, and the sense of patients’ security, seem to relate to active control systems in the health care service.
Material/Methods: Semi-structured interviews were conducted with 16 Icelandic GPs who had previously worked in Norway for at least one year. A qualitative research approach was adopted, using the methodology of the 'Vancouver school of doing phenomenology', which seeks to increase the understanding of human phenomena.
Conclusion: When structural changes are performed in the Icelandic health care service it is important to look at other nations’ experience concerning major structural changes in the professional environment of GPs
Points for discussion: A lack of efficiency was found in the Icelandic primary health care system compared to the Norwegian primary health care system. Control of cost containment is more effective when GPs are on salary, but is likely to decrease access and service and lead to overconsumption of secondary care. With more emphasis on private practice and fees for service, it is possible to recruit more new GPs into the profession and decrease the pressure on the out-of-hours service and hospital emergency wards.