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UNIVERSITY-HOSPITAL MERGER IN ICELAND PowerPoint PPT Presentation


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UNIVERSITY-HOSPITAL MERGER IN ICELAND. Gisli Einarsson M.D. Ph.D. Asisstant professor Chief Executive of Education Research & Development Specialist in General Surgery and Medical Rehabilitation. Public Administration in Iceland. Two Levels of Executive Power State Level: < 300.000 people

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UNIVERSITY-HOSPITAL MERGER IN ICELAND

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UNIVERSITY-HOSPITAL MERGER IN ICELAND

Gisli Einarsson M.D. Ph.D.

Asisstant professor

Chief Executive of Education Research & Development

Specialist in General Surgery and Medical Rehabilitation


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Public Administration in Iceland

  • Two Levels of Executive Power

  • State Level: < 300.000 people

    • Almost all Health Care

    • Schools higher than Ground School – University Education (including University of Iceland)

  • Municipalities

    • Nursing Homes

    • Ground School (first ten years)


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Landspítali – University Hospital

  • Landspítali is the largest organization in Iceland in terms of employees, with approximately 5000 employees (3900 f.t.e)

  • The hospital is located around Reykjavík and vicinity. The main activities are concentrated at two sites three kilometers apart.

  • In-patient days around 300 thousand pr. year.


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Landspítali – University Hospital

  • Patient beds900

  • ER visits 75.000

  • Visits; Day-care units 100.000

  • Visits; Out-patients 220.000

  • X-ray, MRI, CT etc. investigations 105.000

  • Operations 15.000

  • Clin.investigations (bact/im/path. etc) 1.400.000


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Only University Hospital in Iceland and County hospital for 2/3 – 3/4 of the population

  • Advantage:Uniformity in services and teaching

  • Best utilization of resources

  • Drawbacks: Lack of CompetitionComplacency

  • Ineffectivity

  • Demands great vigilance to foreign comparison


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Results

Enlargement and strengthening of specialities

-better subspecialist services, fewer on-call lines

Decreased overhead / administration

-one executive board, reduced nursing administration, fewer doctors in-chief

Better utilization of housing and equipment

Increased productivity

Shorter waiting-lists

Improved economy


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Results

  • Increased productivity

  • Surgical operations up 3% in 2003, 2,9% January-July 2004

  • Cardiac interventions eliminated waiting-lists in 2003-2004

  • Decreased in-patient length of stay (just under 5 days July 2004)

  • Faster turn-over (arrivals/discharges)

  • Almost 10 % increase in out-patient visits

  • Shorter waiting-lists

  • Eliminated in cardiology

  • Almost eliminated in orthopedics

  • Decreased considerably in eye-surgery (operations up 16% in-patient and 42% in day-care)


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Results

  • Improved economy

  • Decreased number of f.t.e. by 2.9 % 2003-2004

  • Total expenditures in constant money value 1999-2004:

  • 1999-2000 -0.9 %

  • 2000-2001 -1.4 %

  • 2001-2002 +1.8 %

  • 2002-2003 +2.5 %

  • 2003-2004 -3.0 %


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Development

  • Out-patient/day-care policy completed 2004

  • DRG-evaluation completed 2004

  • Health department committee on the role and interaction of the two acute-care hospitals and out-patient services including primary care and privately run out-patient seervices (380.000 visits)

  • Co-operation agreement with The University of Iceland in 2001 and 2002


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Problems

  • Role of small community Hospitals

  • Nursing Homes

  • Local Competition

  • Inadequate funding for both main roles of the Hospital


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