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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

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
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)
landsp tali university hospital
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.
landsp tali university hospital4
Landspítali – University Hospital
  • Patient beds 900
  • 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
only university hospital in iceland and county hospital for 2 3 3 4 of the population
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
results
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

results7
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)
results8
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 %
development
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
problems
Problems
  • Role of small community Hospitals
  • Nursing Homes
  • Local Competition
  • Inadequate funding for both main roles of the Hospital