Iceland’s national health service provides for all

In Iceland, universal access to health care is enshrined in law. As a result the country has no private health insurance and the island’s 290,000 residents rely on a national health service—state-run hospitals and primary health care centers—at minimal charge. If they see specialists in private practice, about 75 percent of the fees are reimbursed by the government.

Margrét Oddsdóttir, M.D., HS ’92, professor and chief of surgery at Landspitali University Hospital in Reykjavik, described the Icelandic health system in March at the 50th annual Samuel Clark Harvey Lecture sponsored by the Department of Surgery. Most surgical procedures, she said, can be done in Iceland, but patients travel abroad for heart operations in infants, solid organ transplantation (other than living-related renal transplantation) and allogenic bone marrow transplantation. The national health system has a waiting list for surgery, but if waiting time exceeds six months, patients may travel abroad for treatment at government expense. Today, the only waiting list longer than six months is for cataract eye surgery.

Such a health system—which accounts for 10 percent of the country’s gross domestic product—is possible in a small, homogeneous population, Oddsdóttir said, adding, “I don’t know if it’s possible in a large, heterogeneous population like the United States.”