New reimbursement model in Icelandic primary care in 2017: first-year comparison of public and private primary care.

OBJECTIVE: To analyze and compare the effect of a new reimbursement model (based on a modified version of the Swedish free choice reform) on private and public primary care in Iceland during its first year of use. DESIGN: Descriptive comparison based on official data from the Ministry of Welfare, Directorate of Health, and the Icelandic Health Insurance on payments in the Icelandic primary care system. SETTING: Primary care system operating in the Reykjavik capital area. Public primary care has dominated the Icelandic health sector. Both public and private primary care is financed by public taxation. SUBJECTS: Fifteen public and four private primary care centers in the capital region. MAIN OUTCOME MEASURES: Different indexes used in the reimbursement model and public vs. private primary care costs. RESULTS: No statistically significant cost differences were found between public and private primary care centers regarding total reimbursements, reimbursements per GP, number of registered patients, or per visit. Two indexes covered over 80% of reimbursements in the model. CONCLUSION: The cost for Icelandic taxpayers was equal in numerous indexes between public and private primary care centers. Only public centers got reimbursements for the care need index, which considers a patient's social needs, strengths, and weaknesses.KEY POINTSThe Icelandic primary care system underwent a reform in 2017 to improve availability and quality. A new reimbursement model was introduced, and two new private centers opened following a tender.Two out of 14 indexes cover over 80% of total reimbursements from the new model.Only 5 primary care centers, all publicly driven, got reimbursement for the care need index, which is a social deprivation index.Reimbursement systems should mirror the policies of health authorities and empower the workforce.

Prevalence, mental health and substance use of anabolic steroid users: a population-based study on young individuals.

Aims: The use of anabolic androgen steroids to enhance performance is not a modern phenomenon. However, the majority of today's anabolic androgen steroid users are not competitive athletes, but individuals who want to look leaner and muscular. This study aimed to examine the prevalence of anabolic androgen steroid use among young individuals and assess whether their mental health, lifestyle and substance use differ from non-anabolic androgen steroid users. Methods: A population-based study conducted in secondary schools, mean age was 17.3 years. A total of 10,259 participants (50% young women, 1% reported gender as 'other', 49% young men) answered questions on mental health, anabolic androgen steroid use, substance use and sports participation. Statistical analysis included descriptive statistics, t-test, χ2 and logistic regression. Results: The prevalence of anabolic androgen steroid use was 1.6%, and 78% of users were young men. Anabolic androgen steroid users had more anger issues, anxiety, depression, and their self-esteem was lower than among non-anabolic androgen steroid users (P<0.05). A larger proportion of anabolic androgen steroid users, 30%, had attempted suicide compared to 10% of non-users (χ2 (1, 9580) = 57.5, P<0.001). Proportionally, anabolic androgen steroid users were more likely to take medicine for mental health problems and misuse substances than non-users. Participation in non-organised sports, increased anger and body image were associated with increased odds of using anabolic androgen steroids. Conclusions: Anabolic androgen steroid use is a public health threat. It had an alarming effect on the life of individuals who report having used anabolic androgen steroids. Authorities, healthcare workers, parents and others working with young people need to be informed of the signs and risks of anabolic androgen steroid use to reduce future negative implications.

[General practice in Iceland and Norway: GP's experience of different primary health care systems].

INTRODUCTION: Most GPs in Iceland are public employees on fixed salaries which is very different from their Norwegian colleagues. The aim of this study was to explore the experience of Icelandic GPs who have also worked as GPs in Norway and compare their experience of working in these two neighboring countries. MATERIAL AND METHODS: Data were collected through interviews with 16 GPs that during the study period 2009-2010 were all working in Iceland. Two to ten years had passed since their return from Norway. We used qualitative methodology, the Vancouver-School of doing phenomenology. This methodology seeks to increase understanding of human phenomena for the purpose of improving healthcare services. RESULTS: The doctors discussed the benefits of the different systems of delivering medical services. They saw the advantages of the Norwegian healthcare system mostly in that all Norwegians have their own GP, thus achieving a good overview of the health problems of each individual. The GPs are gatekeepers for medical services which potentially -reduces duplication of medical services. The participants also noted more efficient medical services in Norway than in Iceland. What characterizes Icelandic healthcare outside the hospital from their perspective is direct patient contact with specialists without referrals from GPs and incomplete registration system of patients and much use of emergency services in Iceland. CONCLUSION: Participants agreed upon stronger primary healthcare system in Norway compared to Iceland. Moreover, a good job situation in primary care is needed in Iceland to appeal to junior doctors. When changes are made to the Icelandic healthcare system it is important to acknowledge the experience of neighboring countries in terms of advancing health care system reforms. Key words: general practitioner, primary care, job situation, health service research, qualitative research. Correspondence: Hedinn Sigurdsson, hedinn.sigurdsson@heilsugaeslan.is.

Smoking during pregnancy: A population-based study.

AIMS: Tobacco is a major cause of disease and mortality in modern times. The risk of smoking in pregnancy is a serious threat to the development and future health of an unborn child. The aim of this study was to explore the epidemiological factors associated with smoking during pregnancy in a primary healthcare setting. METHODS: All 856 maternity records at the Glaesibaer Health Care Centre in Reykjavik during 2006-2013 were reviewed and information on smoking habits investigated. RESULTS: The records showed that in 108 (12.2%) pregnancies, women smoked at first visit and 63 stopped smoking in early pregnancy, leaving 45 (5.3%) mothers smoking throughout the whole gestational period. The mean age of the smoking women was 27.8 years and for the non-smokers 29.7 years. Low social status (odds ratio (OR) = 2.66; 95% confidence interval (CI): 1.19-5.96), previous mental health diagnosis (OR = 2.7; 95% CI: 1.3-5.6), and unstable relationship with a partner (OR = 3.78; 95% CI: 2.1-7.0) were associated with smoking. Smoking fewer cigarettes was associated with a 0.04-unit lower risk of smoking during pregnancy (OR = 0.04: 95% CI: 0.02-0.08). CONCLUSIONS: Our results indicated that the women who smoked during pregnancy were often heavy smokers and living without a partner. They were younger, had worse mental health, and a lower social status than those pregnant women who did not smoke. Bearing in mind the consequence of smoking in pregnancy, this subgroup should get increased assistance to quit smoking before and during early pregnancy, as well as appropriate medical and social support.