Iceland: Country Health Profile 2019

24 Pages·2019·2.939 MB·English

by  ;

State of Health in the EU
Iceland IS
Country Health Profile 2019
The Country Health Profile series Contents
The State of Health in the EU’s Country Health Profiles 1. HIGHLIGHTS 3
provide a concise and policy-relevant overview of 2. HEALTH IN ICELAND 4
health and health systems in the EU/European Economic
3. RISK FACTORS 7
Area. They emphasise the particular characteristics and
4. THE HEALTH SYSTEM 9
challenges in each country against a backdrop of cross-
country comparisons. The aim is to support policymakers 5. PERFORMANCE OF THE HEALTH SYSTEM 12
and influencers with a means for mutual learning and 5.1. Effectiveness 12
voluntary exchange.
5.2. Accessibility 15
The profiles are the joint work of the OECD and the 5.3 Resilience 18
European Observatory on Health Systems and Policies, 6. KEY FINDINGS 23
in cooperation with the European Commission. The team
is grateful for the valuable comments and suggestions
provided by the Health Systems and Policy Monitor
network, the OECD Health Committee and the EU Expert
Group on Health Information.
Data and information sources The calculated EU averages are weighted averages of
the 28 Member States unless otherwise noted. These EU
The data and information in the Country Health Profiles averages do not include Iceland and Norway.
are based mainly on national official statistics provided
to Eurostat and the OECD, which were validated to This profile was completed in August 2019, based on
ensure the highest standards of data comparability. data available in July 2019.
The sources and methods underlying these data are
To download the Excel spreadsheet matching all the
available in the Eurostat Database and the OECD health
tables and graphs in this profile, just type the following
database. Some additional data also come from the
URL into your Internet browser: http://www.oecd.org/
Institute for Health Metrics and Evaluation (IHME), the
health/Country-Health-Profiles-2019-Iceland.xls
European Centre for Disease Prevention and Control
(ECDC), the Health Behaviour in School-Aged Children
(HBSC) surveys and the World Health Organization
(WHO), as well as other national sources.
Demographic and socioeconomic context in Iceland, 2017
Demographic factors Iceland EU
Population size (mid-year estimates) 343 000 511 876 000
Share of population over age 65 (%) 14.0 19.4
Fertility rate¹ 1.7 1.6
Socioeconomic factors
GDP per capita (EUR PPP²) 39 100 30 000
Relative poverty rate³ (%) 8.8 16.9
Unemployment rate (%) 2.8 7.6
1. Number of children born per woman aged 15-49. 2. Purchasing power parity (PPP) is defined as the rate of currency conversion that equalises the
purchasing power of different currencies by eliminating the differences in price levels between countries. 3. Percentage of persons living with less than 60 %
of median equivalised disposable income.
Source: Eurostat Database.
Disclaimer: The opinions expressed and arguments employed herein are solely those of the authors and do not necessarily reflect the official views of
the OECD or of its member countries, or of the European Observatory on Health Systems and Policies or any of its Partners. The views expressed herein
can in no way be taken to reflect the official opinion of the European Union.
This document, as well as any data and map included herein, are without prejudice to the status of or sovereignty over any territory, to the delimitation
of international frontiers and boundaries and to the name of any territory, city or area.
Additional disclaimers for WHO are visible at http://www.who.int/bulletin/disclaimer/en/
© OECD and World Health Organization (acting as the host organisation for, and secretariat of, the European Observatory on Health Systems and
Policies) 2019
2 State of Health in the EU · Iceland · Country Health Profile 2019
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1 Highlights
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The life expectancy of the Icelandic population is well above the EU average and the health status of the
population is generally good, although there are important socioeconomic inequalities. Behavioural risk factors
are implicated in more than one-third of all deaths in Iceland, with poor nutrition and growing obesity rates of
particular concern. The Icelandic health system performs relatively well in providing good access to high-quality
care, but disparities exist between income groups in terms of unmet needs. An important challenge is to
strengthen the primary care system and the gatekeeping role of general practitioners to better respond to the
growing burden of chronic diseases.
IS EU Health status
83
82.6 Life expectancy at birth in Iceland increased by nearly three years
81 80.9 between 2000 and 2017 to reach 82.6 years, almost two years above the
79.7
79 EU average. Reductions in deaths from ischaemic heart disease and stroke
77 77.3 drove these gains. However, inequalities in life expectancy by education
75 level have widened since 2011 as the gains among the least educated
2000 2017
lagged behind the gains of the higher educated.
Life expectancy at birth, years
IS EU Risk factoCrosuntry
%01 %01EU
% of adults More than one in four Icelandic adults (27 %) were obese in 2017, a rate
higher than in any EU country. However, tobacco and alcohol consumption
Smoking 9 %
are among the lowest. Less than one in ten adults smoke daily – half the
19
Obesity 27 % rEaUte of EU countries. Icelandic adults also have one of the lowest levels of
15 aColcuonthryol consumption in Europe, at about 20 % less than the average in EU
Alcohol 7.7 litres countries.
10
IS EU Health system
EUR 3000
Health spending per capita in Iceland has been similar to the average
EUR 2000 in the EU in recent years, but accounts for a lower share of GDP. Public
expenditure accounted for 82 % of health expenditure in 2017, slightly
Smoking 17
EUR 1 000
above the EU average of 79 %. Most of the remaining spending is paid out of
2005 2011 2017
pocket by households, primarily for pharmaceutical and dental expenses.
BingPee rd crainpkiitnag spe2n2ding (EUR PPP)
ObeEsiftyfectiven21ess Accessibility Resilience
Preventable mortality is low, Icelanders generally report low Health expenditure
reflecting the effectiveness of unmet needs for medical care, is expected to grow
prevention policies. Treatable although disparities between in the future because
causes of mortality are also income groups are larger than the of population
much lower than the EU average, EU average and any other Nordic ageing and new
indicating that the health system country. Waiting times for elective technologies. Progress has been
provides effective acute care for surgery have been reduced, but achieved in improving efficiency
potentially fatal conditions. remain higher than in many EU in hospital care and transferring
countries. simpler services from hospitals
Country
Preventable 139 EU High income All Low income to primary care and other care
mortality providers, but the primary care
IS system faces the challenge of
Treatable 62
mortality IS EU EU responding to growing demands
from population ageing in
Age-standardised mortality rate
0% 3% 6% innovative and efficient ways.
per 100 000 population, 2016
% reporting unmet medical needs, 2016
State of Health in the EU · Iceland · Country Health Profile 2019 3
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2 Health in Iceland
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Life expectancy in Iceland is higher than However, the progress in life expectancy since 2000
the EU average, but gains are slowing has been slower than in some EU countries that now
have a higher life expectancy (Spain, Italy and France).
Life expectancy at birth in Iceland increased over the On average, women live 3.2 years longer than men
last decade to reach 82.6 years in 2017, almost two (84.3 compared to 81.1 years), although this gender
years above the EU average of 80.9 years (Figure 1). gap is smaller than the EU average of 5.2 years.
Figure 1. Life expectancy at birth in Iceland is more than one year above the EU average
Years 2017 2000
90 –
Gender gap:
4 Iceland: 3.2 years
85 – 83. 83.1 82.7 82.7 82.6 82.5 82.4 82.2 82.2 82.1 81.8 81.7 81.7 81.6 81.6 81.4 81.3 81.2 81.1 81.1 80.9 EU: 5.2 years
9.1 4
80 – 7 78. 78 77.8 7.3
7 8
76 75. 75.3 74.9 74.8
75 –
70 –
65 –
Spain ItalyFranceNorwaIycelanSdweden MaltaCyprusIrLeluaxnedmbNoeturhgerlandsAustriaFinlanBdelgiuPmortuganlitGreed ecKiengdoSlmoveniGaermanDyenmark EUCzechiaEstoniaCroatiaPolanSldovakiHaungaLrityhuaniRaomaniaLatviBaulgaria
U
Source: Eurostat Database.
Social inequalities in life Figure 2. The education gap in life expectancy is
about 5 years for men and 3.5 years for women
expectancy are widening

Inequalities in life expectancy in Iceland exist not
only by gender but also by socioeconomic status,

including education and income level. In 2018, the life

expectancy of men at age 30 with the lowest level of 56.2
education was almost five years lower than for those y5e2a.6rs years 48.8 y5e3a.7rs

years
with the highest level. This education gap in longevity
was smaller among women, at 3.6 years (Figure 2).

Between 2011 and 2018, the gap between those most Lower Higher Lower Higher
and least educated widened by 1.5 years, as there was educated educated educated educated
women women men men
virtually no gain among the least educated (Statistics
Education gap in life expectancy at age 30:
Iceland, 2019).
Iceland: 3.6 years Iceland: 4.9 years
This education gap in life expectancy can be EU21: 4.1 years EU21: 7.6 years
explained partly by differences in exposure to
Note: Data refer to life expectancy at age 30. High education is defined
various risk factors and lifestyles, including higher as people who have completed tertiary education (ISCED 5-8) whereas
smoking rates, poorer nutritional habits and higher low education is defined as people who have not completed secondary
education (ISCED 0-2).
obesity rates among men and women with low Sources: Statistics Iceland (data refer to 2018) and Eurostat Database for
levels of education (see Section 3).It is also related the EU average (data refer to 2016).
to differences in income level and living standards,
which affect exposure to other risk factors and access
to health care.
4 State of Health in the EU · Iceland · Country Health Profile 2019
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The main cause of death in Iceland remains Mortality rates from Alzheimer’s disease have N
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ischaemic heart disease, but mortality increased greatly since 2000, making this the second L
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from Alzheimer’s disease is increasing cause of death in Iceland, although the increase is C
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due at least partly to improvements in diagnosis and
The mortality rate from ischaemic heart disease changes in death registration practices.
decreased substantially between 2000 and 2016
Lung cancer is still the most frequent cause of death
(Figure 3), partly due to a reduction in tobacco
by cancer, followed by colorectal cancer and prostate
consumption (see Section 3). Nevertheless, 13 % of all
cancer.
deaths in Iceland in 2016 were attributed to ischaemic
heart disease.
Figure 3. Cardiovascular diseases are still the leading causes of death in Iceland
% change 2000-16 (or nearest year)
100
Pancreatic cancer Alzheimer’s disease
50
Breast cancer Lung cancer
Colorectal cancer
0
20 40 80 100 120 140
Prostate cancer Chronic obstructive pulmonary disease
-50
Pneumonia
Stroke
Ischaemic heart disease
-100
Age-standardised mortality rate per 100 000 population, 2016
Note: The size of the bubbles is proportional to the mortality rates in 2016. The increase in mortality rates from Alzheimer’s disease is largely due to changes
in diagnostic and death registration practices.
Source: Eurostat Database.
Most Icelandic people report being in good Figure 4. Inequalities in self-rated health by income
level are similar to the EU average
health, but disparities by income group persist
Low income Total population High income

Three-quarters of people report being in good health, Ireland
a higher proportion than the EU average of 70 %. Cyprus
Norway
However, as in other countries, people on lower Italy1
Sweden
incomes are less likely to report being in good health:
Netherlands
70 % in the lowest income group report being in good Iceland
Malta
health, compared to 84 % in the highest (Figure 4). United Kingdom
Belgium
Spain

Greece1
Denmark
Luxembourg
Romania1
Austria
Finland
EU

France
Slovakia
Bulgaria
Germany
Slovenia
Czechia

Croatia
Hungary
Poland
Estonia
Portugal
Latvia

Lithuania
0 20 40 60 80 100
% of adults who report being in good health
Note: 1. The shares for the total population and the population on low
incomes are roughly the same.
Source: Eurostat Database, based on EU-SILC (data refer to 2017, except
for Iceland 2016).
State of Health in the EU · Iceland · Country Health Profile 2019 5
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N Several years of life in old age are lived with In 2017, Icelanders aged 65 could expect to live
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L some diseases and disabilities more than 20 years, with women expected to live an
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C additional 21.4 years and men a further 19.8 years
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The share of people aged 65 and over is steadily (Figure 5). However, this gender gap is reversed when
growing in Iceland because of rising life expectancy it comes to the number of years lived with disability
and declining fertility rates. In 2019, 14 % of people because women live a greater proportion of their lives
were aged 65 and over, up from 10 % in 1980, and this with chronic diseases and disabilities. Women aged 65
is projected to reach 25 % by 2050. and over are also more than twice as likely as men to
report depressive symptoms.

Figure 5. Two-thirds of Icelanders aged 65 or over report a functional limitation
Life expectancy at age 65
Women Men
4.3
6.3
21.4 19.8
years years
15.1
15.5
Years without Years with
disability disability
% of people aged 65+ reporting % of people aged 65+ reporting limitations
functional limitations1 in activities of daily living (ADL)2
Women Men Women Men
19% 13%
27%
33%
44% 48%
29% 19% 82% 87%
No limitations Some limitations No limitation At least one
in ADL limitation in ADL
Severe limitations
% of people aged 65+ reporting depression symptoms3
Women Men
11% 5%
Note: 1. Functional limitations include physical and sensory limitations (seeing, hearing and walking). 2. Basic activities of daily living include dressing,
walking across a room, bathing or showering, eating, getting in or out of bed and using the toilet. 3. Based on the PHQ-8 index, people are considered to
have depression symptoms if they report two or more depression-related problems (out of eight variables).
Source: Eurostat Database for life expectancy with and without disability (data refer to 2017); European Health Interview Survey for other indicators (data
refer to 2015).
6 State of Health in the EU · Iceland · Country Health Profile 2019
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3 Risk factors
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Behavioural risk factors account for more consumption (including direct and second-hand
than one-third of all deaths in Iceland smoking) was responsible for an estimated 15 % of
all deaths. In contrast, alcohol consumption was
Behavioural risk factors contribute to more than estimated to be responsible for only 1 % of deaths,
one-third of all deaths in Iceland (Figure 6). Dietary far lower than the EU average of 6 %. Low physical
risks contributed to more than one in six of all deaths activity was estimated to be responsible for 3 % of
in 2017, including low fruit and vegetable intake, as deaths, the same as the EU average.
well as high sugar and salt consumption. Tobacco
Figure 6. More than one in three deaths in Iceland are attributed to modifiable lifestyle risk factors
Dietary risks Tobacco Low
Iceland: 17% Iceland: 15% physical
EU: 18% EU: 17% activity
Iceland: 3%
EU: 3%
Alcohol
Iceland: 1%
EU: 6%
Note: The overall number of deaths (800) related to these risk factors is lower than the sum of each one taken individually (850), because the same death
can be attributed to more than one risk factor. Dietary risks include 14 components such as low fruit and vegetables diet, high sugar-sweetened beverages
consumption; and tobacco include smoking and second-hand smoking.
Source: IHME (2018), Global Health Data Exchange (estimates refer to 2017).
Overweight and obesity rates are higher In contrast, one in five (19.5 %) of 15-year-olds engage
in Iceland than in most EU countries in moderate to vigorous physical activity, which is
higher than the EU average (15 %) although there
Obesity results in a higher risk of hypertension, is a stark difference between the rates of physical
diabetes, heart attack and other cardiovascular activity in girls (14 %) and boys (25 %). Despite regular
diseases, and is also a risk factor for some forms of physical activity being more frequent in Icelandic
cancer. Obesity rates among Icelandic adults have children, as well as adults, than in most EU countries,
increased over the past decade, from 12 % in 2002 poor nutritional habits are likely to contribute to
to 27 % in 2017. One in five 15-year-old Icelandic boys obesity rates. In 2017, nearly half of adults reported
and girls were overweight or obese in 2013-14, the that they do not even eat a single portion of fruit
third highest rate in Europe. every day, a higher proportion than in most EU
countries. The proportion of adults who report not
eating a portion of vegetables per day is lower (about
one-third) and close to the EU average (Figure 7).
State of Health in the EU · Iceland · Country Health Profile 2019 7
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N Adolescent tobacco and excessive alcohol binge drinking1) during the past month in 2015, the
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L consumption rates are very low lowest rate in Europe. Icelandic adults also consume
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C much less alcohol compared to most EU countries.
I The smoking rate in adolescents is lower in Iceland
The low rates of tobacco and excessive alcohol
than in any EU country, with only 5 % of 15- and
consumption among adolescents are partly
16-year-old boys and 7 % of girls reporting that they
attributable to Iceland’s prevention approach, which
had smoked cigarettes in the past month in 2015. This
was launched in the late 1990s. This initiative sought
rate has been steadily decreasing since 1995. Among
to strengthen community protective factors, including
Icelandic adults, less than 10 % reported smoking
parental monitoring, parental communication,
daily in 2018 – a share that is among the lowest in
social involvement and adolescent participation in
Europe. However, the proportion of smokers among
organised sports to decrease risk factors (Kristjansson
the population with limited education is more than
et al., 2016).
double that among the highly educated population.
Excessive alcohol consumption is also more limited in
Iceland than in many EU countries. Around 7 % of 15-
and 16-year-old boys and 8 % of girls reported at least
one episode of heavy alcohol drinking (also called
Figure 7. Obesity is a major public health issue in Iceland
Smoking (children)
Vegetable consumption (adults) 6 Smoking (adults)
Fruit consumption (adults) Binge drinking (children)
Physical activity (adults) Alcohol consumption (adults)
Physical activity (children) Overweight and obesity (children)
Obesity (adults)
Note: The closer the dot is to the centre, the better the country performs compared to other EU countries. No country is in the white ‘target area’ as there is
room for progress in all countries in all areas.
Source: OECD calculations based on ESPAD survey 2015 and HBSC survey 2013-14 for children indicators; and EU-SILC 2017, EHIS 2014 and OECD Health
Select dots + Effect > Transform scale 130%
Statistics 2019 for adults indicators.
1: Binge drinking is defined as consuming five or more alcoholic drinks on a single occasion for children and adolescents.
8 State of Health in the EU · Iceland · Country Health Profile 2019
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4 The health system
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Iceland has a state-centred system clinics and enter into contract-based fee-for-service
with universal coverage payments with the Icelandic Health Insurance
Agency, which is the main public purchaser of
The health system in Iceland is mostly publicly services. A new health care policy has recently been
funded, covering all residents, with a partly integrated adopted that seeks to address many of these issues –
purchaser-provider relationship (a tax-based, emphasising the gatekeeping role of primary care and
state-run system). There are seven health care regions the importance of integration across the health care
and the national health insurance system is financed system as well as value-based financing.
through the annual national budget.
Iceland spends more than the EU average per
The private sector has grown rapidly person on health, but less as a share of GDP
While most health care providers are public, the Health expenditure per capita in Iceland is
number and scope of private non-profit and private slightly higher than the EU average, but lower as a
for-profit providers has increased in recent years. percentage of GDP (Figure 8). Health spending per
This has made health care provision more diverse capita amounted to EUR 3 055 in 2017 (adjusted for
and fragmented and has resulted in the need for differences in purchasing power), slightly above the
regulation and contracting. In the absence of the EU average of EUR 2 884. However, Iceland spent 8.3 %
primary care sector exercising a gatekeeping role, of its GDP on health, much less than the EU average
medical specialists were able to set up private of 9.8 %.
Figure 8. Health expenditure per capita in Iceland is slightly higher than the EU average, but lower as a share
of GDP
Government & compulsory insurance Voluntary schemes & household out-of-pocket payments Share of GDP
EUR PPP per capita % of GDP
5 000 12.5
4 000 10.0
3 000 7.5
2 000 5.0
1 000 2.5
0 0.0
NorwaGyermanyAustriSawNeedtehnerlanDdsenmarkFLruaxnecembourBgelgiumIrelanIdcelaUnndiFitenlda nKidngdom EU Malta ItalySpainCzechiSlaoveniPaortugalCyprusGreecSleovakLiitahuaniaEstoniaPolanHdungarByulgariaCroatiaLatviRaomania
Source: OECD Health Statistics 2019 (data refer to 2017).
Most health spending is publicly funded – almost 17 % of health expenditure in 2017 –
slightly above the EU average of almost 16 %. These
Public expenditure accounts for the bulk of health are mainly co-payments for primary care visits,
expenditure in Iceland, amounting to almost 82 % dental care and pharmaceuticals, but reductions
of current health expenditure in 2017, above the or exemptions are provided to vulnerable groups.
EU average (79 %). Out-of-pocket (OOP) payments Inpatient care is free of charge, as are all tests and
accounted for nearly all of the remaining spending medications required during hospitalisation.
State of Health in the EU · Iceland · Country Health Profile 2019 9
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N A large share of funding goes to inpatient share than the EU average of 16 %. Through a range
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L and outpatient care, but little to prevention of measures, Iceland has brought down the share it
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C spends on pharmaceuticals and medical devices from
I Iceland spends the largest share of its health more than 18 % in 2010 to 14 % in 2017. Only 2.5 % of
resources on inpatient and outpatient care, health spending was allocated to prevention in 2017
allocating to each slightly more than 30 % of the (below the EU average of 3.1 %).
total (Figure 9). In 2017, it also spent one-fifth (20 %)
of health expenditure on long-term care, a larger
Figure 9. Inpatient and outpatient care are the two main expenditure categories
EUR PPP per capita Iceland EU
1 200
32% 31%
1 000 sopfe tnodtianlg sopfe tnodtianlg
958 946
800 835 858 20%
of total
spending
600
611 14%
of total
spending 522
400 471
414
200 2.5%
of total
spending
0 7777 89
0 0 0 0 0
Inpatient care1 Outpatient care2 Long-term care3 Pharmaceuticals Prevention
and medical devices4
Note: Administration costs are not included. 1. Includes curative-rehabilitative care in hospital and other settings; 2. Includes home care; 3. Includes only the
health component; 4. Includes only the outpatient market.
Source: OECD Health Statistics 2019; Eurostat Database (data refer to 2017).
The number of doctors and nurses after-hour services. There are also private PCCs, which
is higher than the EU average provide the full range of primary care services based
on a contract with the Icelandic Health Insurance
Iceland has a high number of doctors and nurses Agency.
per capita compared to the EU average (Figure 10).
However, a large share of doctors are specialists, with Iceland has a comparatively high number of nurses,
general practitioners (GPs) accounting for only one including both registered professional nurses and
in six doctors in 2017 (16.5 %), compared to an EU associate practical nurses. However, the demand
average of more than one in four (27 %). The high for nurses is increasing rapidly due to population
number of specialists compared to GPs results in ageing and the resultant increased demand for their
higher visit rates to specialists compared to other services in both hospitals and nursing homes. Training
Nordic countries. and recruiting sufficient numbers of new nursing
professionals has proved challenging, exacerbated by
In the absence of a GP gatekeeping and referral a considerable proportion of the nursing workforce
function, the primary care sector is relatively weak. approaching retirement (Icelandic National Audit
The first point of contact is often a private medical Office, 2017).
specialist. Nevertheless, there are public primary care
centres (PCCs) throughout the country, where GPs are
salaried. These centres offer a broad range of primary
care services, including home nursing, school nursing,
health promotion and disease prevention, as well as
10 State of Health in the EU · Iceland · Country Health Profile 2019