For Whom Is the System? Surgeon Questions Iceland's Healthcare Priorities Amid Long Waits

A neurosurgeon is questioning the fundamental purpose of Iceland's healthcare system, arguing that long waiting lists have become an accepted part of public discourse but represent real individuals suffering daily from pain, disability, and uncertainty. Halldór Skúlason, a neurosurgeon, stated in an opinion piece for Morgunblaðið that healthcare should be a fundamental right, not a luxury. He contends that the system's goal must be timely treatment for those in need. When the system's organization and funding do not align with actual patient requirements, it is valid to ask who the system truly serves.

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For whom is the system actually?

Skúlason points out that the procedures covered by the Icelandic Health Insurance often fall short of the actual demand. He uses his own workplace, Læknastöðin í Orkuhúsinu, as an example, where approximately 250 to 300 surgeries for conditions like herniated discs and other back problems are needed annually. However, current agreements only allow for about 100 procedures. This disparity, he explains, inevitably lengthens waiting lists. He questions the logic of allocating funding for only 100 surgeries when the need is for 250 to 300, criticizing the practice of spreading this limited capacity throughout the year. This approach, he argues, does not solve the problem of unmet demand but rather extends wait times and risks creating a two-tier system where those who can pay receive immediate service.

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Healthcare is and should be a fundamental right, not a luxury.

The societal cost of these delays is significant, Skúlason writes. Patients endure severe pain and reduced ability to work, facing the risk of permanent health damage. A minor procedure that could lead to quick recovery and return to work can be delayed for months or even years, worsening conditions, diminishing recovery prospects, and increasing overall costs. He emphasizes that society loses out due to these long waits, as the cost of delayed treatment often exceeds the expense of timely intervention. Furthermore, if patients cannot receive necessary treatment within a reasonable timeframe in Iceland, they are entitled to seek it abroad at public expense, a significantly more costly option when travel, accommodation, and administrative fees are factored in.

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The goal of the system must be that those who need treatment receive it in a timely manner.

Skúlason criticizes the short-sightedness of investing heavily in specialist training only to limit their ability to practice. He warns that if doctors lack the flexibility to treat patients domestically, they will seek opportunities elsewhere, particularly in Nordic countries. Losing specialists due to systemic constraints represents a loss for the entire healthcare system and society. He asserts that efficiency in healthcare should not be measured solely by spreadsheets but by preventing chronic problems, keeping people in the workforce, and avoiding multiplied costs. The healthcare system, he concludes, should focus on patient needs, not systemic convenience, and calls for heeding the advice of doctors who have a clear overview of waiting list trends.

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In the procedure categories that the Icelandic Health Insurance negotiates, fewer procedures are repeatedly planned for than the need calls for.