Public and Private Healthcare: A perspective

At the onset, it should be stressed that the experiences garnered from personal recollections and cursory literature analysis should not be misconstrued as an expert opinion. That being said, having had the dubious pleasure of being processed through the healthcare systems across multiple continents, and with inputs from a wider global community may make for an engaging read. An egalitarian society ideally assumes healthcare for all. Indeed, the WHO posits that “…the highest attainable standard of health is a fundamental right of every human being”. A workable definition of private and public medical assistance is often blurred by the various attempts to subsidize healthcare. This is typically due to the government attempting to provide affordable healthcare without micromanaging the entire healthcare industry. Healthcare expenditure in Iceland has been carefully managed with academic inputs [1] which have led to consistently high rankings. Indeed, as of 2015 [2], the Icelandic healthcare system has been ranked to be the second-best in the world based on access to and quality of healthcare, taking into account also an estimate of "amenable mortality". This is a measure of deaths that could theoretically have been avoided by timely and effective health care.

Photo: Barði Benediktsson

Making a case for public healthcare

From the data [3, 4] then, and in the context of the data-driven and successful public healthcare responses [5] to the COVID-19 pandemic, it would appear that the discussion on public and private healthcare systems stalls with the conclusion that public healthcare is indeed superior. However, even in Iceland, the usage of complementary medicine has been on the rise [6]. Although these are in conjunction with and not to the exclusion of allopathy, it may serve as an indicator of the disconnect between requiring healthcare and receiving it. In spite of having a higher doctor-to-patient ratio compared to much of the world, comparisons can be and have been made [7] which indicate that even higher ratios (i.e. one GP per person) could further strengthen the public healthcare system and de-duplicate specialist efforts.

Privatization drivers

State-sponsored healthcare coverage (both partial and complete) may be a cornerstone of democratic nations, however, in most countries with a choice, the public sector is commonly perceived to be overburdened and less sensitive to personalized patient needs. The benefits of privatizing healthcare can be justified in terms of progressive efforts made to enhance the viability of a medical doctorate for practitioners while also providing the nation with a larger pool of medical professionals in times of need. This argument is trivially fallacious, however, and countries that veer strongly towards this model (e.g. the U.S.) tend to force their populace towards onerous contracts with employers who can provide the gold standard in such nations, “Occupational Healthcare”. As a concept, there are few more elitist ideals than that of privatized healthcare, where access is granted not in terms of need, but in terms of contractual obligations. In some sense, everyone wins out with private healthcare, it is accessible to those who can afford it and lucrative for those who can provide it. The only caveat, of course, is that large sections of society are left behind in the re-enactment of class-privilege structures. The social good caused by an inflexible system of equal opportunity in practice goes against the rat-race mentality enforced by modern merit-based economies; the core concept being that efforts (the accumulation of merit) are typically directly correlated to an increase in privilege (or access to more immediate medical attention in this situation).

Contextual comparisons

The privatization of healthcare in countries that are overburdened by a boundlessly increasing populace is often the only avenue open for residents wishing to avail themselves of complex specialist procedures, which are prohibitively expensive for public health care institutions. This need not necessarily be a major factor, as research, in particular, remains driven by public funding in most countries due to regulatory restrictions. It is not surprising that private agencies are often curtailed in R&D sectors. The relentless crush of an ailing populace also yields dividends, practitioners gain far more practical expertise. Cynical though this sounds, medicine is an applied practice, not wholly a theoretical one, and access to patients is key in medical training programs as well. Medical tourism, the practice of travelling to another country specifically with the intent of undergoing medical procedures, is also primarily facilitated by private institutions. This is mostly due to the fact that stringent checks of eligibility (defined liberally in terms of residence in Iceland) generally accompanies access to public healthcare. That all endeavours conceptually are improved in the limit of idealized governmental control is a foregone conclusion, almost by definition the ideal government shall take decisions in the best interest of its beneficiaries. 

The pandemic, however, has shone a harsher light on the private sector. In part due to the vaccination dissemination being largely controlled by the public sector, and due to the pandemic laws (variants of which are enforced in most countries), the private sector has often failed to provide the more immediate access for which it is best known. Personally, having been admitted every six months for everything from poisonings to broken limbs, occupational healthcare (and private healthcare in general) is the difference between being pronounced dead on arrival and being admitted into an intensive care unit. Life-threatening black humour aside, the acute shortage of medical facilities seen in the more public-focused nations rarely makes itself felt in countries where public healthcare is traditionally over-burdened, to begin with. For poorer nations with larger populations, the Icelandic public healthcare system, and variants thereof, remain a fever dream, inaccessible in the near future without the sudden injection of a massive amount of money.

References

[1] S. Ólafsson, "Welfare trends of the 1990s in Iceland," Scandinavian Journal of Public Health, vol. 31, no. 6, pp. 401–404, Dec. 2003. Accessed: Jan. 27, 2022. [Online]. Available: https://doi.org/10.1080/14034940310019489

[2] R. M. Barber et al., "Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990–2015: A novel analysis from the Global Burden of Disease Study 2015," The Lancet, vol. 390, no. 10091, pp. 231–266, Jul. 2017. Accessed: Jan. 27, 2022. [Online]. Available: https://doi.org/10.1016/s0140-6736(17)30818-8

[3] A. O. Sigurdardottir, A. W. Garwick, and E. K. Svavarsdottir, "The importance of family support in pediatrics and its impact on healthcare satisfaction," Scandinavian Journal of Caring Sciences, vol. 31, no. 2, pp. 241–252, Jun. 2016. Accessed: Jan. 27, 2022. [Online]. Available: https://doi.org/10.1111/scs.12336 

[4] H. Birgisdottir, R. I. Bjarnadottir, K. Kristjansdottir, and R. T. Geirsson, "Maternal deaths in Iceland over 25 years," Acta Obstetricia et Gynecologica Scandinavica, vol. 95, no. 1, pp. 74–78, Nov. 2015. Accessed: Jan. 27, 2022. [Online]. Available: https://doi.org/10.1111/aogs.12797 

[5] E. L. Sigurdsson et al., "How primary healthcare in Iceland swiftly changed its strategy in response to the COVID-19 pandemic," BMJ Open, vol. 10, no. 12, Dec. 2020, Art. no. e043151. Accessed: Jan. 27, 2022. [Online]. Available: https://doi.org/10.1136/bmjopen-2020-043151

[6] Gunnarsdottir, T. J., Örlygsdóttir, B., & Vilhjálmsson, R. (2019). The use of complementary and alternative medicine in Iceland: Results from a national health survey. Scandinavian Journal of Public Health, 48(6), 602-608. https://doi.org/10.1177/1403494819863529

[7] H. Sigurðsson, S. Gestsdóttir, K. G. Guðmundsson, and S. Halldórsdóttir, "Heimilislækningar á Íslandi og í Noregi: Reynsla lækna af ólíku fyrirkomulagi heilbrigðisþjónustu í löndunum tveimur," Læknablaðið, vol. 2017, no. 03, pp. 129–134, Mar. 2017. Accessed: Jan. 27, 2022. [Online]. Available: https://doi.org/10.17992/lbl.2017.03.127