Increase in copayments in healthcare is a bad message to working people
The Minister of Health has announced a 100% increase in patient copayments for primary care services, effective August 1, to meet the growing costs of the service amid demographic changes. The elderly, the disabled, and children will continue to pay no visit fee. In addition, on September 1, a special visit fee for physical therapy will be introduced, occupational therapy and speech therapy, which will be outside the health care co-payment system and will be in addition to the maximum amount patients pay for health services that fall within the system. The minister also announces that a working group will be established to re-evaluate the copayment system, where it will be specifically examined whether to make copayments in the healthcare system income-related.
Shifting the growing health care costs of the nation's elderly onto working people sends a bad message in the run-up to the evaluation of the terms of collective bargaining agreements at the end of next month and the complex situation facing the labor market. Ideas about tying service fees for basic public services to income are problematic and increase the risk of discrimination in access to services. Basic welfare services should be funded through a progressive tax system, not through means-tested fees that increase marginal tax rates on working people and reduce transparency and predictability.
Increased cost-sharing reduces equity in access
Direct cost-sharing by patients for health care services is one of the most significant factors determining equal access to services for all groups in society. Direct out-of-pocket spending by patients has increased in recent decades, and household health care spending has grown much more than public health care spending. Just over 15% of all health care spending in the country comes directly from patients' pockets. About a decade ago, direct out-of-pocket payments for patients in this country were the highest in the Nordic countries, with the exception of Finland, but the gap has been closing with the other countries, However, direct patient cost-sharing in the country decreased in 2021-2022, but that trend has reversed, and direct cost-sharing grew again in 2023-2024. Figures for those who forgo healthcare due to cost are much higher in Iceland than in neighboring countries.
Health care spending will not be funded by increased patient fees.
In 2017, fundamental changes were made to the copayment system for healthcare services in this country, where a cap was placed on patient costs for medical services, examinations, and training, Charging rules were simplified and equity among patient groups was increased. These systemic changes were a significant improvement and addressed harsh criticism, particularly from the ASÍ, about the excessive costs for the chronically ill and those who typically require extensive healthcare services, for which there had previously been no cap. However, medications are still in a separate cost-sharing system, and psychological services are, Dental care and travel costs for those who must travel long distances for services are among the items that fall outside the system, and the costs for these are therefore added to the maximum cost within the general co-payment system. One of ASÍ's main criticisms of the new copayment system was that it was, in practice, primarily a transfer of costs between groups, while groups that need to use a lot of healthcare services are better protected, charges, however, increased for the vast majority of users who need occasional services. The overall patient share of healthcare costs was thus unchanged, and costly services remained out-of-pocket. A review of the copayment system is well-timed, and there is every reason to review and analyze the experience of the past 10 years. ASÍ now states, as before, its readiness for constructive participation in such work but rejects ideas of financing basic welfare services by increasing direct charges on working people.
News taken from ASÍ homepage