Since 2020, I have been documenting my experiences with healthcare systems, both in the United States (How to Get the Right Diagnosis: 16 Tips for Navigating the Healthcare System) and in Iceland (Article in Analytical Insider, October 2021).
Unfortunately, I was hospitalized earlier this month, and while a health crisis is never welcome, it provided an opportunity to once again apply my expertise to healthcare analysis. Having recently been to a hospital in both Iceland and the United States, I decided to assess the extent to which the US healthcare system emulates Icelandic best practices. My disappointing conclusion is that the US system is inadequate in many respects, mainly for structural reasons.
My observations below are based on anecdotal evidence, but I suspect they reflect common experiences across the country because they are largely structural in nature. Iceland’s top five practices are:
Over-specialization. During my stay in Iceland, I was seen by doctors from nine specialties, but I was impressed by the willingness of these doctors to think outside their field of expertise. Icelandic doctors said they feel the medical system empowers them to consider the wider context of someone’s condition and can focus on the correct diagnosis.
Unfortunately, American doctors are often unable to think outside the box of their specialty for fear of litigation and financial/professional damage.
Key assumptions. In complex cases, it is important not to discard the hypothesis prematurely. In Iceland, two initial assumptions that made sense turned out to be wrong, and one that seemed implausible turned out to be right. The team discovered these errors because a culture was in place where anyone—regardless of position—could ask questions and challenge professional judgment.
In the United States, complex health care is in the hands of specialists who rarely challenge the opinions of other doctors, especially if that doctor represents another discipline. For example, pulmonologists are reluctant to dispute cardiologists, but infectious disease specialists do not outwardly dispute the recommendations of a rheumatologist. Many are even reluctant to question senior doctors in their discipline. For legal and administrative reasons, physicians face strong disincentives to question another physician’s key assumptions or analysis.
Listening. In Iceland, the first question doctors and nurses ask me is “How are you feeling?” When I mentioned a symptom that didn’t fit their pattern of what could be wrong, they investigated the discrepancy and didn’t ignore it.
In the United States, almost all doctors and nurses wanted more time to deal with inconsistent data, but they simply didn’t have the time. I’ve seen them actively manage how much time they can take to listen (often limited to 10-15 minutes) versus dodging me to get through a daunting caseload. My experience with healthcare in the US is that healthcare providers are incentivized to increase revenue by processing more cases faster.
Several hypotheses. In Iceland, doctors and nurses worked as a team to create a list of possible alternative diagnoses (think of the TV show House). Instead of testing the hypotheses in a serial fashion, they performed a synchronous evaluation. As a result, the diagnostic process was much more efficient.
Hospitals in the United States are similarly inclined to consider multiple potential diagnoses, but are more likely to test each hypothesis sequentially to minimize risk and legal liability. In my experience, outpatient care is based almost entirely on a sequential treatment model.
Cooperation. What impressed me about Iceland was the strong culture of cooperation demonstrated by everyone involved in my case. At least three times, a team of doctors, nurses and even technicians met to review diagnoses, decide on the best treatment and estimate a discharge date. In 18 days, I was visited by 12 doctors, and the transfer of knowledge was smooth and comprehensive. They were able to work together so effectively probably because their system was not driven by the need to optimize revenue generation.
I was also treated by a group of 12 doctors in the United States earlier this month, but they had to work harder to cooperate. Many structural barriers had to be overcome, including difficulties in sharing information across different data systems, communication and engagement of outpatient consultants with inpatient physicians, and administrative requirements for physicians to stay within their procedural lanes.
In short, my most recent medical emergency reinforced my concerns — shared by most of the doctors and nurses I consulted — that the American system is fundamentally and structurally broken. The increasing challenges facing doctors and nurses in the United States are driving many to leave the profession. They do not believe that the system will be improved; too many are literally counting the days until they can retire. The implications of the Supreme Court’s decision to overturn Roe v. Wade for the practice of medicine will seriously exacerbate this problem.
Learn what you can do as a patient to help overcome these challenges by reading my book Getting the Right Diagnosis: 16 Tips for Navigating the Medical System.
Does European health insurance card work in Iceland?
Most people cannot use a European Health Insurance Card (EHIC) or a UK-issued Global Health Insurance Card (GHIC) for treatment in Iceland.
What happens if I get sick in Iceland?
Emergencies: For emergencies in Iceland, call 112. If you get sick, you can usually just call or go to the nearest hospital or health center. Health: Icelanders are blessed with a very healthy environment. Due to the use of geothermal and hydroelectric energy, pollution is almost negligible.
How much does health insurance cost per month for a single person here? In 2020, the national average cost of health insurance is $456 for an individual and $1,152 for a family per month. However, costs vary among the wide selection of health plans. Read also : As another football season begins, the mental health crisis permeates the fabric of college sports. Understanding the relationship between health coverage and costs can help you choose the right health insurance for you.
Who is best health insurance provider?
Top 10 Health Insurance Companies in India Read also : MDHHS forms 11 Regional Health Equity Advisory Councils to combat health disparities among high-risk and underserved communities.
- Care Health Insurance (formerly Religare Health Insurance)
- Manipal Health Insurance Company Cigna Limited.
- Bajaj Allianz Health Insurance Company Limited.
- New India Assurance Company Limited.
- Oriental Insurance Company Limited.
- National Insurance Company Limited.
Which country has free healthcare?
Countries with universal healthcare are Austria, Belarus, Bulgaria, Croatia, Czech Republic, Denmark, Finland, France, Germany, Greece, Iceland, Isle of Man, Italy, Luxembourg, Malta, Moldova, Norway, Poland, Portugal, Romania, Russia, Serbia , Spain, Sweden, Switzerland, Ukraine and the United Kingdom. See the article : Local health officials are dealing with an epidemic of monkeypox in New York City.
Which countries do not pay for healthcare? Here are ten notable countries that still lack universal health care.
- Syria.
- Yemen. …
- Afghanistan. …
- Pakistan. …
- Nigeria. …
- Egypt. …
- Iran. Most Iranians now receive health care services through the public sector. …
- South Africa. South Africa is working towards a universal health care model. …
Is healthcare free in the US?
The US government does not provide health benefits to citizens or visitors. Every time you get medical care, someone has to pay for it. Healthcare is very expensive. According to the US government website, if you break your leg, you could end up with a $7,500 bill.
Is college free in Iceland?
Tuition fees in Iceland Public universities in Iceland do not charge tuition fees, only small application and enrollment fees. Even private universities such as the University of Reykjavík have comparably modest tuition fees in international comparison. However, the cost of living in Iceland is very high.
Is the University of Iceland a good school? The University of Iceland is ranked 434th among the world’s best universities. Schools are ranked according to their performance against a set of generally accepted indicators of excellence.
Does Iceland have good education?
In a 2016 study, Iceland was ranked the third most literate country in the world, behind Finland and Norway. About 332,000 people live in the small island nation. Iceland is known for being progressive. Its efforts for equality can be seen in the structure of the education system.
Does Iceland accept international students?
In Iceland, international students are allowed to work while completing their degree. However, the number of hours they are allowed to work may vary depending on their country. Students with EEA/EFTA citizenship do not need to obtain a work permit to work.
Is ielts required to study in Iceland?
At the University of Iceland, only a few undergraduate programs are taught in English. The minimum score for most of these programs is TOEFL 79, IELTS 6.5 or PTE Academic 58, please note the exceptions below.
