landspÍtali – university hospital - gísli einarsson, md. ph.d. chief executive of r&d –...

LANDSPÍTALI – UNIVERSITY HOSPITAL - Gísli Einarsson, MD. Ph.D. Chief Executive of R&D – Turku August 2004

UNIVERSITY-HOSPITAL UNIVERSITY-HOSPITAL MERGER IN ICELANDMERGER IN ICELAND

Gisli Einarsson M.D. Ph.D.Gisli Einarsson M.D. Ph.D.

Asisstant professorAsisstant professor

Chief Executive of Education Research & DevelopmentChief Executive of Education Research & Development

Specialist in General Surgery and Medical RehabilitationSpecialist in General Surgery and Medical Rehabilitation


Public Administration in IcelandPublic Administration in Iceland

Two Levels of Executive PowerTwo Levels of Executive Power

State Level: < 300.000 peopleState Level: < 300.000 people Almost all Health CareAlmost all Health Care Schools higher than Ground School – University Education Schools higher than Ground School – University Education

(including University of Iceland)(including University of Iceland)

MunicipalitiesMunicipalities Nursing HomesNursing Homes Ground School (first ten years)Ground School (first ten years)


Landspítali – University HospitalLandspítali – University Hospital

Landspítali is the largest organization in Landspítali is the largest organization in Iceland in terms of employees, with Iceland in terms of employees, with approximately 5000 employees (3900 f.t.e)approximately 5000 employees (3900 f.t.e)

The hospital is located around Reykjavík and The hospital is located around Reykjavík and vicinity. The main activities are concentrated vicinity. The main activities are concentrated at two sites three kilometers apart.at two sites three kilometers apart.

In-patient days around 300 thousand pr. year. In-patient days around 300 thousand pr. year.


Landspítali – University HospitalLandspítali – University Hospital

Patient bedsPatient beds 900900 ER visitsER visits 75.000 75.000 Visits; Day-care unitsVisits; Day-care units 100.000 100.000 Visits; Out-patientsVisits; Out-patients 220.000 220.000 X-ray, MRI, CT etc. investigations X-ray, MRI, CT etc. investigations 105.000 105.000 OperationsOperations 15.000 15.000 Clin.investigations (bact/im/path. etc) 1.400.000Clin.investigations (bact/im/path. etc) 1.400.000


Only University Hospital in Iceland and Only University Hospital in Iceland and County hospital for 2/3 – 3/4 of the County hospital for 2/3 – 3/4 of the populationpopulation

Advantage:Advantage: Uniformity in services and teachingUniformity in services and teaching Best utilization of resourcesBest utilization of resources

Drawbacks: Drawbacks: Lack of CompetitionLack of Competition ComplacencyComplacency

IneffectivityIneffectivity

Demands great vigilance to foreign Demands great vigilance to foreign comparisoncomparison


ResultsResults

Enlargement and strengthening of specialitiesEnlargement and strengthening of specialities-better subspecialist services, fewer on-call lines-better subspecialist services, fewer on-call lines

Decreased overhead / administrationDecreased overhead / administration-one executive board, reduced nursing administration, fewer doctors in--one executive board, reduced nursing administration, fewer doctors in-

chiefchief

Better utilization of housing and equipmentBetter utilization of housing and equipment Increased productivity Increased productivity Shorter waiting-listsShorter waiting-lists Improved economyImproved economy


ResultsResults

Increased productivityIncreased productivity Surgical operations up 3% in 2003, 2,9% January-July 2004Surgical operations up 3% in 2003, 2,9% January-July 2004 Cardiac interventions eliminated waiting-lists in 2003-2004Cardiac interventions eliminated waiting-lists in 2003-2004 Decreased in-patient length of stay (just under 5 days July 2004)Decreased in-patient length of stay (just under 5 days July 2004) Faster turn-over (arrivals/discharges)Faster turn-over (arrivals/discharges) Almost 10 % increase in out-patient visitsAlmost 10 % increase in out-patient visits

Shorter waiting-listsShorter waiting-lists Eliminated in cardiologyEliminated in cardiology Almost eliminated in orthopedicsAlmost eliminated in orthopedics Decreased considerably in eye-surgery (operations up 16% in-patient and 42% in Decreased considerably in eye-surgery (operations up 16% in-patient and 42% in

day-care)day-care)


ResultsResults

Improved economyImproved economy Decreased number of f.t.e. by 2.9 % 2003-2004Decreased number of f.t.e. by 2.9 % 2003-2004

Total expenditures in constant money valueTotal expenditures in constant money value 1999-2004: 1999-2004: 1999-2000 -0.9 %1999-2000 -0.9 % 2000-2001 -1.4 %2000-2001 -1.4 % 2001-2002 +1.8 %2001-2002 +1.8 % 2002-2003 +2.5 %2002-2003 +2.5 % 2003-2004 -3.0 %2003-2004 -3.0 %


DevelopmentDevelopment

Out-patient/day-care policy Out-patient/day-care policy completed 2004completed 2004

DRG-evaluation completed 2004DRG-evaluation completed 2004 Health department committee Health department committee on the role and on the role and

interaction of the two acute-care hospitals and out-patient interaction of the two acute-care hospitals and out-patient services including primary care and privately run out-patient services including primary care and privately run out-patient seervices (380.000 visits)seervices (380.000 visits)

Co-operation agreement with The University Co-operation agreement with The University of Iceland in 2001 and 2002of Iceland in 2001 and 2002


ProblemsProblems

Role of small community HospitalsRole of small community Hospitals

Nursing HomesNursing Homes

Local CompetitionLocal Competition

Inadequate funding for both main roles of the Inadequate funding for both main roles of the HospitalHospital

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