1. LANDSPÍTALI – UNIVERSITY HOSPITAL - Gísli Einarsson, MD. Ph.D. Chief Executive of R&D – Turku August 2004 UNIVERSITY-HOSPITAL MERGER IN ICELAND Gisli Einarsson M.D. Ph.D. Asisstant professor Chief Executive of Education Research & Development Specialist in General Surgery and Medical Rehabilitation

2. LANDSPÍTALI – UNIVERSITY HOSPITAL - Gísli Einarsson, MD. Ph.D. Chief Executive of R&D – Turku August 2004 Public Administration in Iceland n Two Levels of Executive Power n State Level: < 300.000 people l Almost all Health Care l Schools higher than Ground School – University Education (including University of Iceland) n Municipalities l Nursing Homes l Ground School (first ten years)

3. LANDSPÍTALI – UNIVERSITY HOSPITAL - Gísli Einarsson, MD. Ph.D. Chief Executive of R&D – Turku August 2004 Landspítali – University Hospital n Landspítali is the largest organization in Iceland in terms of employees, with approximately 5000 employees (3900 f.t.e) n The hospital is located around Reykjavík and vicinity. The main activities are concentrated at two sites three kilometers apart. n In-patient days around 300 thousand pr. year.

4. LANDSPÍTALI – UNIVERSITY HOSPITAL - Gísli Einarsson, MD. Ph.D. Chief Executive of R&D – Turku August 2004 Landspítali – University Hospital n Patient beds900 n ER visits 75.000 n Visits; Day-care units 100.000 n Visits; Out-patients 220.000 n X-ray, MRI, CT etc. investigations 105.000 n Operations 15.000 n Clin.investigations (bact/im/path. etc) 1.400.000

5. LANDSPÍTALI – UNIVERSITY HOSPITAL - Gísli Einarsson, MD. Ph.D. Chief Executive of R&D – Turku August 2004 Only University Hospital in Iceland and County hospital for 2/3 – 3/4 of the population n Advantage: Uniformity in services and teaching n Best utilization of resources n Drawbacks: Lack of Competition Complacency n Ineffectivity n Demands great vigilance to foreign comparison

6. LANDSPÍTALI – UNIVERSITY HOSPITAL - Gísli Einarsson, MD. Ph.D. Chief Executive of R&D – Turku August 2004 Results Enlargement and strengthening of specialities -better subspecialist services, fewer on-call lines Decreased overhead / administration -one executive board, reduced nursing administration, fewer doctors in- chief Better utilization of housing and equipment Better utilization of housing and equipment Increased productivity Increased productivity Shorter waiting-lists Shorter waiting-lists Improved economy Improved economy

7. LANDSPÍTALI – UNIVERSITY HOSPITAL - Gísli Einarsson, MD. Ph.D. Chief Executive of R&D – Turku August 2004 Results n Increased productivity n Surgical operations up 3% in 2003, 2,9% January-July 2004 n Cardiac interventions eliminated waiting-lists in 2003-2004 n Decreased in-patient length of stay (just under 5 days July 2004) n Faster turn-over (arrivals/discharges) n Almost 10 % increase in out-patient visits n Shorter waiting-lists n Eliminated in cardiology n Almost eliminated in orthopedics n Decreased considerably in eye-surgery (operations up 16% in-patient and 42% in day-care)

8. LANDSPÍTALI – UNIVERSITY HOSPITAL - Gísli Einarsson, MD. Ph.D. Chief Executive of R&D – Turku August 2004 Results n Improved economy n Decreased number of f.t.e. by 2.9 % 2003-2004 n Total expenditures in constant money value 1999-2004: n 1999-2000 -0.9 % n 2000-2001 -1.4 % n 2001-2002 +1.8 % n 2002-2003 +2.5 % n 2003-2004 -3.0 %

9. LANDSPÍTALI – UNIVERSITY HOSPITAL - Gísli Einarsson, MD. Ph.D. Chief Executive of R&D – Turku August 2004 Development n Out-patient/day-care policy completed 2004 n DRG-evaluation completed 2004 n Health department committee on the role and interaction of the two acute-care hospitals and out-patient services including primary care and privately run out-patient seervices (380.000 visits) n Co-operation agreement with The University of Iceland in 2001 and 2002

10. LANDSPÍTALI – UNIVERSITY HOSPITAL - Gísli Einarsson, MD. Ph.D. Chief Executive of R&D – Turku August 2004 Problems n Role of small community Hospitals n Nursing Homes n Local Competition n Inadequate funding for both main roles of the Hospital