Too late, too vague, too soft: How and why the idea of the first point of contact in the Icelandic health care system has failed

Abstract

This research is about ideas, interests and institutions in health care in Iceland. It describes how the idea of primary care centres as the first point of patients´ contact in health care, on one hand, and the idea of patients´ freedom to choose where to seek medical care, on the other, have been the competing views shaping the system for almost fifty years. The research seeks to shed lights on why the authorities have not succeeded in making primary care become the first point of contact in health care. It aims to create a better understanding about why and how such a gap between objectives and outcomes in public policy emerges. This study draws on published and unpublished findings from the author´s earlier research on the Icelandic health care system, and interviews with medical doctors, civil servants and politicians. Theories on policy implementation are applied in order to bring out a theoretical perspective on government´s policy implementation. Furthermore, the research brings out how issues in health care reach government´s agenda and why government´s attempts at change do sometimes succeed, but most often don´t. It concludes that better access to primary care services emphasized by the early 1970s legislation was first and foremost aimed at people living outside the two main urban areas. On the other hand, the idea of patients´ first point of contact as a goal of government policy emerged too late, its aim and implementation was too ambiguous and the tool of government applied too weak.