Social justice and health care in an age of austerity: Users' perspectives from rural Iceland

Despite Iceland being sparsely populated, Icelandic law emphasizes social justice and equal access to healthcare, regardless of residence. The aim of the study was to examine changes in attitudes of the population in... [ view full abstract ]

Despite Iceland being sparsely populated, Icelandic law emphasizes social justice and equal access to healthcare, regardless of residence. The aim of the study was to examine changes in attitudes of the population in Fjallabyggð towards access to healthcare service, diversity and quality of it, in an age of austerity, which the restructuring after the economic collapse of 2008 demanded, and the tunnel in Héðinsfjörður made possible. We used a mixed method with a transformational design. First, data were collected by questionnaires (response rate of 53% [N = 732] in 2009 and 30% [N = 415] in 2012), followed by ten interviews (2009 and 2014). The results were integrated and interpreted within the ecological model of Bronfenbrenner relating to the interactions between the individual and the environment. Findings show significantly less satisfaction with the availability and diversity of healthcare service in 2012 after the tunnel and downsizing. Solid primary healthcare, good local elderly care, some freedom in healthcare choice and reliable emergency services were considered fundamental for life in a rural area. The results indicate that improved transportation infrastructure contributed positively to the development of healthcare service and enhanced equality and human rights. However, the state cuts negatively impacted attitudes. To comply with the law and international agreements, it is important to explore further the multifaceted impact of healthcare downsizing on service users and their environment. This emphasizes the importance to advocate for more service users empowerment in political decision making regarding health care.