I’m very interested in the way that health care is delivered across the globe because I think there is a lot to learn from other cultures and countries.

My lectures, consulting work and live surgery events have taken me across the globe to more than 50 countries. And now I continue to venture out of my own backyard to see firsthand the state of ophthalmology in the remote corners of the world.

Iceland is an amazing country but a very small one with just about 300,000 people inhabiting an island that is the size of Kentucky. The sole medical school is the University of Iceland, and most of the graduates go to other countries for post-graduate specialty training. Not all of these physicians return to Iceland to practice medicine and surgery, working for the main hospitals or for a private clinic. There are about 30 ophthalmologists for the country, most of whom practice near the capital of Reykjavik.

Iceland’s state of medicine received worldwide attention a few years ago when some physicians went on strike to protest the low pay and high workload. While it was resolved, there is still a bit of confusion for the patients as to what is covered by the national health system and what is out of pocket.

The complexity, which is not unique to Iceland, is that patients have an expectation for the best care, and they want it provided by the government. But when they have to be put on waiting lists to have routine cataract surgery or when they have to pay out of pocket for procedures or tests that are not covered, they are disappointed.

We come back to the same choice that exists in essentially all health care systems: (1) immediate access to care, (2) the best and most cutting-edge technology, and (3) low-cost and government-funded care. Of these three items, you get to pick any two.

If you want immediate access to the best care, it will be expensive. If you want immediate access and low-cost care, then it probably won’t be the best. And if you want the best care and you want the government to pay for it, you may have to wait many months or even years for your turn.

On a more jovial note, I did find the biggest cataract that I have ever seen in my life. Well, it’s not the ophthalmology definition of a cataract, but rather the original definition of the word, which is to describe a waterfall. The attached picture is of Háifoss, which is truly breathtaking and the most amazing cataract that I’ve ever seen.

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