Blönduós Health Centre – Performance audit

This report deals with the operations of the Blönduós Health Centre (BHC which is a small, rural health centre in northern Iceland. The goal of the audit was to investigate whether there was a sufficiently clear connection between budget appropriations to the BHC and the role it is expected to perform, and whether its budget needs to be increased.
The audit revealed that the BHC’s efficiency is similar to that of other comparable Icelandic health bodies of a like size. In order to obtain a more detailed picture in this respect, however, the health bodies would have to divide costs between their activities in a co-ordinated manner and indicate the special circumstances affecting their measured efficiency. The audit also shows that external services do not explain the difference in total costs for the inhabitants of separate service areas.

In 2004, the BHC’s regular operations were nearly in balance after years of running a deficit. The BHC’s management staff also seem to make effective use of its budget. An investigation into the public budgets of bodies examined based on the populations that they serve revealed a significant difference that cannot be explained by material circumstances. However, it does not seem obvious that the BHC should receive an adjustment over and above comparable bodies. Before making such an adjustment, the basis of each of the bodies’ budgets needs to be reviewed in order to maximise their comparability.

The BHC’s operations have been successfully adjusted to the changed circumstances of rural health centres as well as a changed composition of projects. In general, medical visits and telemedicine have not been enhanced in an integrated manner in rural areas, as was previously assumed, in order to offset the imbalance between rural and urban areas in terms of access to medical specialists. It is worth noting that the inhabitants of the rural areas examined use only one-third of the specialist services used by the inhabitants of the Greater Reykjavík area.

In its audit, the National Audit Office points out various advantages of governing health services centrally rather than at the local government level. This would provide a better overview as a whole and facilitate standardisation, such as the provision of comparable services throughout the country. However, the Office emphasises that centralised government must not prevent individual public bodies from being able to adjust their services to local circumstances and needs.