Letter from Reykjavik

Medical care in Iceland can be viewed as an experiment of nature. This small island society has combined the Nordic social and welfare structures with advanced international medicine. The Vikings settled Iceland in the ninth century, and the population has remained biologically homoge-neous because of its remote isolation. This homogeneity may provide a unique opportunity to contribute to the understanding of the genetics of common disorders. Iceland's isolation has also limited the resources that are available for clinical training. Therefore, it has been necessary for most physicians who graduate from the med-ical school at the University of Iceland to obtain postgrad-uate training abroad. This has been of enormous benefit to Icelandic medicine. Fewer opportunities for foreign medical graduates to train in the United States would have a substantial effect on the future practice of Icelandic medicine. The Icelandic health care system faces many challenges. Because health care spending has been reined inf priorities must be set more clearly than in the past, and heated discussions have erupted about gatekeeping and merging of hospitals. These have been "interesting times " for Ice-landic medicine. Other countries may learn lessons from our medical situation: a microcosm, to be sure, but no longer an isolated one