1. Health Care in Denmark
24 October 2014
Danish Regions

2. Basic principles of Danish Health Care
A public health care system
Equal and free access for all citizens
Freedom of choice
Mainly financed through general taxes
Decentralized organization
General Practice (family doctor) as gatekeeper
Free choice:
The danish patients can choose whatever a hospital in Denmark as long as it is about basic treatment.
Extended free choice:
And if a patient shall wait more than 2 months it is possible to use the right of excented free choice. That means that the patient can choose to be treated on one of the 180 private clinics and hospital tha Danish Regions aktually have an agreement with. And the public will pay for the treatment.
24 October 2014
Danish Regions

3. Political and administrative levels
Danish Parliament/Government
Ministry of Health, National Board of Health etc.
5 Regions
5 Boards with 41 elected politicians
98 Municipalities
98 Boards with between 9 and 31 elected politicians
General elections to regional and municipality boards every 4 years
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Danish Regions

4. The Danish Health Care Who is responsible for what?
State
Legislation
National health care policy
The overall framework of the health care economy
Regions
Hospital (somatic and psychiatric, in- and outpatient)
Primary healthcare contracts (GP, specialists in private practice, adult dental services, physiotherapists, psychologists, chiropodist, chiropractor)
Reimbursement of medicine
Municipalities
Home care
Rehabilitation services outside hospitals,
Treatment of drug and alcohol abuse
Prevention and health promotion
District nurses
Children's dental services
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Danish Regions

5. The Danish Health Care Plans and the Bermuda Triangle
Plan for highly specialised care
Hospital plans
Plans for GP’s, specialists etc.
Health Care plan
Agreements between regions and municipalities
Contracts with GP etc.
Hospitals
Municipality services
(e.g. rehabilitation,
home care)
General Practice
How do we make it work?
And does it work?
24 October 2014
Danish Regions

6. The Danish Health Care Five Regions
North Denmark Region
Danish population: 5,6 mio.
Central Denmark Region
Capital Region of Denmark
Region of Southern Denmark
Region Zealand
Geografi:
The regions have between 0.6 and 1.6 million inhabitants. The smallest geographical region, Capital Region of Denmark covers 2,561 square kilometers, whereas the largest, Central Denmark Region covers 13,142 square kilometers.
The regional council is headed by a president who is elected by the regional council from among its members.
The regional council elects an executive committee with members. The regional council can decide to establish ad hoc committees to assist and advise the council in its work.

7. The Danish Health Care Capacity
52 public hospitals
FTE
3.600 GP’s and specialists in private practices
Ansatte:
Der arbejder FTE på de offentlige sygehuse, fordelt på
14 procent læger (u. praktiserende læger)
33 procent sygeplejersker
10 procent sosu-assistenter
12 procent andet sundhedsfagligt personale
30 procent øvrigt personale, herunder blandt andet psykologer, administrativt personale, rengøring, teknisk personale m.v.
3.600 alment praktiserende læger og speciallæger har overenskomst med regionerne.
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Danish Regions

8. The Danish Health Care Trends
Reduction in number of hospitals and beds
Centralization and specialization
Fewer hospitals with ED’s
Focus on pre hospital emergency care
Focus on intermediate care
Hospitals to be renovated + new hospitals built (41 billion DKR to be spent)
GP’s collaborating in larger clinics
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Danish Regions

9. The Danish Health Care Activity
Each year 95 out of 100 Danes have contact with the health care system, either through the hospital, family doctor, specialists or dentists
Each year 2.6 million Danes are treated at a somatic hospital and in addition are 120,000 patients in psychiatric treatment
There is an annual 40.5 million visits to GP
11.5 million visits to specialists
95 ud af 100 danskere er hvert år i kontakt med sundhedsvæsenet enten via sygehuset, egen læge, speciallæger eller tandlæger
2,6 millioner danskere behandles hvert år på et somatisk sygehus og herudover er patienter i psykiatrisk behandling
1,1 millioner indlæggelser er der hvert år på de somatiske sygehuse - og ca indlæggelser er der på de psykiatriske sygehuse
Der foretages hvert år 11,5 millioner ambulante somatiske behandlinger på de danske sygehuse. Derudover er der 1,1 million ambulante besøg på psykiatriske sygehuse
Aktiviteten er steget med cirka 30 procent mellem 2006 og 2012
Der er årligt 40,5 millioner kontakter hos alment praktiserende læger og 11,5 millioner besøg hos privat praktiserende speciallæger
 I 2012 blev 30 procent af patienterne, der modtog behandling i almen praksis, ikke behandling mv. andre steder i det regionale sundhedsvæsen.
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Danish Regions

10. The Danish Health Care Trends
A slight increase of the number of discharges over the last 10 years
Average length of hospitalization at somatic hospitals is below 3.8 days in average
Decrease from 4.4 days in 2008
Average length of hospitalization in psychiatry is in average 19 days for adults and 31 days for kids
Decrease of 16 % (adults) and 7 % (kids) since 2009
Reorganization of patients
Increase of outpatient visits (74 % of all visits)
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Danish Regions

11. The Danish Health Care Operating expenses
Budget 2014: 102,7 billion DKR (17 billion USD)
Driftsudgifter
Det danske sundhedsvæsen koster årligt ca. 103 milliarder kr. Det er ca kroner pr. dansker.
Udgifterne er fordelt således:
Sygehusområdet: 80 procent, dvs. ca. 82 milliarder kr.
Praktiserende læger: 15 procent, dvs. ca. 15 milliarder kr.
Medicintilskud: 5 procent, dvs. ca. 5,5 milliarder kr.
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Danish Regions

12. The Danish Health Care Financing
The regions cannot levy their own taxes
Financing consists of:
State Grant – 75 Percent
State activity related grant– 5 Percent
Municipality basic grant – 5 Percent
Municipality activity related grant – 15 Percent
Annual agreements between Danish Regions and government
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Danish Regions

13. The Danish Health Care Financial set-up
ACTIVITY RELATED GRANT (5 %)
Regions
State
BLOCK GRANT (75 %)
CO-FINANCING
(20 %)
BLOCK GRANT
DIRECT TAXES
Citizens
Municipalities
DIRECT TAXES
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Danish Regions

14. Private Practice
Practice sector consists of a number of small self-employed businesses
It is important that the private practice sector is an integral part of whole health care system
General practice
Specialists (e.g. ear and eye specialists)
Adult dental services
Physiotherapists
Psychologists
Chiropodist
Chiropractor
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Danish Regions

15. Private Practice
The regions' Wages and Tariffs Board (RLTN) enters into an agreement with each professional organizations and practitioners in relation to the health services they need to deliver to patients, the service demands, as well as the pay which they get for it
The private practice is allowed to offer other health services, than those which are founded by the regions
It is written in in the Health Act in which areas there are user fees, and which is fully funded by the regions
The regions provide financial founded for the private practice
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Danish Regions

16. Co-operation with the Private Sector The supply of health care is the Regions responsibility
NON-PROFIT HOSPITAL
PRIVATE HOSPITAL
PUBLIC HOSPITAL
If the region is not able to offer the treatment needed within 2 (1) months, the patient can choose treatment at a private hospital (§87)
Four out of five regions have agreements with private hospitals through public procurement (e.g. orthopaedic operations, eye operations)
At the moment Danish Regions have agreements with 119 private hospitals and clinics
A region can also cooperate with non-profit hospitals, that provided services for patients with epilepsy, gout, brain and also traumatised refugees and care of terminally ill patients
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Danish Regions

17. Co-operation with the Private Sector Number of public patients at Private Hospitals and Clinics
Source: Landspatientregisteret § 75 + § 87, please note, that 2014 is an estimate
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Danish Regions

18. Co-operation with the Private Sector The Regions Expenses
Mio. kr.
2007
2008
2009
2010
2011
2012
2013
The extended free choice (§ 87)
728
1.273
877
916
596
495
332
Public procurement (§75) 73 94
199
258
168
116
134
Non-profit private hospital
(§79 stk. 2)
414
417
416
425
532
552
551
Other healthcare supplied by private hospitals 25 56 96 99 62 52 91
Total expenses
1.240
1.839
1.588
1.698
1.359
1.214
1.109
Source: The Regions Financial Statement
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Danish Regions

19. Patient Rights Part of the DNA
The right to a quick assessment
(within 30 or 60 days)
Access to your own medical record
Guarantee for treatment of life-threatening
diseases
Freedom of choice
The right to have a contact person within 48 hours if needed
If you are subjected to coercive measures, you have the right to have a patient counselor
Staff must maintain secrecy – also towards the nearest family members
Access to your own medical record:
If you are 15 years of age or more, you have the right to see or get a copy of your medical record. You must contact the department, which must reply to your request within ten days.
Freedom of choice: Between all public hospitals when you need to be examined or treated. The same applies to a number of private hospitals which the regions cooperates with.
Waiting time: If you are referred to an medical examination or treatment at a hospital there shall be no more than one-month waiting time. If the waiting time is longer than a month, your free choice of hospital will be expanded. The hospital will now give you the offer to be referred to another hospital (private sector or in another region).
Free treatment: If you have a Health Card you have access to free treatment from your own doctor or specialist. Moreover, you can get reimbursement for medicine, dental care, dental care, physiotherapy, podiatry, chiropractic care and psychological support.
The right to receive information: about treatment options, the expected outcome of treatment, complications and side effects, the significance it will have if you choose not to receive treatment
The right to a quick assessment: You can read about your right to being assessed within 30 days
In psychiatry the personnel must try to achieve the patient’s voluntary participation before
use of coercion
No more than one-month waiting time for treatment
The right to receive information
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Danish Regions

20. Challenges What is facing us?
An increasing elderly population
More people suffers from chronic conditions
Keeping up with the development of new technologies and medicines
New kinds of treatments
Documentation of quality
Limited resources
Increasing expectations and demands
……will put the health services under tremendous pressure
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Danish Regions

21. The Quality Agenda Part of the DNA
Effect: Patients should be given the treatment that works best
Equality: There should be equality in care and treatment
Patient safety: Treatment should be safe for patients
The patient in focus: Patients and caregivers should be in focus and be involved
Punctuality: Treatment must take place in a timely manner
Cost-effective: The best possible health value for money
QUALITY
Punctuality
Effect
Patient safety
Cost-effective
Equality
The patient in focus
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Danish Regions

22. The Quality Agenda Quality is a part of the solution
A new agenda that requires a massive change
Changes to be implemented systematically and in depth
Quality in health care means:
Doing what is right the first time
Having coherence in the action
Focus on the patient
Good quality is not an additional expenditure but bad quality is!
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Danish Regions

23. The Quality Agenda Quality is a part of the solution
Quality initiatives
Savings
Increasing costs
Cost-neutral
Quality improvement
Decreasing costs
Quality-neutral
Quality reduction
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Danish Regions

24. Out-of-pocket payment
Without a referral from a doctor, there is a user fee to services provided by specialists such as physiotherapists, psychologists, etc.
Co-payment to dentist treatment (over the age of 18)
User fees for medicine
However, you have the opportunity to receive reimbursement for prescription medications when medical expenses exceed a certain amount per year
Alternatively private health insurances
can provide subsidies or grants
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Danish Regions

25. Patient as Partner Part of the DNA
More and better information on treatment choices, clinical results and evidence
Patients have knowledge, abilities and trust in managing their disease and health
A relation build upon clear communication, continuity and shared decision making
Partnership between patient and staff
The center of decision making
Diagnosing patients preferences
”The silent misdiagnosis”
Agreement in relation to goals and results
from the treatment
Patient engagement is the new
”blockbuster drug”
Supported self management and active participation in treatment and care equals an effective method
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Danish Regions

26. Comparison Denmark-USA
9,3 %
11 %
16,9 %
2,867 USD
3,547 USD
4,810 USD
DENMARK
6,7 %
8 %
9,4 %
2,088 USD
3,042 USD
3,644 USD
USA
Middel levetid (hele befolkningen)
80,1 år DK
78,7 år USA
80,2 år OECD
Middel levetid (Kvinder)
82,1 år DK
81,1 år USA
82,9 år OECD
Middel levetid (Mænd)
78,1 år DK
76,3 år USA
77,5 år OECD
81,1
82,1
82,9
76,3
77,5
78,1
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Danish Regions
Source: