Health Care in Denmark

John Erik Pedersen

Senior Adviser

AGENDA

1. Introduction to the health care system in Denmark

2. Organisation: Government, regions and municipalities

3. Financing health care

4. Planning Hospital Care in Denmark

5. Hospital investment and “super hospitals”

• A public health care system

• Free and equal access for all citizens

• Mainly financed through general taxes

• Decentralized organization

BASIC FEATURES

• National level: Parliament and government / minister

• Regional level (executive): 5 regions / regional councils

• Local level (executive): 98 municipalities / municipal councils

POLITICAL & ADMINISTRATIVE LEVELS

NATIONAL RESPONSIBILITIES

Regulating, coordinating and advising functions of the decentralized

providers of health care services

• Determining national health policies

• Adopting legislation

• Setting overall framework of the economy

• General planning within the health sector

• Defining guidelines

• Performing control

• Hospital and psychiatric treatment

• Primary health care / public health care scheme

• General Practitioners (family doctors)

• Private practicing specialists

• Adults dental services

• Physiotherapy

REGIONAL RESPONSIBILITIES

MUNICIPAL RESPONSIBILITIES

• Preventive care and health promotion

• Rehabilitation outside hospital

• Treatment of alcohol and drug abuse

• Co-financing regional health care

• Child nursing

• Child dental services and special dental care

• School health care

• Home nursing

Kolding88.674

Haderslev55.604

Sydsjælland-Møn/Vordingborg46.307

Slagelse/Antvorskov76.185

Vejen/Kongeå41.350

Thisted/Thy46.158

Syddjurs/Kalø40.196

Mariager Fjord/Mariagerfjord42.001

Favrskov42.575

Fredensborg39.187Hillerød

44.551

Ærø6.939

Rebild28.457

Jammerbugt38.884

Vesthimmerland37.593

Norddjurs38.352

Langeland14.223

Faaborg-Midtfyn51.144

Guldborgsund63.533

Nakskov Fjord49.469

Faxe34.313

Odsherred32.739

Gribskov40.409

Rudersdal53.621

((Kongsdal))39.267

Brønderslev-Dronninglund35.320

Ringkøbing-Skjern57.818

Ikast-Brande39.371

Frederiksværk-Hundested30.253

Hjørring67.816

Aalborg192.353

Frederikshavn63.799

Skive48.368

Viborg89.918

Randers93.118

Silkeborg84.167

Skanderborg55.068

Furesø37.311

Struer22.752

Lemvig22.760

Holstebro56.204

Herning82.935

Hedensted43.477

Horsens75.697

Vejle100.518

Esbjerg115.415

Varde49.377

Billund26.076

Tønder41.321

Aabenraa60.151 Sønderborg

76.459

Nyborg31.009

Kerteminde23.071

Svendborg58.354

Middelfart36.113

Bogense28.655

Assens41.201

Holbæk66.611

Næstved78.446

Sorø28.336

Kalundborg48.697

Stevns21.776

Køge54.926

Roskilde79.441

Lejre25.971

Frederikssund42.926

Hillerød44.551

Ringsted30.830

Morsø22.479

Fanø3.151

Fredericia49.147

Odder21.133

Århus294.954

Odense185.871

Solrød20.703

Samsø4.125

Allerød23.458

Hørsholm24.292

Lyngby-Tårnbæk51.611

Gentofte68.991

Gladsaxe62.007

Ballerup46.759

Herlev27.166

Greve47.671

Ishøj20.668

Vallensbæk12.260

Brøndby34.513

Høje Tåstrup45.553

Albertslund28.146

Glostrup20.785

Rødovre36.312

Hvidovre49.863

Dragør13.156

Tårnby39.582

København502.362

Frederiksberg91.886

Christiansø

Læsø2.145

Helsingør61.295

Bornholm43.347

PATIENT

Generalpractitioner

Dentist etc.

Practising specialist

Emergencyward

Hospital

WHERE TO GO, IF YOU GET ILL

CENTRAL

GOVERNMENT

MUNICIPALITIES

REGIONS

BLOCK GRANT

BLOCK GRANT(75 per cent)

Activity related contribution(5 per cent)

Co-financing (20 per cent)

Collect direct taxes

Collects direct taxes

FINANCING HEALTH CARE

Controlling Health Care Activity and Expenditure

• Fiscal policy and hence controlling total public expenditure is a top-

down process

• Central government and parliament define overall budget – national,

regional and municipal

• Annual overall budgets for each level agreed in ”voluntary”

agreements with the regions’ and municipalities’ associations.

• Total hospital expenditure and expected activity (DRG) in regions

defined in agreement. And required productivity improvement.

PUBLIC EXPENDITURE ON HEALTH REGIONS

Regional expenditure

• Hospitals: 79%

• Primary health care: 13%

• Pharmaceuticals: 6%

• Administration etc.: 2%

Municipal expenditure

• Co-financing: 62%

• Rehabilitation: 10%

• Prevention: 3%

• Dental care: 12%

• Other: 13%

PUBLIC EXPENDITURE ON HEALTH MUNICIPALITIES

CHANGES IN THE HEALTH CARE SYSTEM - I

• Currently we are implementing a major restructuring of the Danish hospital

system

• Goal: to improve quality

• Principle: ”practice-makes-perfect”- volume is essential

• The overall aim is to merge specialized functions in fewer and larger units in

order to increase the quality of care, create better learning environments and

secure the optimal use of resources

CHANGES IN THE HEALTH CARE SYSTEM - II

• Background: The Health Care Act, 2005:

• Empowers Health and Medicines Agency to issue binding recommendations

• National Advisory Board consisting of representatives from regions and medical

societies to advise Health and Medicines Agency

• Recommendations was developped in close cooperation with physicians

from medical societies and regions

• All specialities were analyzed 2006-2009

CHANGES IN THE HEALTH CARE SYSTEM - III

• The 5 regions have applied for specialized functions approvals

• All private hospitals have to apply in same way

• One application for each specialty

• It must be described how each of the demands will be fulfilled

• Functions implemented by January 2011 unless otherwise agreed

• The regions and private hospitals must report on progress in implementation

proces – preferably by documentation of data

• The Act: New similar process in 3 years. Process will be evaluated before

new start.

CHANGES IN THE HEALTH CARE SYSTEM - IV

• Basic recommendations on organisation of acute hospital care

(emergency wards):

• Integrated Acute Care Units

• Population base of 200.000 – 400.000 inhabitants

• Makes room for app. 20 acute hospitals in Denmark (App. 40 in 2006)

HOSPITAL INVESTMENT PROGRAMME

• The Government is investing 25 billion Danish kroner [app. 3,4

billion Euros] - old hospitals to be modernized or replaced by fewer

modern “super-hospitals”

• Together with the regions’ own investment the amount is more than

40 billion Danish kroner [approximately 5,4 billion Euros]

• A panel of experts has examined the regions’ hospital plans and

major hospital projects and recommended to the Government which

projects to be supported from the Government

• 16 hospital projects (both new hospitals and modernization of

existing hospitals) are to be realized in the coming years

Future hospitals with emergency care unit (18+3)

*

*

**

**

* *

*

*

*

**

*

*

*

*

*

*

*

Aabenraa Sygehus

Antal indbyggere pr. km20-50

50-100

100-150

150-300

300+

Esbjerg SygehusKolding Sygehus

Sygehus Thy-Mors,Thisted

Regionshospitalet RandersRegionshospitalet Viborg

Sygehus Vendsyssel, Hjørring

Nyt Universitetshospital i Odense

Slagelse Sygehus

Nykøbing F. Sygehus

Regionshospitalet i Horsens

Bornholm Hospital

Bispebjerg HospitalHerlev Hospital

Hillerød Hospital

Nyt sygehus i Aalborg Øst

Det Nye Universitetshospital i ÅrhusNyt regionshospital i Gødstrup

Hvidovre Hospital

*

*Holbæk sygehus*

Køge Sygehus

CHANGES IN THE HEALTH CARE SYSTEM - V• The Government is investing an historical amount of 25 billion

Danish kroner [approximately 3,4 billion Euros], so the old hospitals

will be modernized or replaced by fewer modern “super-hospitals”

• Together with the regions’ own investment the amount is more than

40 billion Danish kroner [approximately 5,4 billion Euros]

• An expert panel has reviewed the regions planned hospitals

projects and recommended to the Government which projects

should be supported with funds from the Government

• Result: 16 hospital projects (both new hospitals and modernization

of existing hospitals) are to be realized in the coming years