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)
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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
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*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