health care in denmark 24 october 2014danish regions

Danish Regions

Health Care in Denmark

24 October 2014

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

24 October 2014 Danish Regions

• 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


Political and administrative levels

The Danish Health CareWho is responsible for what?


State• Legislation• National health care

policy • The overall framework

of the health care economy

Municipalities• Home care• Rehabilitation services

outside hospitals, • Treatment of drug and alcohol

abuse• Prevention and health

promotion• District nurses• Children's dental services

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

The Danish Health CarePlans and the Bermuda Triangle

General Practice

Hospitals

Municipality services (e.g. rehabilitation,

home care)


• 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.

Danish population: 5,6 mio.

The Danish Health CareFive Regions

Capital Region of Denmark

Region Zealand

Region of Southern Denmark

Central Denmark Region

North Denmark Region

The Danish Health CareCapacity

• 52 public hospitals

• 107.000 FTE

• 3.600 GP’s and 1.100 specialists in private practices

14%

33%

23%

30%

Hospital Doctors

Nurses

Other health care personnel

Other personel (psychologist, admin-istration, cleaning operatives, techni-cal personel)


The Danish Health CareTrends

• 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


The Danish Health CareActivity

• 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


The Danish Health CareTrends

• 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)


The Danish Health CareOperating expenses

Budget 2014: 102,7 billion DKR (17 billion USD)

80%

15%

5%

Hospitals

GP, specialists, dentists

Medicine, reimbursement


The Danish Health CareFinancing

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


The Danish Health CareFinancial set-up


State

Municipalities

Regions

Citizens

BLOCK GRANT (75 %)

CO-FINANCING(20 %)

BLOCK GRANT

ACTIVITY RELATED GRANT (5 %)

DIRECT TAXES

DIREC

T TAXE

S

Private Practice

• General practice• Specialists (e.g. ear and eye

specialists)• Adult dental services • Physiotherapists• Psychologists• Chiropodist• Chiropractor

• 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



• 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 regions provide financial founded for the private practice

• 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

Private Practice

Co-operation with the Private SectorThe supply of health care is the Regions responsibility


PUBLIC HOSPITALPRIVATE HOSPITAL

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

NON-PROFIT 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)

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

2007 2008 2009 2010 2011 2012 2013 20140

20,000

40,000

60,000

80,000

100,000

120,000

47,948

85,480

110,852 110,67696,585

88,344 88,345

110,470

Chart Title

Source: Landspatientregisteret § 75 + § 87, please note, that 2014 is an estimate

Co-operation with the Private SectorNumber of public patients at Private Hospitals and Clinics


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


Co-operation with the Private SectorThe Regions Expenses

Patient Rights Part of the DNA The right to a quick

assessment(within 30 or 60 days)

Freedom of choice

The right to have a contact person within

48 hours if needed

Access to your own medical record

Guarantee for treatment of life-

threatening diseases

No more than one-month waiting time for

treatmentThe right to receive

information

Staff must maintain secrecy – also towards

the nearest family members


If you are subjected to coercive measures, you have the right to have a

patient counselor

In psychiatry the personnel must try to achieve the

patient’s voluntary participation before

use of coercion

ChallengesWhat 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

The Quality AgendaPart of the DNA

QUALITY

Punctuality

Effect

Patient safety

Cost-effective

Equality

The patient in focus

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


• 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!


The Quality AgendaQuality is a part of the solution

The Quality AgendaQuality is a part of the solution


Increasing costs Cost-neutral Quality improvementDecreasing costs

Quality-neutral Quality reduction

Quality initiatives Savings

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


Patient as PartnerPart of the DNA Patients have

knowledge, abilities and trust in managing

their disease and health

Partnership between patient and staff

A relation build upon clear communication, continuity and shared

decision making


Agreement in relation to goals and results

from the treatment

Supported self management and active participation in

treatment and care equals an effective method

The center of decision making

Diagnosing patients preferences

”The silent misdiagnosis”

Patient engagement is the new

”blockbuster drug”

More and better information on treatment

choices, clinical results and evidence

Comparison Denmark-USA


DENMARK

USA

16,9 %9,3 %

8 %6,7 %

4,810 USD2,867 USD

Source: http://www.oecd.org/statistics

3,547 USD11 %

9,4 % 3,644 USD2,088 USD 3,042 USD

81,1 82,982,1

76,3 77,5 78,1

health care in denmark 24 october 2014danish regions

Documents

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