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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
24 October 2014 Danish Regions
Political and administrative levels
The Danish Health CareWho is responsible for what?
24 October 2014 Danish Regions
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)
24 October 2014 Danish Regions
• 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)
24 October 2014 Danish Regions
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
24 October 2014 Danish Regions
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
24 October 2014 Danish Regions
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)
24 October 2014 Danish Regions
The Danish Health CareOperating expenses
Budget 2014: 102,7 billion DKR (17 billion USD)
80%
15%
5%
Hospitals
GP, specialists, dentists
Medicine, reimbursement
24 October 2014 Danish Regions
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
24 October 2014 Danish Regions
The Danish Health CareFinancial set-up
24 October 2014 Danish Regions
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
24 October 2014 Danish Regions
24 October 2014 Danish Regions
• 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
24 October 2014 Danish Regions
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
24 October 2014 Danish Regions
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
24 October 2014 Danish Regions
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
24 October 2014 Danish Regions
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?
24 October 2014 Danish Regions
• 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
24 October 2014 Danish Regions
• 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!
24 October 2014 Danish Regions
The Quality AgendaQuality is a part of the solution
The Quality AgendaQuality is a part of the solution
24 October 2014 Danish Regions
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
24 October 2014 Danish Regions
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
24 October 2014 Danish Regions
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
24 October 2014 Danish Regions
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