11
Introduction to Denmark-the Danes
- Storstrom regionand
- Occupational health at hospitals
22
The Kingdom of Denmark
Greenland + Pharaoe Island + Denmark
33
The Kingdom of Denmark
44
Denmark
Population 5.342.00042.000 km2
7314 km coast-line
55
The Danes
Total population: 5.342.000 18% under age 14
15% over 65
Life expectancy at birth:Males 74,1 years
Females 78,9 years
66
Age FFeemmaalleess
% MMaalleess
% 25-59 79 88
55-59 55 77
25-29 89 92
Persons with education and professional trainingPersons with education and professional training
Kilde:EUROSTAT&WHOKilde:EUROSTAT&WHO
77
What more do they have in common ?
88
They pay TAX – TAX - TAX
Direct tax on personal incomeIndirect tax e.g. VAT on duties and goods
Property tax
An example:
Personal income: 400.000 d.kr.
Direct tax on personal income To state :75.000 d.kr
To county: 48.000 d.krTo municipality: 77.00 d.kr.
Indirect tax: more than 50.000 d.kr.
100 d. kr. = 16,5 USD
99
The Royal Family
1010
the Danish Parliament
1111
Regions and regional councils
1212
Storstrom Region
260.498 inhabitants24 municipalities
1313
Countys total budget 2003 = 6.3 billion d.kr.
Storstrom Region
260.500 inhabitants
9000 employeesof which 3.293 in Health Care
and 3.583 i Social Care
1414
Storstrom Region
Health care
Education & culture
Social care
Total Countys budget 2003 = 6.3 billion d.kr.
Roads & environment
1515
Administrative levels, organizational structure and managementAdministrative levels, organizational structure and managementof health careof health care
NationalNational
RegionalRegional
MunicipalMunicipal
State governmentState government
14 Counties plus Copenhagen and Frederiksberg14 Counties plus Copenhagen and Frederiksberg
273 Municipalities plus Copenhagen and Freriksberg 273 Municipalities plus Copenhagen and Freriksberg
Legislation, guidelines, standardsLegislation, guidelines, standardsSurveillance and supervisionSurveillance and supervision
Targets for health care expenditureTargets for health care expenditureIncentives for local actionIncentives for local action
Level
Level
Hospitals and prenatal care centers,Hospitals and prenatal care centers,
General practitioners, specialists, General practitioners, specialists, dentists, physioterapist etc.dentists, physioterapist etc.
Nursing homes, home nurses, health Nursing homes, home nurses, health visitors, school health carevisitors, school health care
Social services – life long care for the elderly and disabledSocial services – life long care for the elderly and disabled
Bigger Bigger hospital regionshospital regions
Municipal general care centersMunicipal general care centers
TrendTrend
1616
19801980 20002000
No. of hosp.No. of hosp. 117117 7171
No. of bedsNo. of beds 30.96730.967 18.68318.683
DischargesDischarges 894.485894.485 1.123.2451.123.245
Bed daysBed days 8.413.4008.413.400 5.964.5865.964.586
No. of out.pt’sNo. of out.pt’s 3.154.6423.154.642 5.453.2835.453.283
Average lenght of Average lenght of stay (days)stay (days)
9.49.4 5.35.3
Capacity and activity in somatic hospitalsCapacity and activity in somatic hospitalsall Denmarkall Denmark
Source: Ministry of HealthSource: Ministry of Health
1717
Health care in Denmark - some Health care in Denmark - some characteristicscharacteristics
Concensus:Concensus:Access to health care should be independent of ability to payAccess to health care should be independent of ability to pay
or place of residenceor place of residence
Free access to care in primary sectorFree access to care in primary sector
Health care publicly financed through taxes Health care publicly financed through taxes and run by public authoritiesand run by public authorities
1818
Family doctor (General Practitioner) by patients own choiseFamily doctor (General Practitioner) by patients own choise
GP as gatekeeper (and adviser) to secondary sector (hospitals)GP as gatekeeper (and adviser) to secondary sector (hospitals)
Agreed shared care and action between counties and municipalitiesAgreed shared care and action between counties and municipalities
Patients are very satisfied with hospital services and especially with GP´sPatients are very satisfied with hospital services and especially with GP´s
Health care in Denmark - some Health care in Denmark - some characteristicscharacteristics
1919
Cooperation between county and municipal levelCooperation between county and municipal levelBased on:Based on:
Agreed shared careAgreed shared care
Joint action on prevention and health promotion asJoint action on prevention and health promotion as an integrated part of health care and social servicesan integrated part of health care and social services
2020
PopulationPopulation
PatientsPatients
State government
County councils
Municipal councils
Voluntary health insurance
Municipal health services
Home visitors and school h.c.
Children dentists
Care for elderly and disabled
County health services
Hospitals and maternity care
General practitioners
Specialist
Dentists
Private hospitals
Taxes
Pre
miu
ms
Out
of
pock
et
paym
ents
Block grants
Global budgets
Fee for service
Fee for service
Capitationand fee for service
2121
the Danish Minister of Employment
National Institute of
Occupational Health
The factories inspectorate
The working environment complaints board - they take care of complaints related to the factories inspectorate
Departments of Occupational Health
The enterprices
Occupational Health Service in Denmark-the Danish work environment consultantsystem
of multidisciplinary preventive serviceunits
Occupational health service
Sector occupational health service
The danish occupational health system
2222
What are we doing to make a safety in
handling the patients ?
-Safety organization with members from the leaders and the staff
-Workplace valuation
-Education to selected employees, who has to give
-Short instruction to new employees and students
-Advices to their colleges
-Appropriate arrangement in the rooms
- Appropriate assistive technology
2323
Incidents of reported work related suffering per 10.000 employees
1995 1996 1997 1998 1999 2000 2001 2002
63 66 68 67 55 60 63 57
Hospital employeesHospital employeessuffering and accidents suffering and accidents
Incidents of reported work related accidents per 10.000 employees
1995 1996 1997 1998 1999 2000 2001 2002
170 178 167 163 158 165 137 122
The number of employees
1995 1996 1997 1998 1999 2000 2001 2002
103.091 103.745 103.416 101.731 102.712 102.235 103.162 104.235
2424
Real good or good selfestimated health Storstrom Region
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
16-24 år 25-44 år 45-66 år 67-79 år 80 år +
Selfestimated health
Center of Public Health 2004
Kilde: Sundheds-& sygelighedsundersøgelserneStatens Institut for Folkesundhed
Female Male
2525
Fit to do what you want to do
Fit to do what you want to doStorstrom Region
0%
20%
40%
60%
80%
100%
16-24 år 25-44 år 45-66 år 67-79 år 80 år +
Folkesundhedscenteret maj 2004
Kilde: Sundheds-& sygelighedsundersøgelserneStatens Institut for Folkesundhed
Female Male
2626
Don’t feel stressed
Don't normaly feel stressedStorstrom Region
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
16-24 år 25-44 år 45-66 år 67-79 år 80 år +
Center of Public Health 2004
Kilde: Sundheds-& sygelighedsundersøgelserneStatens Institut for Folkesundhed
Female Male
2727
Good physical mobility
Good physical mobility (60+years)Storstrom Region
0%
20%
40%
60%
80%
100%
60-66 år 67-79 år 80 år +
Center of Public Health 2004
Kilde: Sundheds-& sygelighedsundersøgelserneStatens Institut for Folkesundhed
Female Male
2828
Rarely or never infuence on ones one job Storstrom Region
0% 5% 10% 15% 20% 25% 30%
<10 års udd.
10 års udd.
11-12 års udd.
13-14 års udd.
15+ års udd.
Occupational Health
Udd. = education
Center of Public Health 2004
Kilde: Sundheds-& sygelighedsundersøgelserneStatens Institut for Folkesundhed