Danish Health Care An International Perspective

1
Danish Health CareAn International Perspective
Tony Hockley Civitas Roundtable 11 May 2005,
Copenhagen
2
Introduction

• A stalwart of the public integrated model
• Unrestricted, equal, and free access
• Relative decline in health status
• Gradual growth of co-payment (and insurance) in
  limited areas
• Change by Baby steps Chresten Anderson

3
Funding

• 75 by block grant from central government (2007)
• Small role for activity payment
• Medicines patients pay first 520DKK/pa 50
  520-1250DKK (inc 25 VAT on medicines)
• 29 have insurance for co-payments
• 1988 Private Spend 16 Total
• 2000 Private Spend 19 Total

4
Spending
5
Co-Payments of Total

25,0
20,0
15,0
10,0
5,0
0,0
UK
EU
Italië
België
Spanje
Ierland
Frankrijk
Portugal
Duitsland
Nederland
Luxemburg
Griekenland
Denemarken
Van Montfort (2002)
6
Drug Spending( Per Capita)
Pricing and reimbursement limits. Price cuts
(2004)
500
450
400
350
300
250
200
150
100
50
0
United
United
Switzerland
Netherlands
Germany
France
Denmark
Belgium
States
Kingdom
Van Montfort (2002)
1990
1994
1998
7
Drug Co-Payment
SOURCE efpia (2002)
8
Patients Payments for Medicines
9
Policy Focus

• De/Centralisation
• Is centralisation essential to strategic reform?
• Waiting Lists
• Consume new investment
• Tinkering with co-payments
• Priority-Setting by Fire-Fighting
• Kjeld Møller Pedersen 12/2004

10
Reform Prospects
Choice Patients
Q3 2000 2044
Q2 2002 5135
Q2 2004 5481

• Choice from theory to reality information, DRG
  payments
• Dilemma between patient choice and system
  uncertainty
• Restricted role for insurance, co-payment,
  (Danish) private providers

Bech 2004
11
Conclusion

• New central structures may improve opportunities
  for strategic reform?
• Patient payment and choice remain excessively
  focused on medicines, dentistry, waiting lists
• Limited dissatisfaction limits immediate reform
  options
• More baby steps to come