Danish Health Care System

1
Danish Health Care System

• Organization, coordination and finance
• Historically evolving institutional structure
  based on decentralized political management,
  universal welfare state coverage and pragmatic
  negotiated solutions
• Limited role for private actors in hospital
  services and financing

2
Danish Health Care System

• Fairly well performing on measurable indicators
• Expenditure control,
• Productivty,
• Waiting times,
• System development capacity,
• Patient satisfaction
• BUT

3
Danish Health Care System

• Image and reputation issues
• Changing cultural and socio-economic factors
• Waiting time and quality issues
• Changing ideological climate
• Fear of long term financing problems
• Political dynamics
• Have created a political opening for structural
  reform in 2002

4
Danish Health Care System

• .The selected reform strategy will be
  implemented in 2007. 15 counties turn into 5
  larger regions with responsibility for managing
  health care. Financing will change from the
  current county taxation to a mix of state
  taxation and municipal payment for service and
  per capita. Municipalities will assume a larger
  role in prevention and rehabilitation.
• The changes may or may not resolve the issues
  mentioned above, but will change the
  institutional rules of the game

5
Danish Health Care System

• Opportunities and potential
• New organizational forms. More diverse picture
• Perhaps stronger role for private actors. Out
  sourcing. PPP.
• Potential benefits of scale
• Continued experiments with economic incentives
  e.g. to address waiting time issues

6
Danish Health Care System

• Issues and concerns
• Financing and expenditure control
• Planning and coherence
• Transition and transaction costs in the short and
  long term
• Loss of institutional capacity
• Political legitimacy and functionability of new
  regions

7
Danish Health Care System

• Better platform for handling pressures and
  organizational change projects? Challenges and
  issues in the future.
• Quality assessment and improvement
• IT and introduction of electronic patient
  records. A national standard is being developed
  and tested in the Copenhagen area
• Research and application of knowledge
• Evaluation and prioritization of health
  technology
• Clever economic incentives
• Changing needs and demands of the population
• Policy learning and gradual adjustment of
  organizational choices