2. AGENDA
1. Introduction to the health care system in Denmark
2. Organisation: Government, regions and municipalities
3. Financing health care
4. Planning Hospital Care in Denmark
5. Hospital investment and “super hospitals”
3. • A public health care system
• Free and equal access for all citizens
• Mainly financed through general taxes
• Decentralized organization
BASIC FEATURES
4. • National level: Parliament and government / minister
• Regional level (executive): 5 regions / regional councils
• Local level (executive): 98 municipalities / municipal councils
POLITICAL & ADMINISTRATIVE LEVELS
5. NATIONAL RESPONSIBILITIES
Regulating, coordinating and advising functions of the decentralized
providers of health care services
• Determining national health policies
• Adopting legislation
• Setting overall framework of the economy
• General planning within the health sector
• Defining guidelines
• Performing control
6. • Hospital and psychiatric treatment
• Primary health care / public health care scheme
• General Practitioners (family doctors)
• Private practicing specialists
• Adults dental services
• Physiotherapy
REGIONAL RESPONSIBILITIES
7. MUNICIPAL RESPONSIBILITIES
• Preventive care and health promotion
• Rehabilitation outside hospital
• Treatment of alcohol and drug abuse
• Co-financing regional health care
• Child nursing
• Child dental services and special dental care
• School health care
• Home nursing
Kolding
88.674
Haderslev
55.604
Slagelse/Antvor
76.185
Vejen/Kongeå
41.350
Thisted/Thy
46.158
Syddjurs/Kalø
40.196
Mariager Fjord/Mariagerfjord
42.001
Favrskov
42.575
Ærø
6.939
Rebild
28.457
Jammerbugt
38.884
Vesthimmerland
37.593
Norddjurs
38.352
Langeland
14.223
Faaborg-Midtfyn
51.144
Nakskov
49.469
Brønderslev-Dronninglund
35.320
Ringkøbing-Skjern
57.818
Ikast-Brande
39.371
Hjørring
67.816
Aalborg
192.353
Frederikshavn
63.799
Skive
48.368
Viborg
89.918
Randers
93.118
Silkeborg
84.167
Skanderborg
55.068
Struer
22.752
Lemvig
22.760
Holstebro
56.204
Herning
82.935
Hedensted
43.477
Horsens
75.697
Vejle
100.518
Esbjerg
115.415
Varde
49.377
Billund
26.076
Tønder
41.321
Aabenraa
60.151 Sønderborg
76.459
Nyborg
31.009
Kerteminde
23.071
Svendborg
58.354
Middelfart
36.113
Bogense
28.655
Assens
41.201
Kalundborg
48.697
Morsø
22.479
Fanø
3.151
Fredericia
49.147
Odder
21.133
Århus
294.954
Odense
185.871
Samsø
4.125
Læsø
2.145
10. Controlling Health Care Activity and
Expenditure
• Fiscal policy and hence controlling total public expenditure is a top-
down process
• Central government and parliament define overall budget – national,
regional and municipal
• Annual overall budgets for each level agreed in ”voluntary”
agreements with the regions’ and municipalities’ associations.
• Total hospital expenditure and expected activity (DRG) in regions
defined in agreement. And required productivity improvement.
11. PUBLIC EXPENDITURE ON HEALTH
REGIONS
Regional expenditure
• Hospitals: 79%
• Primary health care: 13%
• Pharmaceuticals: 6%
• Administration etc.: 2%
12. Municipal expenditure
• Co-financing: 62%
• Rehabilitation: 10%
• Prevention: 3%
• Dental care: 12%
• Other: 13%
PUBLIC EXPENDITURE ON HEALTH
MUNICIPALITIES
13. CHANGES IN THE HEALTH CARE
SYSTEM - I
• Currently we are implementing a major restructuring of the Danish hospital
system
• Goal: to improve quality
• Principle: ”practice-makes-perfect”- volume is essential
• The overall aim is to merge specialized functions in fewer and larger units in
order to increase the quality of care, create better learning environments and
secure the optimal use of resources
14. CHANGES IN THE HEALTH CARE
SYSTEM - II
• Background: The Health Care Act, 2005:
• Empowers Health and Medicines Agency to issue binding recommendations
• National Advisory Board consisting of representatives from regions and medical
societies to advise Health and Medicines Agency
• Recommendations was developped in close cooperation with physicians
from medical societies and regions
• All specialities were analyzed 2006-2009
15. CHANGES IN THE HEALTH CARE
SYSTEM - III
• The 5 regions have applied for specialized functions approvals
• All private hospitals have to apply in same way
• One application for each specialty
• It must be described how each of the demands will be fulfilled
• Functions implemented by January 2011 unless otherwise agreed
• The regions and private hospitals must report on progress in implementation
proces – preferably by documentation of data
• The Act: New similar process in 3 years. Process will be evaluated before
new start.
16. CHANGES IN THE HEALTH CARE
SYSTEM - IV
• Basic recommendations on organisation of acute hospital care
(emergency wards):
• Integrated Acute Care Units
• Population base of 200.000 – 400.000 inhabitants
• Makes room for app. 20 acute hospitals in Denmark (App. 40 in 2006)
17. HOSPITAL INVESTMENT PROGRAMME
• The Government is investing 25 billion Danish kroner [app. 3,4
billion Euros] - old hospitals to be modernized or replaced by fewer
modern “super-hospitals”
• Together with the regions’ own investment the amount is more than
40 billion Danish kroner [approximately 5,4 billion Euros]
• A panel of experts has examined the regions’ hospital plans and
major hospital projects and recommended to the Government which
projects to be supported from the Government
• 16 hospital projects (both new hospitals and modernization of
existing hospitals) are to be realized in the coming years
18. Future hospitals with emergency care unit (18+3)
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*
**
*
*
* * *
*
*
*
*
*
*
*
*
*
Aabenraa Sygehus
Antal indbyggere pr. km2
0-50
50-100
100-150
150-300
300+
Esbjerg Sygehus
Kolding Sygehus
Sygehus Thy-Mors,Thisted
Regionshospitalet Randers
Regionshospitalet Viborg
Sygehus Vendsyssel, Hjørring
Nyt Universitetshospital i Odense
Slagelse Sygehus
Regionshospitalet i Horsens
Bornholm Hospital
Bispebjerg Hospital
Herlev Hospital
Hillerød Hospital
Nyt sygehus i Aalborg Øst
Det Nye Universitetshospital i Århus
Nyt regionshospital i Gødstrup
Hvidovre Hospital
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*
Holbæk sygehus
*
Køge Sygehus
19. CHANGES IN THE HEALTH CARE
SYSTEM - V
• The Government is investing an historical amount of 25 billion
Danish kroner [approximately 3,4 billion Euros], so the old hospitals
will be modernized or replaced by fewer modern “super-hospitals”
• Together with the regions’ own investment the amount is more than
40 billion Danish kroner [approximately 5,4 billion Euros]
• An expert panel has reviewed the regions planned hospitals
projects and recommended to the Government which projects
should be supported with funds from the Government
• Result: 16 hospital projects (both new hospitals and modernization
of existing hospitals) are to be realized in the coming years
Editor's Notes
We have a public health care system, based on a principle of free and equal access for all citizens.
Around eighty five percent of the Danish health care expenses are financed through general taxes. Hence the majority of health services in Denmark is free of charge for the users.
The responsibility for running the public health service is decentralised, and thus divided between regions and municipalities.
In 2007 we had a big reform. We went from 13 councils to five regions and 271 municipalities to 98 municipalies
Average population: 1,110,000
Average populaton: 57,000
The general practitioner as ”gate keeper”
The patient’s primary contact with the health care system
Responsible of referring the patient to the right professionals, i.e. hospitals, specialists or other professionals – if necessary
This slide shows the payment flows regarding health care.
The regional health care expenditures is covered by activity-related contributions from the state and the municipalities, and a block grant from the state. The regions have no right to collect taxes.
This means that the municipalities co-finance regional health expenditures. The activity-related contribution depends on how much the citizens use the regional health services.
The health care expenditure of the municipalities is covered by a block grant from the state.
Regions financed by state and municipalities – no right to collect direct taxes
The regional health care expenditures is covered by activity-related contributions from the state and the municipalities, and a block grant from the state.
Municipalities co-finance regional health expenditures:
Activity-related contribution depending on citizens use of hospitals etc. → incentive for municipalities to work on rehabilitation, preventive care and health promotion
Health coordination committees and health agreements between municipalities and regions to ensure correlation in treatment, rehabilitation, preventive treatment and care.
Det går godt med dansk sundhed.
Danmark netop vundet guldmedaljen i patientrettigheder for andet år i træk, og vi har Europas næstbedste sundhedsvæsen. Det konkluderer en rapport fra den europæiske tænketank – Health Consumer Powerhouse - i sidste uge. Det flotte resultat skyldes ifølge forskerne bag rapporten ”en målrettet politiske ambition om at forbedre sundhedsydelserne og gennemsigtigheden i sundhedsvæsenet”.
Det er rigtigt, at vi i regeringen har prioriteret at give patienter øgede rettigheder og flere valgmuligheder.
Vi har ansat flere læger og sygeplejersker.
Og vi har givet sundhedsvæsenet flere midler.
Alt det kan I læse om i det fremlagte dokumentation.
Det går godt med dansk sundhed.
Danmark netop vundet guldmedaljen i patientrettigheder for andet år i træk, og vi har Europas næstbedste sundhedsvæsen. Det konkluderer en rapport fra den europæiske tænketank – Health Consumer Powerhouse - i sidste uge. Det flotte resultat skyldes ifølge forskerne bag rapporten ”en målrettet politiske ambition om at forbedre sundhedsydelserne og gennemsigtigheden i sundhedsvæsenet”.
Det er rigtigt, at vi i regeringen har prioriteret at give patienter øgede rettigheder og flere valgmuligheder.
Vi har ansat flere læger og sygeplejersker.
Og vi har givet sundhedsvæsenet flere midler.
Alt det kan I læse om i det fremlagte dokumentation.
Det går godt med dansk sundhed.
Danmark netop vundet guldmedaljen i patientrettigheder for andet år i træk, og vi har Europas næstbedste sundhedsvæsen. Det konkluderer en rapport fra den europæiske tænketank – Health Consumer Powerhouse - i sidste uge. Det flotte resultat skyldes ifølge forskerne bag rapporten ”en målrettet politiske ambition om at forbedre sundhedsydelserne og gennemsigtigheden i sundhedsvæsenet”.
Det er rigtigt, at vi i regeringen har prioriteret at give patienter øgede rettigheder og flere valgmuligheder.
Vi har ansat flere læger og sygeplejersker.
Og vi har givet sundhedsvæsenet flere midler.
Alt det kan I læse om i det fremlagte dokumentation.
Det går godt med dansk sundhed.
Danmark netop vundet guldmedaljen i patientrettigheder for andet år i træk, og vi har Europas næstbedste sundhedsvæsen. Det konkluderer en rapport fra den europæiske tænketank – Health Consumer Powerhouse - i sidste uge. Det flotte resultat skyldes ifølge forskerne bag rapporten ”en målrettet politiske ambition om at forbedre sundhedsydelserne og gennemsigtigheden i sundhedsvæsenet”.
Det er rigtigt, at vi i regeringen har prioriteret at give patienter øgede rettigheder og flere valgmuligheder.
Vi har ansat flere læger og sygeplejersker.
Og vi har givet sundhedsvæsenet flere midler.
Alt det kan I læse om i det fremlagte dokumentation.
