Health Systems in Transition ( HiT ) Denmark: Health System Review 2012

1. Health Systems in Transition (HiT)Denmark: Health System Review 2012 Allan Krasnik Professor, MD, MPH, PhDUniversity of Copenhagen Dept. of Public Health NLI European Observatory of Health Systems and Policies

2. Analysing Health Systems and Policies www.healthobservatory.eu

3. The Observatory WHO?

4. An Effective Partnership The European Observatory is a three-way partnership buildingbridgesbothacross borders and between policy makers and researchers. International Agencies National and Regional Authorities Academia • WHO Europe (host) • European Commission • European Investment Bank • World Bank • Belgium ●Norway • Finland ●Spain • Slovenia ● Sweden • Netherlands • French Union of • Health Insurance Funds • Veneto Region of Italy • London School • of Economics and • Political Science (LSE) • London School of • Hygiene & Tropical • Medicine (LSHTM)

5. A Knowledge Broker The European Observatory is a high-quality knowledge broker based on following principles: • Transfer • Bridge between policymakers and researchers: information • users and producers • Trust • High-quality evidence and a neutral stance recognising the • real context and pressures of • health systems • Tailored • To the specific needs of • policy makers • Timeliness • Of response to policy maker’s needs and requests

6. What and How? Comparative analysis of existing evidence Developing practical lessons and options in health policy-making • Bridge • Between policymakers and researchers Core Mission: The European Observatory supports and promotes evidence-based health policy-making

7. Comparative Analysis: Tools Vertical: Country Monitoring (HiTs) Describing national health systems Common template for direct comparison 53 European + selected OECD countries Horizontal: Health Systems and Policy Analysis Detailed focus on one topic across national health systems Secondary research

8. Practical Lessons and Options: Tools Assessing and Comparing Performance Provides better understanding of uses and abuses of comparative performance data Creates a toolbox for better measurement and analysis Engaging Policy-makers Two channels: policy briefs and face-to-face policy dialogues Tailor-made, focussed on one specific issue Bring together evidence, assess options and formulate implementation roadmaps

9. Summary

10. University of Copenhagen Dept. of Public Health Unit for Health Services Research

12. The Nordic model? • General entitlement • Mainlytaxfinanced • Mainly public hospital providers • Mainlydecentralizedgovernance • GPs in a keyrole But alsomany differences!

13. Life expectancy in selected countries

14. Health expenditure as a share of GDP

15. Financing Danish health care • More than 80% of the total health care expenditure is financed by taxes • The role of out-of-pocket payments differs markedly by service • VHI financed by employers has increased dramatically since 2001 • VHI still only finances about 1.7% of total hospital services in Denmark[ • The five regions are financed through block grants as well as activity-based financing from the municipalities and the state • The 98 municipalities are financed through income taxes and block grants from the state + intermunicipal transfers

16. Stepwise reforms ??????? of Danish health care

17. Afdeling for Sundhedstjenesteforskning Structural reform 2007 • From 274 to 98 municipalities From 14 counties to 5 regions

18. Health service delivery – a fragmented organization • Municipalities are responsible for disease prevention, health promotion, care and rehabilitation performed outside hospitals • Primary care consists of private (self-employed) practitioners (GPs, specialists, physiotherapists, dentists, chiropractors and pharmacists) and municipal health services • GPs act as gatekeepers, referring patients to hospital and specialist treatment. • Most secondary and highly specialized care takes place in general hospitals owned and operated by the regions

19. The patient perspective: Access to healthservices

20. Pathways for gynecological patients Municipal rehabilitation

21. Can GPs cope with the future challenges?

22. Major policy themes • Free choice • Waiting time • Quality of care • Survival • Continuity • Prevention

23. Freechoice and waiting time 1993 Freechoice of hospitals • Extendedfreechoice (2 months) • The new comprehensive Health Act • Waiting time guarantee 1 month • Waiting time guarantee and extendedfreechoice for child and adolescentpsychiatry (2 months) • + Adultpsychiatry

24. Health care services: The pride of Danish welfare society?

25. Qualityissues: 30 daysmortalityafteracutemyocardialinfarction (%)

26. Quality issues: Cancer survival

27. Survival from lung cancer (%) Denmark Denmark

28. Solving problems of continuity of care? • Health agreements • Regions and municipalities • National Board of Health • GPs? • GP coordinator fee • Other incentives required • Clinical pathways • Cancer • Heart disease • IT innovations • The EMR • The Medcom project: Danish online health portal • The Shared Medication Record • The sentinel data capture system

29. Quality issues: Prevention and rehabilitation The new municipal responsibilities – a difficult task! Local governance – local autonomy – soft national measures Issues of • Organization • Evidence • Competences • Resources • Political priority

30. Municipalexpensesfor health promotion and prevention Enhedens navn

31. Municipal rehabilitation plans per 1,000 inhabitants Enhedens navn

32. Conclusions • The health status of the Danish population is improving, but still relatively unfavorable • The public health service provision and tax based financing is still strongly supported • The decentralized organization is under pressure • Quality and continuity of care are major issues • IT support and communication is a main focus area – it is necessary, but not sufficient • More major reforms can be expected in order to meet future challenges

33. Evolution or revolution? “It is raining too much in Denmark for revolutions!”