The Danish Health Care SystemOctober 1, 2014

www.regioner.dk Trine Petersen, Danish Regions, tpe@regioner.dk, phone +45 3529 8461

The basic principles

• A public health care system• Free and equal access for all citizens• Freedom of choice• Mainly financed through general taxes• Decentralized organization• GP/family doctor as gatekeeper

Political and administrative levels

• Danish Parliament/Government- Ministry of Health, National Board of Health etc.

• 5 Regions – 5 Boards with 41 elected politicians • 98 Municipalities – 98 Boards with between 9 and 31 elected politicians

Responsibilities•Regions (no tax income): Hospitals (somatic and psychiatric, in- and outpatient), primary healthcare contracts (GP, specialists in private practice, adult dental services, physiotherapists, psychologists, chiropodist, chiropractor), reimbursement of medicine.•Municipalities (tax income): Home nursing, rehabilitation services outside hospitals, treatment of drug and alcohol abuse, prevention and health promotion, district nurses, children's dental services•State (tax income): Legislation, national health care policy, overall framework of the health care economy

Danish Health Care in brief (to watch when home!?)

“The Case of Denmark”: http://vimeo.com/89693420“New Danish Hospitals”: http://vimeo.com/103503844 ”Hospital Solutions”:http://vimeo.com/105850624”Prehospital treatment in Denmark”:http://vimeo.com/96692510

5,6 mio. Danes

53 hospitals, 18.000 beds

107,000 employees

1,8 mio.1,3 mio.

1,2 mio.0,8 mio.

0,6 mio.

The five Danish regions

Region Zealand

The Capital Region

The Region of Southern Denmark

The Central Denmark Region

The North Denmark Region

• 2,6 million are treated at the hospital• 1,1 million Danes are hospitalised (somatic) • 50.000 in psychiatric hospitals• 11,5 million out-patient treatments• 1,3 million operations• 41 million visits at the normal GP• 5 million visits at the specialized private practitioners

Yearly regional activity in brief

The GP/family doctor as gatekeeper

• Patients choose their GP (within geografical limits)

• 9 out of 10 patients consult their GP at least once a year

• GP’s also cover out-of-hours services• GP’s are private entities and own their own

clinics (generally)

Demographic changes – in one year!

00 - 04 år

05 - 09 år

10 - 14 år

15 - 19 år

20 - 24 år

25 - 29 år

30 - 34 år

35 - 39 år

40 - 44 år

45 - 49 år

50 - 54 år

55 - 59 år

60 - 64 år

65 - 69 år

70 - 74 år

75 - 79 år

80 - 84 år

85 - 120 år

0

1,000,000,000

2,000,000,000

3,000,000,000

4,000,000,000

5,000,000,000

6,000,000,000

7,000,000,000

8,000,000,000

9,000,000,000

Expenses – only with age-change

2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 202558,000,000,000

60,000,000,000

62,000,000,000

64,000,000,000

66,000,000,000

68,000,000,000

70,000,000,000

72,000,000,000

74,000,000,000

76,000,000,000

The demographic challenge

Regional budget (billion DKK)

2014

Overall budget 100,5 Of whichHospitals 72,6GP’s 15,2Hospital medication 7,1 Medication reimburs. 5,5

Region Zealand: 52,6% are obese

1,8 mio.1,3 mio.

1,2 mio.0,8 mio.

0,6 mio.

Our health, e.g.

The Capital Region: 90% drink too much

The Region of Southern Denmark: 19,2% smoke on daily basis

The Central Denmark Region

The North Denmark Region

2010-2013 Less smokers (from 20,9 % to 17,0 %)

Less big smokers (from 10,9 % to 8,2%)Less (low risk) drinkers (from 24,3 to 20,6 %)

Less high risk drinkers (10,6 % to 8,5)

Some trends

• - Reduction in number of hospitals and beds• - Centralization and specialization• - Fewer hospitals with ED’s• - Focus on prehospital emergency care• - Focus on intermediate care• - Hospitals to be renovated + new hospitals built (40 billion DKK to

be spent)• - GP’s collaborating in larger clinics• Number of discharges over the last 8-10 years – slight increase• Outpatient visits – huge increase• Average length of stay is now 4 days – huge decrease

The medicine approachMedicine expenses (million DKK)

The eHealth approach

Electronic Health Record (EHR)• EHR consists of

– Clinical documentation– Computerised provider order entry– Patient scheduling– Inpatient administrative systems

0

5

10

15

20

25

2007 2010 2013

Jutland (South)

Sealand

Jutland (North)

Jutland

Capital

The quality agenda

Quality is a huge part of the solution to the challenges

Quality in health care means: • Putting the patient (and relatives) first• Doing what is right the first time• Having coherence in the action

Good quality is not an additional expenditure but bad quality is

The Quality approach

Kilde: IHI . Technical Brief J une 2007, p. 2.

Triple aim

Agenda

• Quality• Patient involvement• Leadership• Realtime data• Patient safety• All teach all learn

Spreading best practise

• www.VIS.dkBased on openness and crowdsourcing

–More team than indvidual–More relation than profile– more health than sector –More problem sensing than comfort seeking–More Ipod than pioneer