Lessons from Denmark in Healthcare System Performance Measurement and Management Else Smith, Ph.d., M.D. Former Director General at The Danish Health and Medicine Authority ( )

The Danish health care sector – Organisation and financing  Free and equal access to public health care  Universal coverage (same system for all)  Tax financed (85%) (progressive income tax)  Private co-payment in certain areas (15%)  Private insurance (20%: 0.5 mill. personal and 0.5 mill. employer-paid insurances) 2

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4 Healthcare sector in Denmark Many laws on patients’ rights - latest an examination- and treatment guarantee. Digitalization of the healthsector: E-journals and telemedicine widely used. Re-admissions and waiting lists. Hospital-acquired infections. Time spend in hospital and survival time, with special focus on cancer. Social inequality in health (priority of present governement).

Focus on: Quality, effect and coordinated care pathways across sectors General national collection of many patientdata on all admittence to hospitals. 3. generation national health agreements (municipality, general practitioners and hospitals). National monitoring of flows in pathways for cancer and heart diseases. Laws on patients’ rights. Personal medicine profile card. E-journal – data sharing including with patients. Speciality planning at national level under the authority of DHMA by law. National clinical guidelines. 6

Speciality planning – quality by pooling expertise Professional core requirements for all hospitals Pooling expertise for rare and difficult conditions - because practice makes perfect ! High-quality treatment services for all patients Same quality regardless of time and place Fewer, bigger and higher specialised hospitals 6

National clinical guidelines State and regions agreed on spending 12 mio. US $ over 4 years to develop 50 national clinical guidelines. Regions are responsible for the implementation. A national clinical guideline is a set of systematically prepared, scientific recommendations describing diagnosis, treatment, care and rehabilitation for specific patient groups – based on evidence for the effect and best practice. Control of progress in a national stearinggroup. Expect to see more money allocated in the coming years, but… 7

How do we manage the expectations and demands? Political commitment and priority. Plan for better integrated care. Look at our health educations – do we need other competencies? Work across different sectors, e.g. education and work. sector and social sector. Re-organizing hospitals –fewer beds, flexibility. Development of our primary health care sector. Communication to the public. 8

9 Municipality health care system Health offers General Practitioner Chiropractor Psychologist Physiotherapist Diagnostic centers Specialised hospital Medical specialist Alternative treatment Pharmacy Home Rehabilitation Telemedicine Self mediciation Dentist Occupational therapist Chirapodist Municipality health care Health offers, information etc. Outpatient clinics, home visits Social sector Employment Education Recreation

Thank you for your attention! Copenhagen in summertime 10