The Danish Health Care System October 1, Trine Petersen, Danish Regions, phone

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”: “New Danish Hospitals”: ”Hospital Solutions”: ”Prehospital treatment in Denmark”:

5,6 mio. Danes 53 hospitals, 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) 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!

Expenses – only with age-change

The demographic challenge

Regional budget (billion DKK) 2014 Overall budget100,5 Of which Hospitals 72,6 GP’s15,2 Hospital medication7,1 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 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 approach Medicine expenses (million DKK)

The eHealth approach

Electronic Health Record (EHR) EHR consists of – Clinical documentation – Computerised provider order entry – Patient scheduling – Inpatient administrative systems

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 Triple aim

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

Spreading best practise Based 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