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The Danish Health Care System: the Consensus Report

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The Danish Health Care System: the Consensus Report The Danish Health Care System: An Analysis of Strengths, Weaknesses, Opportunities and Threats The Consensus Report Kjeld Møller Pedersen, University of Southern Denmark Mickael Bech, University of Southern Denmark Karsten Vrangbæk, AKF Danish Institute of Governmental Research The Danish Health Care System: An Analysis of Strengths, Weaknesses, Opportunities and Threats Kjeld Møller Pedersen, Mickael Bech, Karsten Vrangbæk ISBN - 978-87-92795-00-7 Table of Contents Table of Contents ................................................................................................................................2 Summary.............................................................................................................................................6 A snapshot of the Danish health system ..............................................................................................8 Framework........................................................................................................................................10 Overview of challenges (threats) and opportunities ..........................................................................12 Challenges .............................................................................................................................................12 Opportunities ........................................................................................................................................12 Overview of strengths and weaknesses .............................................................................................13 Strengths ...............................................................................................................................................13 Weaknesses...........................................................................................................................................13 Objectives of the Danish health system................................................................................................14 Solutions................................................................................................................................................15 Challenges.........................................................................................................................................16 Demographic development: Aging and stagnating number of occupationally active ..........................16 The manpower situation: shortage.......................................................................................................18 Fiscal sustainability: difficult to finance the health system of the future .............................................18 Expenditure development 1999‐2008 ...............................................................................................18 Determinants of growth in health expenditures ...............................................................................20 Prognosis for health care expenditures.............................................................................................21 (In)equity issues ....................................................................................................................................24 Inequity in life style/risk factors ........................................................................................................27 Inequity in access ..............................................................................................................................29 High expectations..............................................................................................................................29 Globalization/Europeanization of health care markets & health tourism...........................................31 2 Integration of private providers and financing with a universal and comprehensive public health care system and the creation of a level playing field for competition..........................................................31 Opportunities....................................................................................................................................33 Personalized medicine ..........................................................................................................................34 New technologies..................................................................................................................................35 Expectations and competencies of the population participation and self care....................................35 Strengths...........................................................................................................................................36 Patient rights.........................................................................................................................................36 Choice and waiting time guarantees.....................................................................................................36 Choice of primary care ......................................................................................................................36 Choice of hospitals.............................................................................................................................37 High patient satisfaction and trust........................................................................................................37 Easy access in primary care, incl. gatekeeper role ................................................................................38 (Reasonable) expenditure control, including efficiency and reimbursement systems .........................38 Introduction of ‘packages’ for cancer and certain cardiac conditions and fast track issue ..................39 Work in progress on (coherent) patient pathways ...............................................................................40 Increased focus on palliative care/end of life care ...............................................................................40 Considerable investments in new hospitals..........................................................................................41 Strengthening of pre‐hospital treatment/care .....................................................................................42 Quality assurance and monitoring ........................................................................................................43 Well functioning multi‐level democratic structures for integrated decision making and implementation.....................................................................................................................................46 Weaknesses ......................................................................................................................................47 Tensions within the democratic multilevel governance structure: Limited voter interest and unclear role for politicians at decentralized levels.............................................................................................47 Ambivalence towards strengthening of prevention and health promotion .........................................48 Ambivalent attitude towards explicit political priority setting..............................................................49 3 Tight budgets and/or wrong allocation and activity based financing ...................................................50 Life expectancy and health status.........................................................................................................51 Slow introduction of new treatments? .................................................................................................53 Lack of vision for new hospitals, i.e. ‘hospitals of the future’ and a vision for primary care ................55 Too slow take up of the chronic care model? .......................................................................................56 Cooperation between municipalities – gPs – hospitals ........................................................................59 Lack of focus on rehabilitation ..............................................................................................................59 Inequity .................................................................................................................................................60 Solutions ...........................................................................................................................................61 What is an added life year worth? ........................................................................................................62 Telemedicine: Large scale pilot projects for monitoring the chronically ill...........................................63 Proposal.............................................................................................................................................66 Methods for prioritization and proposal for an institute for priority setting analyses .........................67 Co‐payment...........................................................................................................................................70 Co‐payment in Denmark and the Nordic countries ..............................................................................70 Proposal.............................................................................................................................................71 Improve equity in
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