Transcript Document
Danish Health Care
An International Perspective
Tony Hockley
Civitas Roundtable
11 May 2005, Copenhagen
1
Introduction
A stalwart of the “public integrated
model”
“Unrestricted, equal, and free access”
Relative decline in health status
Gradual growth of co-payment (and
insurance) in limited areas
Change by “Baby steps” Chresten Anderson
2
Funding
75% by block grant from central
government (2007)
Small role for activity payment
Medicines: patients pay first
520DKK/pa; & 50% 520-1250DKK (inc
25% VAT on medicines)
29% have “insurance” for copayments
1988 Private Spend 16% Total
2000 Private Spend 19% Total
3
Spending
Health Spending 2002 (OECD)
6000
Total
5000
Public
Pharma
3000
2000
1000
A
U
S
U
K
nd
Sw
itz
er
la
ed
en
Sw
N
et
he
r la
nd
s
an
y
G
er
m
nc
e
Fr
a
D
en
m
ar
k
C
an
ad
a
gi
um
0
Be
l
US$
4000
4
EU
UK
Portugal
Nederland
Luxemburg
Ierland
Italië
Griekenland
Frankrijk
Spanje
Denemarken
Duitsland
België
Co-Payments % of Total
25,0
20,0
15,0
10,0
5,0
0,0
Van Montfort (2002)
5
Drug Spending
($ Per Capita)
Pricing and reimbursement limits. Price cuts (2004)…
500
450
400
350
300
250
200
150
100
50
0
United
States
United
Kingdom
Switzerland Netherlands
1990
Germany
1994
1998
France
Denmark
Belgium
Van Montfort
(2002)
6
ly
UK
Ne
th
s
No
rw
a
Po y
rtu
ga
l
Sp
ai
n
Sw
ed
en
Sw
it z
Ita
Au
st
ria
Be
lg
iu
De m
nm
ar
k
Fi
nl
an
d
Fr
an
ce
G
er
m
an
y
G
re
ec
e
Ire
la
nd
% total reimbursed pharmacy market (2002)
Drug Co-Payment
Paitents' Share of Drug Costs
45
40
35
30
25
20
15
10
5
0
SOURCE: efpia
(2002)
7
Patients’ Payments for
Medicines
2300
2200
2100
DKK (m)
2000
1900
1800
1700
1600
1500
1999
2000
2001
2002
2003
8
Policy Focus
De/Centralisation
Waiting Lists
Is centralisation essential to strategic
reform?
Consume new investment
Tinkering with co-payments
= “Priority-Setting by Fire-Fighting”
Kjeld Møller Pedersen 12/2004
9
Reform Prospects
Choice
Patients
Q3
2000
2044
Q2
2002
5135
Q2
2004
5481
Bech 2004
Choice: from theory to reality –
information, DRG payments
“Dilemma” between patient
choice and system uncertainty
Restricted role for insurance, copayment, (Danish) private
providers
10
Conclusion
New central structures may improve
opportunities for strategic reform?
Patient payment and choice remain
excessively focused on medicines,
dentistry, & waiting lists
Limited dissatisfaction limits
immediate reform options
More “baby steps” to come…
11