Transcript Document

Danish Health Care
An International Perspective
Tony Hockley
Civitas Roundtable
11 May 2005, Copenhagen
1
Introduction
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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
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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)
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29% have “insurance” for copayments
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
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
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De/Centralisation
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Waiting Lists
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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
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Bech 2004
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Choice: from theory to reality –
information, DRG payments
“Dilemma” between patient
choice and system uncertainty
Restricted role for insurance, copayment, (Danish) private
providers
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Conclusion
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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