Transcript PowerPoint-præsentation

Health Care in Denmark
24 October 2014
Danish Regions
Basic principles of Danish Health Care
• A public health care system
• Equal and free access for all citizens
• Freedom of choice
• Mainly financed through general taxes
• Decentralized organization
• General Practice (family doctor) as gatekeeper
24 October 2014
Danish Regions
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
General elections to regional and municipality boards every 4
years
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Danish Regions
The Danish Health Care
Who is responsible for what?
State
•
•
•
Legislation
National health care
policy
The overall framework
of the health care
economy
Regions
•
Municipalities
•
•
•
•
•
•
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Home care
Rehabilitation services
outside hospitals,
Treatment of drug and alcohol
abuse
Prevention and health
promotion
District nurses
Children's dental services
•
•
Danish Regions
Hospital (somatic and
psychiatric, in- and
outpatient)
Primary healthcare
contracts (GP, specialists in
private practice, adult
dental services,
physiotherapists,
psychologists, chiropodist,
chiropractor)
Reimbursement of
medicine
The Danish Health Care
Plans and the Bermuda Triangle
•
•
•
•
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Plan for highly specialised care
Hospital plans
Plans for GP’s, specialists etc.
Health Care plan
Agreements between regions and
municipalities
Municipality services
• Contracts with GP etc.
(e.g. rehabilitation,
home care)
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Danish Regions
Hospitals
General
Practice
The Danish Health Care
Five Regions
North Denmark Region
Danish population: 5,6 mio.
Central Denmark Region
Capital Region of Denmark
Region of Southern Denmark
Region Zealand
The Danish Health Care
Capacity
• 52 public hospitals
Hospital Doctors
14%
• 107.000 FTE
• 3.600 GP’s and 1.100
specialists in private
practices
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30%
Nurses
Other health care personnel
33%
23%
Danish Regions
Other personel (psychologist,
administration, cleaning
operatives, technical
personel)
The Danish Health Care
Trends
•
•
•
•
•
•
Reduction in number of hospitals and beds
Centralization and specialization
Fewer hospitals with ED’s
Focus on pre hospital emergency care
Focus on intermediate care
Hospitals to be renovated + new hospitals built (41 billion DKR
to be spent)
• GP’s collaborating in larger clinics
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Danish Regions
The Danish Health Care
Activity
• Each year 95 out of 100 Danes have contact with the health
care system, either through the hospital, family doctor,
specialists or dentists
• Each year 2.6 million Danes are treated at a somatic hospital
and in addition are 120,000 patients in psychiatric treatment
• There is an annual 40.5 million visits to GP
• 11.5 million visits to specialists
24 October 2014
Danish Regions
The Danish Health Care
Trends
• A slight increase of the number of discharges over the last 10
years
• Average length of hospitalization at somatic hospitals is below
3.8 days in average
• Decrease from 4.4 days in 2008
• Average length of hospitalization in psychiatry is in average 19
days for adults and 31 days for kids
• Decrease of 16 % (adults) and 7 % (kids) since 2009
• Reorganization of patients
• Increase of outpatient visits (74 % of all visits)
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Danish Regions
The Danish Health Care
Operating expenses
Budget 2014: 102,7 billion DKR (17 billion USD)
5%
Hospitals
15%
GP, specialists, dentists
80%
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Danish Regions
Medicine, reimbursement
The Danish Health Care
Financing
The regions cannot levy their own taxes
Financing consists of:
• State Grant – 75 Percent
• State activity related grant– 5 Percent
• Municipality basic grant – 5 Percent
• Municipality activity related grant – 15 Percent
Annual agreements between Danish Regions and government
24 October 2014
Danish Regions
The Danish Health Care
Financial set-up
Regions
State
CO-FINANCING
(20 %)
Citizens
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Municipalities
Danish Regions
Private Practice
• General practice
• Specialists (e.g. ear and eye
specialists)
• Adult dental services
• Physiotherapists
• Psychologists
• Chiropodist
• Chiropractor
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• Practice sector consists of
a number of small selfemployed businesses
• It is important that the
private practice sector is
an integral part of whole
health care system
Danish Regions
Private Practice
• The regions' Wages and Tariffs Board
(RLTN) enters into an agreement with
each professional organizations and
practitioners in relation to the health
services they need to deliver to
patients, the service demands, as well
as the pay which they get for it
• The regions provide financial founded
for the private practice
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• The private practice is allowed to offer
other health services, than those which
are founded by the regions
• It is written in in the Health Act in
which areas there are user fees, and
which is fully funded by the regions
Danish Regions
Co-operation with the Private Sector
The supply of health care is the Regions responsibility
PUBLIC HOSPITAL
If the region is not able
to offer the treatment
needed within 2 (1)
months, the patient can
choose treatment at a
private hospital (§87)
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NON-PROFIT HOSPITAL
A region can also
cooperate with non-profit
hospitals, that provided
services for patients with
epilepsy, gout, brain and
also traumatised refugees
and care of terminally ill
patients
Danish Regions
PRIVATE HOSPITAL
Four out of five regions have
agreements with private
hospitals through public
procurement (e.g. orthopaedic
operations, eye operations)
At the moment Danish Regions
have agreements with 119
private hospitals and clinics
Co-operation with the Private Sector
Number of public patients at Private Hospitals and Clinics
120,000
100,000
80,000
60,000
110,852
110,676
85,480
40,000
110,470
96,585
88,344
88,345
2012
2013
47,948
20,000
0
2007
2008
2009
2010
2011
Source: Landspatientregisteret § 75 + § 87, please note, that 2014 is an estimate
24 October 2014
Danish Regions
2014
Co-operation with the Private Sector
The Regions Expenses
Mio. kr.
2007
2008
2009
2010
2011
2012
2013
728
1.273
877
916
596
495
332
Public procurement (§75)
73
94
199
258
168
116
134
Non-profit private hospital
(§79 stk. 2)
414
417
416
425
532
552
551
Other healthcare supplied by
private hospitals
25
56
96
99
62
52
91
1.240
1.839
1.588
1.698
1.359
1.214
1.109
The extended free choice (§ 87)
Total expenses
Source: The Regions Financial Statement
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Danish Regions
Patient Rights
Access to your own
medical record
Part of the DNA
Guarantee for
treatment of lifethreatening
diseases
If you are subjected to
coercive measures, you
have the right to have a
patient counselor
No more than onemonth waiting time for
treatment
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The right to a quick
assessment
(within 30 or 60 days)
Freedom of choice
The right to have a
contact person within
48 hours if needed
Staff must maintain
secrecy – also towards
the nearest family
members
The right to receive
information
Danish Regions
In psychiatry the personnel
must try to achieve the
patient’s voluntary
participation before
use of coercion
Challenges
What is facing us?
• An increasing elderly population
• More people suffers from chronic conditions
• Keeping up with the development of new technologies and
medicines
• New kinds of treatments
• Documentation of quality
• Limited resources
• Increasing expectations and demands
……will put the health services under tremendous pressure
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Danish Regions
The Quality Agenda
Part of the DNA
Effect: Patients should
be given the treatment
that works best
Equality: There should
be equality in care and
treatment
Effect
Equality
Patient safety
Patient safety:
Treatment should be
safe for patients
The patient in focus:
Patients and caregivers
should be in focus and
be involved
QUALITY
The patient in
focus
Punctuality: Treatment
must take place in a
timely manner
Punctuality
Cost-effective: The best
possible health value for
money
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Cost-effective
Danish Regions
The Quality Agenda
Quality is a part of the solution
•
•
A new agenda that requires a massive change
Changes to be implemented systematically and in depth
Quality in health care means:
• Doing what is right the first time
• Having coherence in the action
• Focus on the patient
Good quality is not an additional expenditure but bad
quality is!
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Danish Regions
The Quality Agenda
Quality is a part of the solution
Quality initiatives
Increasing costs
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Cost-neutral
Savings
Quality improvement
Decreasing costs
Danish Regions
Quality-neutral
Quality reduction
Out-of-pocket payment
• Without a referral from a doctor, there is a user fee to services
provided by specialists such as physiotherapists,
psychologists, etc.
• Co-payment to dentist treatment (over the age of 18)
• User fees for medicine
– However, you have the opportunity to receive reimbursement for
prescription medications when medical expenses exceed a certain
amount per year
Alternatively private health insurances
can provide subsidies or grants
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Danish Regions
Patient as Partner
More and better
information on treatment
choices, clinical results and
evidence
Part of the DNA
A relation build upon
clear communication,
continuity and shared
decision making
Partnership between
patient and staff
The center of
decision making
Agreement in relation to
goals and results
from the treatment
Diagnosing patients
preferences
”The silent misdiagnosis”
Supported self management
and active participation in
treatment and care equals an
effective method
Patient engagement is
the new
”blockbuster drug”
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Patients have
knowledge, abilities
and trust in managing
their disease and
health
Danish Regions
Comparison
Denmark-USA
9,3 %
11 % 16,9 %
2,867 USD 3,547 USD
4,810 USD
DENMARK
6,7 %
8%
9,4 %
2,088 USD
3,042 USD 3,644 USD
USA
81,1 82,1 82,9
76,3 77,5
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78,1
Danish Regions
Source: http://www.oecd.org/statistics