Health Policies: Denmark (2016)

Introduction
The Danish healthcare system is built on a model of solidarity based on principles of equality. There is, however, an increasing tendency towards more elements deriving from a marked-oriented model, with more freedom of choice and the patients' autonomy as a value. The Danish healthcare system is primarily publically funded and its regulation is decentralised, with only a slight degree of central involvement (Vallgårda & Krasnik 2002:29). The degree of decentralisation is greater than what is seen in other countries, with central regulation guiding, for instance, financing and specifying certain statutory services in order to prevent a large degree of inequality in health (Vallgårda & Krasnik 2002:17).  

The Danish healthcare system can be categorised into three areas by means of function. The primary health service consists of general practitioners, specialist doctors, dentists, physiotherapists, and pharmacies, for instance. Activities are placed outside institutions and primarily in close proximity to the population. Secondary health service consists of activities in hospitals, while the tertiary service is constituted by care homes (Vallgårda & Krasnik 2002). Activities are financed through regional and municipal taxes and through the National Health Service. There is a co-payment on the services of dentists, private practicing physiotherapists, psychologists, and prescription medication, for example, and a full user charge on non-prescription medication and glasses. Private health insurance policies are becoming increasingly popular.
The Danish healthcare system costs approximately €13.7 billion annually, or €2,400 per inhabitant, which is the result of a 40 % increase in expenses between 2000 and 2014 (Danish Regions 2015).

Due to the ageing population, an increase in the demand for health services is expected. Further, expectations regarding the quality of services are high and increasing, just as the proportion of people with chronic diseases is expected to increase in the future. Decreasing financial resources have incited local government at the municipal and the regional levels to rethink the organisation of the healthcare system. The result is the establishing of so-called ‘Super Hospitals’, with a centralisation of hospitals and medical specialities at a limited number of locations. On a smaller scale are the more locally placed Health Houses, which try to foster the idea that operators from the municipality and the praxis sector work from the same address and that this is conductive to the best health effects for the inhabitants. The organisation is in line with the idea of 'The Nigh Health Care System' (Kommunernes Landsforening) as the guiding principle.

 

Long-term care 
The rules on long-term care are laid out in the Consolidation Act on Social Services and are based on the general principle of free and equal access. Policies stress that services are based on the individual’s wants and needs, with the aim to ensure continuity in the event of illness and infirmity (Schultz 2010); a main aim is to ensure that the elderly can stay in their own homes for as long as possible.

The municipalities govern home healthcare and nursing homes. The structure and extent of available home healthcare as well as the number of available places in nursing homes is thus the result of different political priorities on the municipal level. Overall, the organisation of this care has changed since the 1980s, with care homes replaced by sheltered housing units (close-care accommodation with care facilities and associated care staff but with housing areas separated from care service areas) and home care services play a larger part. The home care services can be in the form of home nursing, home care, and/or practical help. The guiding principle in the organisation of long-term and elderly care originates in 'The Nigh Health Care System' (Kommunernes Landsforening). Individuals lawfully residing in Denmark are entitled to personal care and help with practical tasks. Help is assigned on the basis of an individual assessment and there is no minimum of required time for help. 

Local taxes and block grants from the state finance the services. Permanent personal and practical assistance is free, whereas temporary assistance can be chargeable (based on income). Expenses not related to staff can be self-paid (e.g. meals). People can choose either a private or public provider of practical assistance (since 2002) and from 2003 also providers of personal care (Schultz 2010). In 2007, around 63 % of municipalities provided a free choice of practical assistance and 41 % of personal care providers (Rostgaard 2007, in Schultz 2010). One in six elderly persons aged 65 or above receives some form of home care (Rostgaard 2015). Informal caregivers play a limited role in Denmark. Further, personal care is limited to between partners (Schultz 2014). Local authorities do, however, support both volunteers and family caregivers, the latter of whom are provided with substitute or respite care as well as cash allowances for palliative care. Under specific circumstances, the carer of a closely related person can be employed by the municipality for up to six months (Schultz 2010). In the case of in-home care needs of significant magnitude, it is possible to employ helpers of one’s own choosing with financial support (for long-term care of individuals age 18 and over).

In order to secure coordinated and efficient care for the individual citizen, systems have been implemented to coordinate consistency in the long-term care given under the responsibilities of the local municipality and the health services given and operated by the regions (Danish Health Authorities).

With an ageing population, there is an increasing demand for help with practical and personal care. 
It is expected that the proportion of the oldest old will rise in the Danish population and, as they are more likely to live alone, the demand for care is correspondingly increasing (as people living in single households are more likely to need care (Schultz 2010)).

 

Authors – Contributors
Lene Tølbøll 
Aalborg University

 

Bibliography

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