New health care clusters will be designed to create better coordination between acute care hospitals, primary care and municipalities
As planned, the Danish conservative government last week published its proposal for a new health care reform in Denmark called “Patient First,” intended to make the health care system in Denmark more patient-focused, better connected and with advanced quality of care and improved patient rights.
Overall, the proposed health care reform is very much in line with the outline I wrote about on LinkedIn in September last year:
- 21 new health care clusters will be established around the 21 specialized, acute care hospitals creating better coordination and connectivity between the hospitals, primary care and the local municipalities and improve the quality of care and patient journeys.
- Primary care physicians, a cornerstone in the Danish health care model as every citizen has their own primary care doctor, will continue in their pivotal role as key coordinators of patient care. The primary care sector will have additional resources with 100 more physicians and 160 additional primary care trainees added each year in 2019 and 2020. This is a major injection of primary care doctors, which to some extent will address the problem of physician shortage.
- The Regions, the current five regional health authorities with elected politicians, will be replaced by five regional, professional health care administrations under a new national health authority Healthcare Denmark that will be located in Aarhus (my childhood city!). Healthcare Denmark will be led by a board of health care professionals, administrators and patient representatives who will oversee the quality of health care and coordinate the delivery of care at the national level, as well as ensure patient rights.
- Key aspects of care for patients with chronic diseases will be moved from the acute hospital care setting to the primary care sector for diseases, such as, COPD, type 2 diabetes, cardiovascular disease, musculoskeletal disease and light-to-moderate mental health conditions.
- A national fund will be established with a DKK 6 billion budget to support the transformation to a new structure and new initiatives that bolster preventative care.
- Patient rights that are already quite advanced in Denmark by international standards will be further strengthened across a number of areas. One important element is that patients will be offered alternative treatment options at private hospitals and clinics if the public hospitals can’t deliver the care needed within 30 days.
Frede Olesen, Professor in Primary Care, Aarhus University, calls the proposal “a great blueprint for improving the Danish healthcare system. It recognizes the fundamental structural issues in the current system with a lack of balance and coordination between acute care and primary care and it improves the strength of the primary care sector with additional number of primary care physicians and trainees.”
“The proposal also upgrades the ability of the healthcare system to provide more precise guidance for healthcare quality at the national level through Healthcare Denmark, and it mandates the municipalities to do a better job with rehabilitation and social care for patients.”
Frede Olesen is less enthusiastic about the removal of elected politicians from the regional councils as they have brought an important democratic element to the regional management of health care. However, Frede Olesen hopes that the indirectly elected mayors and health committee chairs of the municipalities can play an important democratic role as a counter balance to the administrative and clinical professionals in the leadership of the health care clusters.
International model for health care reform?
Some international experts may be puzzled and wonder why Denmark is preparing a major health care reform since the country has a publicly funded, single-payer health care system, which has been highly touted, for example by international politicians and policy experts who have promoted Denmark as the model for a similar “Medicare for All” approach in the United States.
However, the potential new Danish health care reform does not change the single-payer model in Denmark. Instead, it fundamentally addresses structural problems with lack of connected patient care across acute and primary sectors, unnecessary regional variations in care and shortage of physicians in primary care, all of which are challenges in most Western health care systems irrespective of them being publicly or privately funded.
Interestingly though, the new Danish health care reform proposal elevates the role of private hospitals as alternative treatment options based on the proposed 30-day treatment guarantee, which some view as the beginning of partial privatization of health care delivery in Denmark.
The proposal for a new health care reform, which is expected to be in effect in 2021 after a transitional period, is supported by the majority of the political parties in the Danish parliament and has generally been positively received in Denmark.
If the proposal is confirmed by the majority in the Danish parliament, it may become an inspiring blueprint for national health care systems in other countries.