Introduction
Basic principles of the health care system
In Denmark health care is consideres a public responsibility. Virtually
all health care services are finances, planned and operated by public authorities. The
financing derives mainly from general taxation.
All residents in Denmark have equal eccess, free of charge to almost
all health care services, regardless of employment and financial ans docial status.
The system is characterized by a far-reaching decentralization of
responsibility for health care to politically elected regional and local councils. Thus
responsibility for rhe health care services is distributed among the three administrative
levels in Denmark: National, regional and local level. The autorities of the tree levels
cooperate closely and thus secure a coherent helth care system.
Over the recent decade a general trend in Danish health policy has been
the distributing of tasks from the hospiral sector to the primary health sector. More
services have been made available at community level an the services of the primary health
sector have been expanded. This trend reflects the idea that citizens should be offeres
treatment at the nearest possible level.Over the last years it has been widely recogniszed
that existing health problems cannot be solved by treatment alone. Consequently the
efforts to prevent disease have been strengthened. Much weight has been attached to
lifestyle factors such as nutrition, tobacco, alcohol etc.
Health promotionis not only the responsibility of the health care
system. It comprises a wide range of tasks in many sectors, for example improving the work
environment, increasing road saftey, improving housing and community environment and
stregthening social services at community level.
Consequently the health care policy focuses on cooperation between a
wide range of authorities and organizations. One result of this cooperation is
acomprehensive programme on health promotion. Twelve ministries have been involves in the
elaboration of this programme which has been coordinated by the Ministry of Health.
MINISTRY OF HEALTH
11. HERLUF TROLLES GADE
DK-1052 COPENHAGEN K. DENMARK
Telephone +45 33 92 33 60
Telefax +45 33 93 15 63
Administrative Organization
Danish health care sector comprises two subsectors:
- Hospital services
- Primary health care services
-
Responsibility for the service is distributes among the three political and
administrative levels in Denmark: National, regional and local level.
National level
At national level the task is essentially to initiate, coordinate and supervise the
healt care system. One of the main tasks is so set the goals for the national helth
policy.
The Ministry of health is the principal health authority and is responsible for
legislation on health. This includes legislation on health care, personnel, hospitals and
pharmacies, pharmaceutical products, nutrition, vaccinations, maternal and child care,
patiets' rights etc.
The Ministry controls the health care system mainly by issuing general rules and
guidelines.
The Ministry runs a number of central agencies with various executive, advisory and
supervisory functions.
The National Board of Helth
The main fuctions of the Board care
- executive tasks in the administration of health services
- advisory functions with respect to national government
- advisory functions with respect to local authorities and health professionals
- supervisory functions with respect to health professionals
- regulation and planning of the education of health professionals
At regional level the tasks of the board are carried out by state-employed public
health officers.
The staff of the board numbers about 325 persons, whereof approximately 30% are health
professionals and pharmacists.
Address:
National Board of Health, 13, Amaliegade, Box 2020, DK-1012 Copenhagen K, Denmark,
Telephone +45 33 91 16 01 Telefax +45 33 93 16 36
The National Food Agency
The National Food Agency administrates the legislation on food-stuffs in Denmark. The
agency assists the Ministry of health in law making and acts as adviser on food and food
related questions.
The municipalities are responsible for ensuring that the food legislation is complied
with. The National Food Agency operates and supervises the Danish food control system,
which consists of 38 municipal food control units.
The staff numbers totally about 230 persons.
The main tasks of the agency are
- to protect the consumers from food related health risks
- to protect the consumers from disinformation
- to ensure fair conditions for food industry and trade
- to promote healthy eating habits among the Danes in order to prevent diseases related to
nutrition.
Address:
The National Food Agency, 19, M¿rkh¿j Bygade, DK-2860 S¿borg, Denmark, Telephone +45
39 69 66 00 Telefax +45 39 66 01 00
The Danish Institute for Clinical Epidemiology (DICE)
DICE is a research institute. Its main functions are
- conduct of a national Health Interview Survey Programme
- epidemiologic research and health services research
- maintenance of computerized register and a register of multiple sclerosis
- research related to health promotion and disease prevention
- assisting the National Borad of Health and other public authorities in carrying out
epidemiologic and statistical investigation
The staff numbers about 30 persons, half of whom are research from various disciplines.
Address:
Danis Institute for Clinical Epidemiology, 24 Svanem¿llevej, DK-2100 Copenhagen ¯,
Denmark, Telephone +45 31 20 77 77 Telefax +45 31 20 80 10
The National University Hospital
The National University Hospital is the only hospital owned and run by the State. The
hospital is under the authority of the Ministry of Health. It is the biggest hospital in
Denmark with approximately 1.550 beds. The staff numbers about 8.000 persons.
The hospital is organised, equipped and staffed to perfom virtually all kinds of
specialized hospital treatment. The hospital has more than 40 specialized clinical
departments and serves as a model hospital to regional hospitals at all levels.
The hospital is the national centre for
- specialized patient treatment
- specialized departmental and interdemartmental research and development work
- pre- and postgraduate training of medical doctors and other health personnel
- experimental and developmental work in areas of public health
Address:
The National University Hospital, 9, Blegdamsvej, DK-2100 Copenhagen ¯, Denmark,
Telephone +45 35 45 35 45 Telefax +45 35 37 66 45
The Patients' Complaints Board
The Patients' Compaints Board is an independant body composed of lawyers and laymen as
well as health personnel.
The Board considers compaints about professional errors made by health personnel.
One thousand cases are put before the Board each year. 85% of these concern doctors.
Address:
The Patients' Compaints Board, 2. Ravnsborggade, DK-2200 Copenhagen N, Denmark,
Telephone +45 31 35 99 33 Telefax +45 31 35 94 67
The Danish Council of Ethics
The Council has an advisory function and has issued several reports and recommendations
on various ethical matters. Amongst these are reports on brain death, patients' self
determination and information, the regulation of research conducted on fertilized human
ova and foetuses and the human genome project.
The Council consists of 17 members, 8 of whom are appointed by the Minister of Health
and the rest by a special parliamentary committee.
Address:
The Danish Council of Ethics, 2,3, Ravnsborggade, DK-2200 Copenhagen N, Denmark,
Telephone +45 35 37 58 33 Telefax +45 35 37 57 55
The Council on Health Promotion Policy
The Minister for Health has set up an independent Council on Health Promotion Policy,
The Council consists of 24 members.
The main functions of the Council are
- to follow the development in health promotion
- to survey and evaluate public health promotion efforts
- to make proposals for new health promotion initiatives
- to make health promotion the subject of public debate
Under the Council on Health Promotion Policy the Minister for Health has set up an
independent Council on Alcohol, which consists of 9 members. This Council has the same
functions as the Council on Health Promotion Policy, but restricted to alcohol issues.
Address:
The Council on Health Promotion Policy, c/o Ministry of Health, 11, Herluf Trollesgade,
DK-1052 Copenhagen K, Denmark, Telephone +45 33 92 33 60 Telefax +45 33 93 15 63
The Danish Council on Smoking and Health
The Council is an independent council of experts under the Ministry of Health. The
council consists of 9 members appointed by the Minister for Health.
The main functions of the Council are
- to reduce the health damaging effects of smoking
- to reduce the number of new smokers particularly among children and adolescents
- to secure smoke-free environments
- to reduce the tobacco consumption of existing smokers
Address:
The Danish Council on Smoking and Health, 2,2, Ravnsborggade, DK-2200 Copenhagen N,
Denmark, Telephone +45 35 37 52 00 Telefax +45 35 37 52 88
The State Serum Institute
With a staff of about 900 the State Serum Institute is the central public health
institute for Danish hospitals and general practitioners in the field of medical
microbiology, immunology and related disciplines, and a national and international
research centre. Furthermore, the institute produces vaccines and blood products.
There are plans to privatise the State Serum Institute.
Address:
The State Serum Institute, 5, Artillerivej, DK-2300 Copenhagen S, Denmark, Telephone
+45 32 68 32 68 Telefax +45 68 38 68.
Regional level
Denmark's 16 counties are general administrative entities at regional level. They are
headed by politically elected county councils.
One of the counties' major tasks is the supply of health care services. The counties
are responsible for hospital care and primary, curative care (except home nursing) as well
as for health promotion initiatives.
The activities are mainly financed through county income taxes. The level of the county
income tax being a crucial political issue, planning the health care services requires a
balance between good services and taxes.
Differences in income and demography are compensated for by government block grants.
The Association of County Councils in Denmark takes care of matters that are common to
all county councils.
Address:
The Association of County Councils in Denmark; 10, Landem¾rket, Box 1144, DK-1010
Copenhagen K, Denmark, Telephone +45 33 91 21 61 Telefax +45 33 11 21 15.
Local level
Denmarks's 275 municipalities are general administrative entities at local level. Like
the counties they are headed by elected councils. They finance their activities in much
the same way as the counties.
The municipalities have a wide range of responsibilities of which health care tasks are
only a minor part.
The municipalities are responsible for home nursing services and a number of preventive
programmes, including public health nurses, school health and child dental services.
The municipalities are also responsible for planning and running most of the social
welfare system, including services adjacent to health care, like nursing homes for the
elderly.
The National Association of Local Authorities takes care of matters that are common to
the authorities at local level.
Address:
The National Association of Local Authorities, 11 Gyldenl¿vesgade, DK-1603 Copenhagen
V, Denmark, Telephone +45 33 12 27 88 Telefax +45 33 12 23 50
Financing
Most of the health care services are free of charge. Therefore the greater part of
health care expenditure, about 85%, is public expenditure. There is some user payment or
co-payment outside hospitals, particularly for drugs, dental care and physiotherapy.
The total public and private health care expenditure of 51,000 million Danish Kroner
(1990) corresponds to 6.3% of the gross domestic product (GDP). This is a rather low
figure compared to other developed countries. The OECD-average is around 7.6%. However,
the figures are not fully comparable.
The Danish health care costs have been close to constant in fixed prices during the
past decade with an average annual rate of growth of 0.5% or less. Therefore, the
proportion of GDP spent on health care has actually diminished since 1980.
Undoubtedly, the successful cost containment is to a large extent due to the fact that
health care is financed by counties and municipalities, which habe been under economic
restraint by the government. There are indications that financial restraints have
triggered off a successful drive to improve productivity and efficiency in the health care
sector.
Primary Health Care
Today primary health care constitutes the backbone of the Danish health care system.
Over the past decade much has been done to redistribute services from the hospital sector
to the primary helth sector. The idea is that health care tasks should be cared for as
near to the citizen as it is appropriate in a given situation.
Primary health care services comprise general practitioners and practicing specialists,
practicing dentists, physiotherapists and home nurses employed by the municipalities.
General practitioners
- Every citizen in Denmark has the right to be enlisted with a general practitioner.
- There are about 3.200 general practitioners in Denmark.
- On average 1600 citizens are enlisted with each general practitioner.
The pillar of the heath care system is the socalled family doctor-system. Anyone aged
16 or over may choose his own general practitioner. Families often keep the same family
doctor for a number of years, which gives the doctor a thorough knowledge of the family's
social and medical condition.
The general practitioner acts as a "gatekeeper". When a person falls ill or
has a health problem, he or she contacts the general practitioner. If the doctor considers
it necessary, he will refer the patient for further examination or treatment either to a
practicing specialist or to hospital. The doctor may also call on the services of health
visitors, home nurses and the community social services.
This system functions round the clock and all facilities are available to the patient
free of charge.
The only deviation from the "gatekeeper" system occurs in the case of sudden,
serious injury or disease. In this case the patient may be treated at the hospital without
any previous contact to the general practitioner.
In principle, the general practitioner runs a private practice either on hin own or in
collaboration with other general practitioners. The main part of the general
practitioner's income, however, derives from the Health Care Reimbursement Scheme.
Practicing specialists
Generally, the practicing specialists examine and treat patients referred to them by
general practitioners. There are about 800 full-time practicing specialists in Denmark. A
similar number have other positions, usually within the hospital services and carry on
their private practices on a part-time basis. The service of the practicing specialists
are aslo covered by the Helat Care Reimbursement Scheme.Practicing dentists
The majority of dentists have private practices. There are 3.400 practicing dentists in
Denmark. According to an agreement with the Health Care Reimbursement Scheme the patients
are reimbursed part of their expenses for dental treatment. The population has a free
choice of dentist.
Physiotherapists
General practitioners can refer patients für treatment by physiotherapists, who are
permitted to establish private clinics. They work under an agreement with the Health Care
Reimbursement Scheme which partly reimburses the fees paid by their patients.
Many municipalities also employ physiotherapists, for instance in nurshing homes.
Pharmacists
In Denmark all medicine is sold by pharmacists authorised by the State. The Minister
for Health determines the number and location of pharmacies. The Health Care Reimbusement
Scheme reimburses some of the patient's expenses for medicine. Many elderly patients and
some with severe chronic deseases and disabilities are supplied with medicine free of
charge.
Home nurses
A home nursing service is compulsory for all municipalities. The general practitioner
or the hospital can refer patients to home nursing care, which is free of charge and often
integrated locally with the home helper services.
Nursing homes
Nursing homes receive elderly people who are not in need of hospital treatment, but who
require sheltered dwelling with some degree of care. The municipalities pay for the main
expenses of the nursing homes, while the residents contribute according to their means.
Nursing homes are considered a part of the social welfare system and not health care.
Hospital Services
- There are about 30.000 hospital beds in Denmark.
- Average utilization is 81%.
- There are about 1.1 million admissions to hospital per year.
- The average lengt of stay is approximately 7 days.
- 98.000 people are employed in the hospital sector, among them 8.800 doctors and 23.000
nurses.
The counties are responsible for the supply of hospital services to their citizens free
of charge. Virtually all hospitals are owned and run by the counties. For hospital
services that require larger catchment populations than one county an inter-county market
has been established.
As of January 1st 1993 Danish citizens who need hospital treatment may
choose between all public hospitals and a number of private clinics which cooperate with
the public hospital services.
This means that a patient, who has been referred for hospital treatment by his or her
general practitioner, may choose which hospital to be admitted to without regard to
geographical considerations. The county of residence will be under obligation to pay for
the treatment. Admission to highly specialized wards, however, is granted only when this
is considered necessary on medical grounds.
The hospitals over the whole spectrum of physical and mental illnesses, providing
diagnosis, treatment and care. They also provide diagnostic assistance to general
practitioners on a considerable scale through laboratory services and imaging diagnostic
services.
During the last decade there have been major changes in the way hospitals function.The
total number of hospital beds has decreased by 25% from more than 40.000 in 1980 to some
30.000 in 1992, corresponding to 6 beds per 1.000 inhabitants. However, the number of
admissions has increased by about 15% in the same period from about 950.000 admissions to
about 1.100.000. This has been possible through a rapid decline in the average length of
stay, which is now less than 7 days (excl. psychiatry), and a correspondingly rapid
expansion of out-patient services. Thus the hospitals have been increasingly directed at
out-patient treatment, which relieves the pressure on the in-patient facilities.
More and more emphasis is put on intensive and efficient tretment which takes advantage
of the rapid medical an technological progress.
Hospital structure
The hospital services within a county consist of a number of hospitals of different
size and type. Generally all major medical specialities are offered by the hospital
servises of a given county.
General hospitals with specialized departments constitute the largest group. Except for
psychiatry, mono-specialized hospitals are almost nonexistent. Danish hospital physicians
are fulltime, salaried staff members. Hospital treatment is free of charge to people
resident in Denmark, Patient are only admitted to hospital after referral from a general
practitioner or via the hospital emergency units, which are available to everyone.
Disease prevention and health promotion
The health promotion programme
Over the last 15 years there has been a growing recognition of the fact that the health
problems predominant today cannot be solved by relying on treatment alone. Improving
public health requires health promotion efforts. As the problems are located in several
sectors of society their solution requires cooperation between these sectors.
The health promotion programme of the Governmant of Denmark is a result of cooperation
between the Ministry of Health and 11 other ministries. It was presented to the Danish
Parliament in 1989.
An important starting-point for the programme is that health promotion schould
constitute a part of total health policy and of the policies of other relevant sectors as
well.
The programme gives priority to:
- preventing accidents
- preventing cancer
- preventing cardiovascular diseases
Furthermore the programme presents a framework for the content of future efforts
directed towards:
- preventing diseases of the musculoskeletal system
- preventing mental diseases
The programme deals with the targets and initiatives of the central authorities. One
basic idea of the programme is that a significant part of the health promotion tasks have
to be initiated locally, in close cooperation with people in the community and the local
autorities and associations.
The idea of making disease prevention and health promotion a natural and integrated
part of the political, administrative and professional work within the health sector has
already borne fruit. An extensive development is seen both in counties and municipalities.
To secure the development and adjustment of the work an independent political council
on prevention and health promotion has been set up. The council surveys and advises on all
public efforts within the field of prevention and health promotion.
An English edition of the health promotion programme and the follow-up report from 1991
are available.
Preventive health services
Denmark has several preventive health services which are part of the established health
care system and free of charge.
Prenatal care and guidance
A pregnant woman can obtain prenatal care from her family doctor and from a midwife at
a local midwifery centre. She is offered several examinations by a midwife and her doctor
before and immediately after delivery. During pregnancy prenatal diagnostic screening is
offered to certain groups of women. A woman may choose to give birth at home or in
hospital.
Public health nurses
The municipal health authorities are notified of all births and offer the mother and
child health care from a visiting public health nurse. Each child is visited serveral
times during its first year depending on the need of the individual child or family. The
main focus of the public health nurse is monitoring the child's health, advising and
supporting the parents and providing information about supplementary health services.
Preventive health examinations
All children are entitled to preventive health examinations by a doctor: the first is
scheduled for five weeks after birth.
Immunization of children
All children are offered free immunization by the family doctor against diphtheria,
polio, tetanus, whooping cough, measles, mumps and German measles. Smallpox inoculation
has been abolished and only a small number of children are now immunized against
tuberculosis.
School health services
The municipalities are responsible for the medical examination of all schoolchildren.
The doctor and the school nurse also praticipate in the health education together with the
teaching staff.
Child and adolescent dental care
All children up to 18 years have access to free routine dental examinations and
treatment. A preventive programme is carried out in day care institutions and schools. The
dental care is provided by practicing dentists or special services organized by the
municipalities.
Occupational health services
The occupational health services are separate from the ordinary health services. The
purpose is to prevent diseases and accidents at the workplace. Legislation sets certain
standards for occupational saftey and health facilities in factories and offices.
Other preventive measures
A wide range of other preventive measures have been established. Many of these have
been initiated by individual counties and municipalties and thus cover only the local
area.
Among national preventive measures are:
- Sex education in all schools, including advice concerning contraception and sexually
transmitted diseases.
- Anonymous testing for human immunodeficiency virus (HIV) antibodies free of charge.
International Health Cooperation
Denmark has a long tradition of active participation in international health
cooperation. There is a strong commitment to international cooperation both at national,
regional and local level among politicians, administrators and health professionals.
The Danish health autorities take an active part in and attach great importance to
cooperation in the European Community and international organizations. As a member of the
various organizations dedicated to health promotion Denmark works for closer cooperation
and a better division of work between the different parties.
- European Community. The cooperation between member states on prevention and helth
promotion is being formalised as a part of the Maastricht Treaty. Over the past years
greater importance has been attached to the exchange of information and experience between
member states on health matters for instance on cancer, AIDS and drugs. Medical research
including informatics also plays an important role within the general research programmes.
Moreover health cooperation has concentrated on securing free movement of goods
(pharmaceutical products, medical devices and food-stuff).
