JANUARY

DENMARK
In addition, nearly 1.5 million people hold supplementary insurance to gain expanded access to private
providers (CEPOS, 2014). Policies are purchased mostly from among seven for-profit insurers and are provided
mainly through private employers as a fringe benefit, although some public-sector employees are also covered.
Students, pensioners, the unemployed, and others outside the job market are generally not covered by
supplementary insurance.
Private expenditures accounted for nearly 16 percent of health care spending in 2013, and private insurance
accounted for about 12 percent of total private expenditures (OECD, 2015a).
What is covered?
Services: Publicly financed health care covers all primary, specialist, hospital, and preventive care, as well as
mental health and long-term care services. Dental services are fully covered for children under age 18.
Outpatient prescription drugs, adult dental care, physiotherapy, and optometry services are subsidized. Home
care and hospice care are organized and financed by the regions as described below.
Decisions about levels of service and new medical treatments are made by the regions, within a framework of
national laws, agreements, guidelines, and standards. Municipalities decide on the service level for most other
welfare services. There is no defined benefits package, but very few restrictions exist for treatments that are
evidence-based and clinically proven.
Cost-sharing: There is no cost-sharing for hospital and primary care services. Cost-sharing is applied to dental
care for those age 18 and older (coinsurance of 35% to 60% of total cost), outpatient prescriptions, and
corrective lenses. Out-of-pocket payments represented 12.4 percent of total health expenditures in 2013 (OECD
2014), covering mostly outpatient drugs, corrective lenses, hearing aids, and doctor and dental care. Patients
with outpatient drug expenses of more than 3,045 DKK (USD394) per year receive the highest reimbursement
rate—85 percent. 1 Private specialists, hospitals, and dentists are free to set their own fees for patients not
covered by public funding.
Safety net: There are cost-sharing caps for children, and municipalities provide means-tested social assistance
to older people. If personal assets are DKK77,500 (USD10,217) or less, 85 percent of all prescription drug costs
are covered. Chronically ill people with high drug usage and costs can apply for full reimbursement above an
annual out-of-pocket ceiling of DKK3,775 (USD498). The terminally ill also can apply for full coverage of
prescriptions. Municipalities may grant financial assistance to individuals certified as otherwise unable to pay for
needed medicine.
How is the delivery system organized and financed?
Primary care: Around 22 percent of all doctors work in general practice. All general practitioners (GPs) are selfemployed
and paid by the regions via capitation (about 30% of income) and fee-for-service (70% of income).
Rates are set through national agreements with the doctors’ associations. Service-based fees are used as
financial incentives to prioritize services. National fees are paid per consultation, whether for office visits,
e-consults, or home visits. The average income for a GP was DKK1.1M (USD145,000) in 2011. The average
salary for senior hospital doctors was DKK1M (USD132,000) (Danske Regioner, 2012).
The practice structure is gradually shifting from solo to group practices, typically consisting of two to four GPs
and two to three nurses (Danske Regioner, 2007). The number of nurses employed has increased in the past
decade; they are paid by the practice and have gradually assumed responsibility for such tasks as blood
1
Please note that throughout this profile, all figures in USD were converted from DKK at a rate of about DKK7.59 per USD,
the purchasing power parity conversion rate for GDP in 2014 reported by OECD (2015b) for Denmark.
40
The Commonwealth Fund