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DENMARK portion is small, it makes up regions’ marginal income and presents a strong incentive (Danske Regioner, 2014). Furthermore, regions are under pressure to deliver good performance, as they can be reformed if they do not deliver. At the regional level, hospital cost control includes a combination of global budgets and activity-related incentives (see above). Inpatient pharmaceutical expenditure is controlled through national guidelines and clinical monitoring combined with collective purchasing. Two specific units have been established to evaluate and coordinate the introduction of expensive pharmaceutical products—the Council for the Use of Expensive Hospital Medicines (RADS) and the Coordinating Council for the First Use of Hospital Medicines (KRIS). Policies to control outpatient pharmaceutical expenditure include generic substitution, prescribing guidelines, and assessment by the regions of deviations in prescribing behavior. Pharmaceutical companies report a monthly price list to the Danish Health Authority, and pharmacies are obliged to choose the cheapest alternative with the same active ingredient, unless a specific drug is prescribed. Patients may choose more expensive drugs, but they have to pay the difference. Collective agreements with general practitioners and specialists include various types of clauses about rate reductions if overall expenditures exceed given levels. Regions also monitor the activity level of individual practices, and may intervene if they deviate significantly from the average. Health technology assessment and cost-effectiveness information, produced nationally and regionally, is an integrated part of the decision-making process for new treatments and guidelines for professionals. Regions may enter into contracts with private providers to deliver diagnostic and curative procedures. Prices for these services are negotiated between regions and private providers and can be lower than rates in the public sector. These measures have been relatively successful in controlling expenditures and driving up activity levels. General productivity in the hospital sector increased almost 20 percent from 2008 to 2012, while maintaining high patient satisfaction and also reducing hospital standardized mortality rates (Danske Regioner, 2014b and 2014c). What major innovations and reforms have been introduced? A reorganization of the hospital infrastructure is currently under way. All five regions are in the process of closing or amalgamating small hospitals and building new hospitals, at a total cost of DKK40.0 billion (USD5.3 bilion). A central part of this process is the reorganization of acute care, with stronger prehospital services and larger specialized emergency departments with senior medical specialists at the front end. The third generation of mandatory “health agreements” for coordination between municipalities and regions came into force in 2014. These agreements cover 2015–2018, and are based on a slightly revised format that resulted from a formal evaluation published in 2011. Upscaling of municipal health services with “temporary care units” and various types of health centers is occurring, with colocation of municipal, private, and regional health providers. At the same time, municipalities are employing more nursing staff and public health specialists to provide more systematic services for population health (Rigsrevisionen, 2013). A plan for reorganization of the central governance structure was decided on by the incoming government in August 2015, and was implemented in the fall of 2015. The reorganization will split the existing Health and Medicines Agency into four separate agencies, dealing with health, medicines, patient safety, and IT/data, to provide more clarity and improve the overall surveillance and accountability structure. 46 The Commonwealth Fund
References DENMARK CEPOS (2014). Halvdelen af danskerne har nu en privat sundhedsforsikring. http://www.cepos.dk/sites/default/files/analyse_ publication/Notat_Halvdelen_af_danskerne_har_nu_en_privat_sundhedsforsikring_apr14.pdf. Danish Healthcare Quality Programme (DDKM). http://www.ikas.dk. Danske Regioner (2007). Organisering af almen praksis. Delrapport. http://www.regioner.dk/Sundhed/Praksissektoren/ Almen+praksis/~/media/73D4270B3EDD4EAA9450599581F4E7E3.ashx. Danske Regioner (2012). Fakta om økonomi og aktivitet i almen praksis. Notat. http://www.regioner.dk/~/media/ Mediebibliotek_2011/Nyheder/Fakta%20om%20%C3%B8onomi%20og%20aktivitet%20i%20almen%20praksis_2012.ashx. Danske Regioner (2014). Økonomisk Vejledning 2013. http://www.regioner.dk/~/media/Filer/Økonomi/Budgetvejledning/ Budgetvejledning%20for%202013/Økonomisk%20vejledning%20aktivitetspuljen%20og%20baseline%202014.ashx. Danske Regioner (2014b). Styr på regionernes økonomi. http://www.regioner.dk/~/media/Filer/Økonomi/Analyser/Styr%20 på%20regionernes%20økonomi/Styr%20på%20regionernes%20økonomi.ashx. Danske Regioner (2014c). Høj produktivitet, øget kvalitet og tilfredse patienter. http://www.regioner.dk/~/media/Subsites/ GF14/Regionernes%20resultater/Effektive%20regioner/høj%20prod%205.ashx. Danske Regioner (2015). LØBENDE OFFENTLIGGØRELSE AF PRODUKTIVITET I SYGEHUSSEKTOREN. 10. delrapport. http://www.regioner.dk/aktuelt/nyheder/2015/januar/~/media/64631EF66EEC42E6AAC59A420C566124.ashx. Esundhed.dk. National website with interactive quality information. http://www.esundhed.dk/sundhedsaktivitet/ sundhedsaftaler/Sider/Sundhedsaftaler.aspx. Frederiksberg Kommune (2015). http://www.frederiksberg.dk/Borger/Aeldre/Hjemmehjaelp-og-sygepleje/Hjemmehjaelp.aspx. HimSS Europe (2014). Electronic Medical Record Adoption in Denmark. http://www.regioner.dk/~/media/ Mediebibliotek_2011/SUNDHED/Sundheds-it/HIMMS_Denmark_2014.ashx. Ministry of Health, 2013. Øget fokus på gode resultater på sygehusene. http://www.sum.dk/Aktuelt/Nyheder/Tal_og_ analyser/2013/Maj/~/media/Filer%20-%20Publikationer_i_pdf/2013/Oeget-fokus/oeget-fokus-paa-gode-resultater-paasygehusene-maj-2013.ashx. Økonomi- og Indenrigsministeriet (2013). Evaluering af Strukturreformen. http://www.regioner.dk/~/media/ Mediebibliotek_2011/Om%20regionerne/Evaluering%20af%20kommunalreformen%20040313.ashx. Organisation for Economic Co-operation and Development (OECD) (2014), OECD.Stat, (database). DOI: 10.1787/data- 00285-en. Accessed on October 6, 2014. Organisation for Economic Co-operation and Development (OECD) Health Data, 2015a. Organisation for Economic Co-operation and Development (OECD) (2015b). OECD.Stat. DOI: 10.1787/data-00285-en. Accessed July 2, 2015. Rigsrevisionen (2013). “Beretning om borgerrettet forebyggelse på sundhedsområdet.” http://www.rigsrevisionen.dk/ publikationer/2013/102012/. Accessed June 20, 2013. Rudersdal Kommune (2015). http://www.rudersdal.dk/Borgerservice_selvbetjening/Aeldre/Boliger_for_aeldre/Plejecentre/ Udgifter_plejebolig.aspx. Sundhedsstyrelsen (2014). Den nationale sundhedsprofil. http://sundhedsstyrelsen.dk/da/nyheder/2014/ den-nationale-sundhedsprofil. Sygeforsikring “danmark” (2014). Årsrapport 2014. http://www.sygeforsikring.dk/Default.aspx?ID=23. Søgaard, J. (2014). Hvor høje er sundhedsudgifterne i Danmark? (How high are health expenditures in Denmark?). Report for Danish Regions. Copenhagen. http://www.regioner.dk/~/media/Mediebibliotek_2011/Nyheder/REGIO/Rapport_hvor%20 h%C3%B8je%20er%20sundhedsudgifterne%20i%20Danmark_2014.ashx. Accessed Oct. 3, 2014. Strandberg-Larsen, M., Nielsen, M.B., Vallgårda, S., Krasnik, A., Vrangbæk, K., and Mossialos, E. (2007). “Denmark: Health System Review,” Health Systems in Transition 9(6):1–164. Sundhed.dk. National portal for patients and providers. https://www.sundhed.dk. Forsikring og Pension (2014). Sundhedsforsikringer – hovedtal 2003–2014. http://www.forsikringogpension.dk/presse/ Statistik_og_Analyse/statistik/forsikring/antalpolicer/Documents/Sundhedsforsikringer.pdf. International Profiles of Health Care Systems, 2015 47
Page 1 and 2: JANUARY 2016 2015 International Pro
Page 3: 2015 International Profiles of Heal
Page 6 and 7: Table 1. Health Care System Financi
Page 8 and 9: Table 3. Selected Health System Per
Page 11 and 12: The Australian Health Care System,
Page 13 and 14: AUSTRALIA low-income adults, childr
Page 15 and 16: AUSTRALIA In 2013, the federal gove
Page 17 and 18: What is being done to reduce dispar
Page 19: References AUSTRALIA Australian Bur
Page 22 and 23: CANADA What is covered? Services: T
Page 24 and 25: CANADA funding to 145 not-for-profi
Page 26 and 27: CANADA Organization of the Health S
Page 28 and 29: CANADA provides recommendations to
Page 30 and 31: CANADA Health Council of Canada (20
Page 32 and 33: CHINA Private health insurance: Com
Page 34 and 35: CHINA is not substantially more exp
Page 36 and 37: CHINA Organization of the Health Sy
Page 38 and 39: CHINA References Chen, X. (2014).
Page 40 and 41: DENMARK In addition, nearly 1.5 mil
Page 42 and 43: DENMARK Social psychiatry and care
Page 44 and 45: DENMARK Quality data for a number o
Page 48 and 49: 48
Page 50 and 51: ENGLAND immunization, and vaccinati
Page 52 and 53: ENGLAND Hospitals: Publicly owned h
Page 54 and 55: ENGLAND Organization of the Health
Page 56 and 57: ENGLAND How are costs contained? Ra
Page 58 and 59: ENGLAND Organisation for Economic C
Page 60 and 61: FRANCE VHI finances 13.8 percent of
Page 62 and 63: FRANCE The average income of primar
Page 64 and 65: FRANCE What are the key entities fo
Page 66 and 67: FRANCE inequities in prevention rel
Page 68 and 69: FRANCE Nolte, E., C. Knai, and M. M
Page 70 and 71: GERMANY There were 42 substitutive
Page 72 and 73: GERMANY The 16 state governments de
Page 74 and 75: GERMANY management system, by the s
Page 76 and 77: GERMANY What major innovations and
Page 78 and 79: INDIA Private health insurance: The
Page 80 and 81: INDIA provide after-hour care, reim
Page 82 and 83: INDIA are provided by other ministr
Page 84 and 85: INDIA How are costs contained? Ther
Page 86 and 87: 86
Page 88 and 89: ISRAEL Together, these two types of
Page 90 and 91: ISRAEL Primary care physicians are
Page 92 and 93: ISRAEL Organization of the Health S
Page 94 and 95: ISRAEL • Using electronic health
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96
Page 98 and 99:
ITALY during hospitalization (Thoms
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ITALY Some regions are promoting ca
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ITALY Organization of the Health Sy
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ITALY although the degree of evolut
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ITALY The author would like to ackn
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JAPAN What is covered? Services: Al
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JAPAN incentives for providers to c
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JAPAN Organization of the Health Sy
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JAPAN The author would like to ackn
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THE NETHERLANDS receive faster acce
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THE NETHERLANDS Hospital payment ra
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THE NETHERLANDS Organization of the
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THE NETHERLANDS References Organisa
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NEW ZEALAND provided in GP clinics.
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NEW ZEALAND management (e.g., clean
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NEW ZEALAND including such informat
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NEW ZEALAND largely through efficie
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132
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NORWAY Primary, preventive, and nur
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NORWAY Patients are free to choose
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NORWAY What are the major strategie
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NORWAY The National System for the
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142
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SINGAPORE Medifund is the governmen
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SINGAPORE Public hospital funding i
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SINGAPORE Public consultation: The
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SINGAPORE To keep demand for servic
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152
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SWEDEN What is covered? Services: T
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SWEDEN Hospitals: There are seven u
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SWEDEN Care, which promotes use of
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SWEDEN What major innovations and r
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SWITZERLAND Insurers offer premiums
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SWITZERLAND Hospitals: About 70 per
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SWITZERLAND Organization of the Hea
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SWITZERLAND To control pharmaceutic
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170
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UNITED STATES What is covered? Serv
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UNITED STATES Administrative mechan
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UNITED STATES The Institute of Medi
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UNITED STATES adopted at least a ba
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The COMMONWEALTH FUND Affordable, q
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