Quelles solutions pour la garde en médecine générale? - KCE

KCE Reports 1771
8.4.3. After-hhours
care in Deenmark
Items
Affter-Hours
Primaary
Care
Expert(s) interviewwed
Researrch
Unit for General Practice,
University of AAarhus,
Denmark:
Lone FFlarup
l.flarup@alm.au u.dk tel: +45 8942 6159
Morten Bondo Christensen, mbc@alm.au.dk
m
Literature base
Nationaal
and international pu ublications and websitees
on the topic of afterr-
hours care in Denmmark
Characteristics off
the health Danish healthcare is both tax x funded and almost eentirely
publicly provideed
system with relevaance
to Health care spending per cap pita: $3,512
after-hours servicces
Coveraage
is universal and co ompulsory. All those rregistered
as residentts
in Denmark are entitled
to health care thaat
is largely free at thee
point of use. Equal access to
healthccare
for all 5.56 million n citizens.
A majoor
national administrat tive reform in 2007 reeduced
the number off
communities from 2271
to 98 and 13 counties
to five regions. After the reform health
care is
financeed
by the regions throu ugh four economical ssources:
a general finaancial
contribution fromm
the central governmment,
a basic contribution
from the communitties
within
the reggion,
an activity depen nded contribution fromm
the central governmment
and finally a cenntrally
collected tax seet
at 8 percent of taxaable
income are earmmarked
for
health.
Public eexpenditure
accounted
for around 82 percent
of total health expeenditure
in 2005.
The five
regions are respons sible for providing hosspital
care, and own and
run the hospitals. The regions also payss
activity depended finnancial
contributions tto
general
and speecialist
practice, physi iotherapy and pharmaaceuticals.
The 988
municipalities are re esponsible for most oof
the nursing homess,
home nursing care, , health visitors, municipal
dentists (childreen’s
dentists and homme
dental
servicees
for disabled people e), school health servvices,
home help, andd
the treatment of alccoholics
and drug adddicts.
Healthcare is organized in such a way that
responsibility
for services provided
lies within thhe
lowest possible addministrative
level, ussually
the county (noww
region) councils (ssubsidiarity).
Since 19970,
most
decisioons
regarding the form and content of healthh
care activity have been
made at county (noow
region) and municipal
level.
The reggions
are given wide powers p to make organnizational
decisions forr
health services according
to their own polittical
decisions and possibilities.
Roughlly
two in five citizens have complementary private insurance as a supplement to the sservices
that are not ffully
covered by the sttate,
such as dentist aand
some
sorts off
physiotherapy, and around a 5% of all citizens
has a private insurrance
that covers acceess
to treatments at prrivate
hospitals. In adddition,
some companiees
provide
health iinsurance
for their em mployees.
GPs arre
organized as self-e employed doctors in pprivate
clinics. GPs, of
which there are rougghly
3,600, operate wwholly
within the public
healthcare system, acting as
gatekeeepers
to specialists an nd hospitals.
Numbeer
of practicing physicians
per 1000 populatiion
= 3.2 (2006)
Patientts
must register with a GP of their choice praactising
within 15 km oof
their home. They haave
the right to changee
their GP, but in pracctice
this rarely happenns.
Each GGP
has about 1,600 registered
patients.
The number
of practising GP Ps in each region is suubject
to collective agreeements
negotiated between
the regions annd
the GP section of thhe
Danish Medical Asssociation.
The ressult
is an even distribu ution across the populaation.
Compaared
to some neighbo ouring countries, the Danish service is chaaracterized
by a high number of telephonee
contacts per doctorr
per hour (> 15 conttacts)
and
relativeely
low cost per contac ct.
Total coosts
per person are re elatively high, though, due to a high numberr
of contacts per inhabbitant
(535 per 1000 peer
year).
In contrrast,
the use of emerg gency departments is rrelatively
low.
After-hoours
care is regionally y organized as an econnomically
agreement bbetween
the GP’s andd
the regions. All GP’ss
under the age of 60 aare
obligated to particiipate.
Situation before reeform
Before the reform of January y 1992 basically the GGP’s
were responsiblee
for their own patientts
24/7/365. The docttor
had to manage thee
patient contact by hhim
selves
mainly without any assistanc ce. In villages and ruraal
areas, between three
and 10 doctors co-ooperated
to provide ouut-of-hours
cover accoording
to a rota. Telephhone
calls
from paatients
were answere ed by the GPs or their
spouses. A large ammount
of patients’ calls
ended with telephoone
advice but homee
visits were the mostt
common
contactt
and surgery consulta ations were kept to a mminimum.
In largee
towns, a locally orga anized rota system proovided
after-hours caree
for the registered paatients
of 20 to 100 GPPs.
Doctors’ duty sessions
lasted eight to 122
hours.
In somee
of the largest towns some rota groups contracted
with a centraal
service with receptioonists
to handle the paatients’
calls but the mmost
common telephonne
contact
was annswered
by the rota group g doctors themseelves.
There were emeergency
consultation centres, but these weere
rarely used; 90–995%
of patients receivved
home
visits.
Results
115