health systems in transition ( hit ) denmark: health system review 2012
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Health Systems in Transition ( HiT ) Denmark: Health System Review 2012. Allan Krasnik Professor, MD, MPH, PhD University of Copenhagen Dept. of Public Health NLI European Observatory of Health Systems and Policies. Analysing Health Systems and Policies www.healthobservatory.eu. - PowerPoint PPT PresentationTRANSCRIPT
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Health Systems in Transition (HiT)Denmark: Health System Review 2012
Allan KrasnikProfessor, MD, MPH, PhDUniversity of Copenhagen
Dept. of Public Health NLI
European Observatory of Health Systems and Policies
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Analysing Health
Systems and Policies
www.healthobservatory.eu
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The Observatory
WHO?
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An Effective Partnership
The European Observatory is a three-way partnership building bridges both across borders and between policy makers and researchers.
InternationalAgencies
• WHO Europe (host)
• European Commission
• European Investment Bank
• World Bank
National and Regional Authorities
• Belgium ●Norway• Finland ● Spain• Slovenia ● Sweden• Netherlands• French Union of Health Insurance Funds• Veneto Region of Italy
Academia
• London School of Economics and Political Science (LSE)
• London School of Hygiene & Tropical Medicine (LSHTM)
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A Knowledge Broker
The European Observatory is a high-quality knowledge broker based on following principles:
TransferBridge between policymakers and
researchers: information users and producers
TrustHigh-quality evidence and a
neutral stance recognising the real context and pressures of
health systems
TailoredTo the specific needs of
policy makers
TimelinessOf response to policy maker’s
needs and requests
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What and How?
Core Mission: The European Observatory supports and promotes evidence-based health policy-making
Comparative analysis
of existing evidence
Developing practical lessons
and options
in health policy-making
Bridge Between
policymakers and researchers
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Comparative Analysis: Tools
Vertical: Country
Monitoring (HiTs)
Describing national health
systems
Common template for direct
comparison
53 European + selected OECD
countries
Horizontal: Health
Systems and Policy Analysis
Detailed focus on one topic across national health
systems
Secondary research
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Practical Lessons and Options: Tools
Assessing and Comparing
Performance
Provides better understanding of
uses and abuses of comparative
performance data
Creates a toolbox for better measurement
and analysis
Engaging Policy-makers
Two channels: policy briefs and face-to-face
policy dialogues
Tailor-made, focussed on one specific issue
Bring together evidence, assess options and
formulate implementation
roadmaps
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Who A partnership of international agencies, national and regional authorities and academic institutions, hosted by WHO/Europe
How Carrying out comprehensive and rigorous analysis of the dynamics of health systems in Europe• Country Monitoring • Health systems and policy analysis• Assessing and comparing performance• Disseminating evidence / engaging with policy-makers
What Supporting and promoting evidence-based health policy-making
Summary
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University of Copenhagen
Dept. of Public Health
Unit for Health Services Research
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The Nordic model?
• General entitlement• Mainly tax financed• Mainly public hospital
providers• Mainly decentralized
governance • GPs in a key role
But also many differences!
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Life expectancy in selected countries
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Health expenditure as a share of GDP
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Financing Danish health care
• More than 80% of the total health care expenditure is financed by taxes
• The role of out-of-pocket payments differs markedly by service
• VHI financed by employers has increased dramatically since 2001
• VHI still only finances about 1.7% of total hospital services in Denmark[
• The five regions are financed through block grants as well as activity-based financing from the municipalities and the state
• The 98 municipalities are financed through income taxes and block grants from the state + intermunicipal transfers
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Stepwise reforms ??????? of Danish health care
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From 274 to 98 municipalities From 14 counties to 5 regions
Structural reform 2007
Afdeling for Sundhedstjenesteforskning
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Health service delivery – a fragmented organization
• Municipalities are responsible for disease prevention, health promotion, care and rehabilitation performed outside hospitals
• Primary care consists of private (self-employed) practitioners (GPs, specialists, physiotherapists, dentists, chiropractors and pharmacists) and municipal health services
• GPs act as gatekeepers, referring patients to hospital and specialist treatment.
• Most secondary and highly specialized care takes place in general hospitals owned and operated by the regions
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The patient perspective: Access to health services
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Pathways for gynecological patients
Municipal rehabilitation
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Can GPs cope with the future challenges?
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Major policy themes
• Free choice
• Waiting time
• Quality of care– Survival– Continuity– Prevention
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Free choice and waiting time
1993 Free choice of hospitals 2002 Extended free choice (2 months)2005 The new comprehensive Health Act2007 Waiting time guarantee 1 month2009 Waiting time guarantee and extended
free choice for child and adolescent psychiatry (2 months)
2010 + Adult psychiatry
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Health care services: The pride of Danish welfare society?
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Quality issues: 30 days mortality after acute myocardial infarction (%)
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Quality issues: Cancer survival
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Survival from lung cancer (%)
Denmark
Denmark
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Solving problems of continuity of care?
• Health agreements– Regions and municipalities – National Board of Health– GPs?
• GP coordinator fee• Other incentives required
• Clinical pathways– Cancer– Heart disease
• IT innovations– The EMR– The Medcom project: Danish online health portal– The Shared Medication Record
– The sentinel data capture system
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Quality issues: Prevention and rehabilitation
The new municipal responsibilities – a difficult task!
Local governance – local autonomy – soft national measures
Issues of • Organization• Evidence• Competences • Resources• Political priority
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Municipal expenses for health promotion and prevention
Sted og datoEnhedens navn
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Municipal rehabilitation plans per 1,000 inhabitants
Sted og datoEnhedens navn
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Conclusions
• The health status of the Danish population is improving, but still relatively unfavorable
• The public health service provision and tax based financing is still strongly supported
• The decentralized organization is under pressure• Quality and continuity of care are major issues• IT support and communication is a main focus area –
it is necessary, but not sufficient• More major reforms can be expected in order to
meet future challenges
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Evolution or revolution?
“It is raining too much in Denmark for revolutions!”