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Danish Health Care An International Perspective

Danish Health Care An International Perspective. Tony Hockley Civitas Roundtable 11 May 2005, Copenhagen. Introduction. A stalwart of the “public integrated model” “Unrestricted, equal, and free access” Relative decline in health status

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Danish Health Care An International Perspective

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  1. Danish Health CareAn International Perspective Tony Hockley Civitas Roundtable 11 May 2005, Copenhagen

  2. Introduction • A stalwart of the “public integrated model” • “Unrestricted, equal, and free access” • Relative decline in health status • Gradual growth of co-payment (and insurance) in limited areas • Change by “Baby steps”Chresten Anderson

  3. Funding • 75% by block grant from central government (2007) • Small role for activity payment • Medicines: patients pay first 520DKK/pa; & 50% 520-1250DKK (inc 25% VAT on medicines) • 29% have “insurance” for co-payments • 1988 Private Spend 16% Total • 2000 Private Spend 19% Total

  4. Spending

  5. Co-Payments % of Total 25,0 20,0 15,0 10,0 5,0 0,0 EU UK Italië België Spanje Ierland Portugal Frankrijk Duitsland Nederland Luxemburg Griekenland Denemarken Van Montfort (2002)

  6. Drug Spending($ Per Capita) Pricing and reimbursement limits. Price cuts (2004)… 500 450 400 350 300 250 200 150 100 50 0 United United Switzerland Netherlands Germany France Denmark Belgium States Kingdom Van Montfort (2002) 1990 1994 1998

  7. Drug Co-Payment SOURCE: efpia (2002)

  8. Patients’ Payments for Medicines

  9. Policy Focus • De/Centralisation • Is centralisation essential to strategic reform? • Waiting Lists • Consume new investment • Tinkering with co-payments = “Priority-Setting by Fire-Fighting” Kjeld Møller Pedersen 12/2004

  10. Reform Prospects • Choice: from theory to reality – information, DRG payments • “Dilemma” between patient choice and system uncertainty • Restricted role for insurance, co-payment, (Danish) private providers Bech 2004

  11. Conclusion • New central structures may improve opportunities for strategic reform? • Patient payment and choice remain excessively focused on medicines, dentistry, & waiting lists • Limited dissatisfaction limits immediate reform options • More “baby steps” to come…

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