Health Care. the Danish Model. Janet Samuel, Danish Regions. Danish Regions

Transcription

1 Health Care the Danish Model Janet Samuel,

2 The Danish Health Care Five Regions North Denmark Region Danish population: 5,6 mio. Central Denmark Region Capital Region of Denmark Region of Southern Denmark Region Zealand

3 The Danish Health Care Who is responsible for what? Municipalities Home care Rehabilitation services outside hospitals, Treatment of drug and alcohol abuse Prevention and health promotion District nurses Children's dental services State Legislation National health care policy The overall framework of the health care economy Specialty planning Regions Hospital (somatic and psychiatric, in- and outpatient) Primary healthcare contracts (GP, specialists in private practice, adult dental services, physiotherapists, psychologists, chiropodist, chiropractor) Reimbursement of medicine

4 Basic principles of Danish Health Care A public health care system Equal and free access for all citizens Freedom of choice Mainly financed through general taxes Decentralized organization General Practice (family doctor) as gatekeeper

5 The GP family doctor The GP acts as gatekeeper Patients choose their own GP (within geographical limits) 9 out of 10 citizens consult their GP at least once a year GP s also cover out-of-hours services (except the Capital Region) GP s are private entities and own their own clinics

6 The Danish Health Care Budget 2014: 102,7 billion DKR (17 billion USD) 5% 15% Hospitals GP, specialists, dentists 80% Medicine, reimbursement

7 The Danish Health Care Capacity 34 (50) public hospitals Hospital Doctors 14% FTE 30% Nurses GP s and specialists in private practices 23% 33% Other health care personnel Other personel (psychologist, administration, cleaning operatives, technical personel)

8 The Danish Health Care Trends A slight decrease in the number of discharges over the last 10 years Increase in outpatient visits 35 percent since 2007 Average length of hospitalization at somatic hospitals is below 3.8 days in average Decrease from 4.4 days in 2008 Average length of hospitalization in psychiatric hospitals/departments is in average 19 days for adults and 31 days for kids Decrease - 16 % (adults) and 7 % (kids) since 2009

9 Avg. length of stay

10 The Danish Health Care Trends Reduction in number of hospitals and beds Centralization and specialization Fewer hospitals with ED s Focus on pre hospital emergency care Focus on intermediate care Hospitals to be renovated + new hospitals built (41 billion DKR to be spent) GP s collaborating in larger clinics Do we need a plan for organizing primary care?

11 Challenges What is facing us? An increasing elderly population More people suffering from chronic diseases Keeping up with the development of new technologies and medicines New kinds of treatments eg. genetic medicine Pressures for documentation of results and quality Limited resources Increasing expectations and demands will put the health services under tremendous pressure

12 Challenges Within the system? Delivering integrated services across settings Sharing data Specialization gone too far? Maintaining an overall good access to GP s Patient safety issues Mortality rates eg. cancer Patient involvement End of life care Psychiatric patients life expectancy way below average Structures and reimbursement schemes do not focus on value for patients

13 The Danish Health Care Plans and the Bermuda Triangle Plan for highly specialized care Hospital plans Plans for psychiatric care Plans for maternity care Plans for GP s, specialists etc. Health Care plan Health Care Agreements between regions and municipalities Contracts with GP etc. Linked together with IT, local agreements, contracts etc. Municipality services (e.g. rehabilitation, home care) Hospitals General Practice

14 Health Care agreements version 3.0 Agreements represent the framework for collaboration. One per region - covering all municipalities and focusing on: Involving patients and relatives Obtaining equality in health and access and specifically obtaining equality between psychiatric and somatic patients Setting goals and following up. Working with quality and patient safety Coordinating capacity across regions and municipalities the Danish LEON-Principle Involving and committing the GP s

15 Danish Health Care ambitions 2015 on wards Tripple Aim approach Focused on value for patients Delivers high quality and is accessible for every need Measuring what matters (e.g. PRO s) Data driven and data sharing Strategic usage of IT telemedicine, apps etc. Integrated care for patients with complex needs Specialist medical care not limited by hospital walls New models of collaboration (and even organization) between hospitals and primary care