Denmark has a well-developed public health service which, among other things, includes specialists, hospitals, home care, visiting nurses and children’s dental care. The health service is based on principles of equal access to health services for all citizens.
The health service has a decentralised structure. Therefore the local authorities and counties make the concrete decisions on the basis of guidelines issued by the Ministry of the Interior and Health. For instance, the council may decide that certain operations are to be performed in one particular hospital in the council rather than in all hospitals in the council.
Satisfaction with the Danish hospitals has increased over the last few years, and a survey from year 2002 indicates satisfaction amongst 90% of patients.
The top authority of the health service is the Ministry of the Interior and Health, who, among other things, draws up laws in the area. The National Board of Health is an authority concerned with health on a professional basis and has the responsibility for e.g. prevention, information and counselling.
Denmark has 90 public hospitals. Every Danish citizen is entitled to free medical care, although fees are applied to dental treatment, certain general practitioner tasks (such as providing a patient with a sick leave note) and medical prescriptions. 85% of healthcare in Denmark is subsidised via direct taxation, drawn directly from an individual’s wages.
Like Denmark as a whole, the healthcare sector has 3 political and administrative levels: the State, the counties and the municipalities (national, regional and local levels). The healthcare service is organised in such a way that responsibility for services provided by the health service lies with the lowest possible administrative level. Services can thus be provided as close to the users as possible.
The 273 local authorities, together with the local authorities of Copenhagen and Frederiksberg, are local administrative bodies. The local authorities have a number of tasks, of which health represents a small part. In the health field, the local authorities are responsible for district nursing, public health care, school healthcare and child dental treatment.
As the running of hospitals requires a larger population than that of the majority of the local authorities, this responsibility lies with the 14 counties. Hospitals in the local authorities of Copenhagen and Frederiksberg are run by a special administrative body: the Copenhagen Hospital Cooperation. The 14 counties are also responsible for the praticising sector; however, this responsibility lies with the local authorities in Copenhagen and Frederiksberg. The counties have wide-ranging powers to organise the health service for their citizens, according to regional wishes and available facilities, without the intervention of the government. Thus the individual counties can adjust services according to need at the different levels, enabling them to ensure the correct number of staff and the procurement of the appropriate equipment. Procurement is done at this level for all of the major hospitals.
The task of the State in healthcare provision is first and foremost to initiate, coordinate and advise. One of the main tasks is to establish the goals for a national health policy. The Ministry of the Interior and Health, in its capacity of principal health authority, is responsible for legislation on healthcare. This includes legislation on health provisions, personnel, hospitals and pharmacies, medicinal products, foodstuffs, vaccinations, pregnancy healthcare, child healthcare and patients’ rights.
Unlike other European countries, Denmark has a minimal private healthcare system. The Danish welfare system is based upon the principle of universal healthcare for all, drawn directly from taxation upon income. Given universal access to healthcare, and a compulsory taxation drawn from an individual’s income to fund the system, there is relatively little use for private hospitals etc. There is a handful, and these are gaining in popularity however, especially given the rise in the number of companies offering employees private healthcare insurance, allowing them to skip queues at public hospitals and get treated immediately at private institutions. Of the $11 billion in total healthcare expenditure in 2002, less than 20% was private expenditure (i.e. for prescriptions, services etc) and the remainder public expenditure. Total healthcare expenditure in Denmark equates to almost 7% of total GNP.