OECD Reviews of Health Care Quality: Denmark 2013
Raising Standards
This review of health care quality in Denmark examines policies related to quality and includes chapters covering primary and integrated care, hospital specialisation and equity. It finds that with a dense array of disease- and service-focused quality initiatives, and with information on the quality of care stored in separate data repositories, Denmark needs to create effective links and synergies between them to drive up quality in the healthcare system as a whole, rather than in disconnected elements.
Primary care will be central in meeting Denmark’s future healthcare challenges of an ageing population with multiple chronic conditions. Therefore, an urgent need is to create a national vision of how a modernised primary care sector will fulfill this new coordination role. National standards, clinical guidelines, accreditation of clinical pathways and targeted financial incentive programmes could support this role, along with more transparent and formalised continual professional development.
To facilitate quality improvement from the ambitious hospital rationalisation, Denmark should collect and disseminate data on the quality of individual physicians as well as the hospitals. Undergraduate training and medical research should be reviewed in light of the new service arrangements. Close surveillance will be needed to monitor whether certain patient groups forego healthcare because travel times to providers are too long. Limited data availability complicate Denmark’s ability to monitor its commitment to equitable healthcare. There is an urgent need for renewed action to tackle risk factors of chronic ill-health that disproportionately affect low-income groups. Better information on the impact of user-charges on unmet need in low-income groups is needed.
Primary care and integrated care in Denmark
Denmark faces a number of health care challenges including increasing public and political expectations around the continuity of care; increased specialisation in the hospital sector, which typically translates into shorter stays and earlier discharge back into the community; and a rise in the number of elderly patients with multiple long-term conditions, requiring safe and effective co-ordination of care and avoiding unnecessary hospitalisation.
This chapter assesses how well positioned Danish primary care is to meet these challenges, particularly the challenge of integrated care. The chapter begins by describing the current configuration and outcomes associated with primary care in Demark, and the quality initiatives implemented by the sector. A section focussed on integrated care follows, before closing with an assessment of the gaps and opportunities in Danish primary health care quality.
Whilst Danish GPs have actively developed a number of in-house quality initiatives, enthusiasm for cross-sectoral working is much less evident. The sector is well placed, however, to modernise its offer, including new ways of working such as making better use of advanced nurse practitioners. Better information infrastructure is key, as will be combining national vision with local freedom to innovate.