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OECD Reviews of Health Care Quality: Denmark 2013

Raising Standards

image of OECD Reviews of Health Care Quality: Denmark 2013

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.    

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Hospital specialisation in Denmark

This chapter examines recent reforms to drive further specialisation in the Danish hospital sector. It begins by providing an overview of the hospital sector and broader reforms to the structure of government responsibilities in health in Denmark. The key elements of the hospital specialisation reforms are argued to be: greater involvement of central government by setting guidelines for where certain specialist services should be located; a major capital investment programme; and regional governments driving the redesign of hospital services on the ground. The hospital specialisation plan is argued to have an impact on the structure of the hospital sector that is well beyond simply high-specialised services. Though the specialisation plan is still in the process of implementation and thus difficult to evaluate, the decisions of policy makers were driven by the clinical judgements of experts as the scientific literature on quality and volume offers limited insights to guide decision making in practice. Looking ahead, the challenge for the government shall be how to best use the new structure of hospital services to drive improvements in the quality of care in Denmark.

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