Analysis

Integrated care: a Danish perspective

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e4451 (Published 13 July 2012) Cite this as: BMJ 2012;345:e4451
  1. Andreas Rudkjøbing, PhD fellow12,
  2. Maria Olejaz, PhD fellow1,
  3. Hans Okkels Birk, external lecturer1,
  4. Annegrete Juul Nielsen, assistant professor1,
  5. Cristina Hernández-Quevedo, technical officer3,
  6. Allan Krasnik, professor12
  1. 1Section of Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, DK-1014 Copenhagen, Denmark
  2. 2Centre for Healthy Ageing, University of Copenhagen
  3. 3European Observatory on Health Systems and Policies, London School of Economics and Political Science, London, UK
  1. Correspondence to: A Rudkjøbing anru{at}sund.ku.dk
  • Accepted 28 May 2012

Despite three decades of reform Denmark’s health sector is still struggling to provide coordinated care for an ageing population with a high burden of chronic disease. Andreas Rudkjøbing and colleagues describe recent initiatives to improve continuity of care

The Danish health system, in common with most Western health systems, is grappling with the dual challenges of strengthening public health initiatives to prevent disease and providing care to a growing number of patients with chronic disease and comorbidity. A recent review of the system suggests that it generally provides high quality services1 and patient satisfaction with primary care and hospital services is high.2 Nevertheless, despite a raft of policies aimed at integrating health services, the Danish system still suffers from a lack of coordination of care. Although Denmark’s health information systems are widely admired, barriers to integration include organisational fragmentation, perverse financial incentives, and the absence of a single electronic medical record.

Danish healthcare system

Denmark, a high income country with 5.6 million inhabitants, is divided into three political and administrative levels: the state, five regions, and 98 municipalities. This division is reflected in the organisation of the health system (box 1), which is a Beveridge-type system similar to that in the United Kingdom and other Nordic countries.

Box 1: Health service delivery in Denmark

  • National level—Overall regulatory, supervisory, and fiscal functions but also increasingly responsible for specific planning activities, such as where interventions are performed, monitoring quality (accreditation), and information technology

  • Regional level—Hospitals, psychiatric healthcare services, and contracts with private (self employed) practitioners (GPs, specialists, physiotherapists, dentists, chiropractors, and pharmacists)

  • Municipal level—Disease prevention, health promotion, and rehabilitation outside hospitals. Other municipal health services, including nursing homes, home nursing, health visitors, municipal dentists, and social psychiatric services

The state is responsible for overall financing and regulation, and is increasingly taking responsibility for activities such as monitoring …

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