Web-economic-crisis-health-systems-and-health-web

368 Economic crisis, health systems and health in Europe: country experience
The benefits package
• Development of new guidelines for referrals for various forms of surgery
(bariatric, back, arthritic knee, shoulder) and other guidelines are being
developed (2011, 2012).
User charges
• User charges introduced in 2011 were abolished (2012) and proposals to
introduce new user charges for GP and hospital visits were rejected.
• Introduction of user charges for in vitro fertilization, sterilization and refertilization
and for translation services for certain migrant groups (2011,
abolished in 2012).
• User charges increased slightly for some dental care services, over-the-counter drugs
and hearing aids to provide finance for initiatives in Danish prisons (2013).
Changes to health service planning, purchasing and delivery
Prices of medical goods
• The Danish regions established the Council for the Use of Expensive Medicines
in Hospitals to improve the rational use of medicines and to develop and align
guidelines across regions, with a focus on drugs with a high share of the budget
and high cost growth (2009); they also established a council to coordinate the
use of new drugs, particularly new cancer drugs (2012).
Salaries and motivation of health sector workers
• Only limited salary increases for health professionals (2012).
Payment to providers
• Competition strengthened among providers, for example, through the
increased use of tenders (involving public hospitals outside each region, and
private hospitals and suppliers to public hospitals in each region) and reviews
of hospital budgets to identify potential savings (2008 onwards).
• Reimbursement rates for medical interventions in private hospitals (mainly
elective surgeries) decreased by approximately 20% (2010).
• The new government changed the calculation of rates paid to private providers
under the “waiting time guarantee scheme” from fixed rates to regionally
negotiated agreements (2011). This lowered the rates and resulted in lower
revenues for private hospitals.
Overhead costs: restructuring the Ministry of Health and purchasing agencies
• The Council for the Use of Expensive Medicines in Hospitals was set up by the
Danish regions to strengthen the regions' bargaining power when procuring
drugs (2009).