JANUARY

DENMARK
sampling and vaccination. Colocation of various clinicians is also on the rise, with GPs, physiotherapists, and
office-based specialists operating out of the same facilities but under separate management.
Anyone who chooses the “group 1” coverage option (98% of the population), under which GPs act as
gatekeepers for secondary care, is required to register with a GP. People can register with any available local
GP. “Group 2” coverage provides free choice of GP and access to practicing specialists without referral, though
a copayment is required. Under both groups, access to hospitals requires referral.
Outpatient specialist care: Outpatient specialist care is delivered through hospital-based ambulatory clinics
(fully integrated and funded, as are other public hospital services) or by self-employed specialists in privately
owned facilities. Private self-employed specialists can be full-time or part-time; full-timers may not have other
full-time jobs. Part-timers also may work in the hospital sector, subject to codes of conduct, with their activity
level monitored and their incomes limited by the regions. Practices may be colocated but normally do not
operate in formal multispecialty groups.
Services from self-employed private providers are paid by the regions on a fee-for-service basis for referred
public patients. Fees are set through negotiations with the regions and are based on regional priorities and
resource assessments. Private specialists and hospitals also receive patients paying out-of-pocket or covered
by voluntary insurance. As a result of legislation initially introduced in 2013 guaranteeing patients the right to
diagnostic assessment within 30 days of referral, private practitioners also may receive patients referred from
public-sector providers; they are paid for these services through specific agreements with the regions.
Patients have a choice of private outpatient specialists upon referral (group 1) or without referral (group 2).
Administrative mechanisms for direct patient payments to providers: There is no out-of-pocket payment for
medical services for patients in group 1. Primary care doctors and specialists are paid directly by the regions
when registering provision of services electronically. Group 2 patients make a copayment to supplement the
automatic payment (Strandberg-Larsen et al., 2007).
After-hours care: After-hours care is organized by the regions, mainly by agreement with GPs on a collective
basis. The Copenhagen region employs staff including specialized nurses, who do the initial screening of calls.
GPs can volunteer to take on more or less responsibility within this scheme, and receive a higher rate of
payment for after-hours than for normal care. Capitation does not apply to after-hours care. The first line
of contact is a regional telephone service, with a GP (or a nurse, in the Copenhagen region) deciding whether
to refer the patient for a home visit or to an after-hours clinic, which is usually colocated with a hospital
emergency department. Information on patient visits is sent routinely to GPs. There are walk-in emergency units
in larger hospitals.
Hospitals: Approximately 97 percent of hospital beds are publicly owned. Regions decide on budgeting
mechanisms, generally using a combination of fixed-budget and activity-based funding based on diagnosisrelated
groups (DRGs), where the fixed budget makes up the bulk of the funding (although significant
fluctuations occur among specialties and hospitals). DRG rates are calculated by the Ministry of Health at the
national level based on average costs. Activity-based funding is usually combined with target levels of activity
and declining rates of payment to control expenditure. This strategy succeeded in increasing activity and
productivity by an average of 5 percent annually from 2009 to 2011 and by 1.4 percent from 2011 to 2012
(Danske Regioner, 2015). Bundled payments are not yet used extensively. Hospital physicians are salaried and
employed by regional hospitals, which bear the attendant costs, as are other health care professionals in
hospitals and in most municipal health services. Patients can choose among public hospitals upon referral, and
payment follows the patient to the receiving hospital if it is located in another region. Physicians at public
hospitals are not allowed to see private patients within the hospital.
Mental health care: There is no cost-sharing for inpatient psychiatric care, but there is some cost-sharing (which
may be covered by voluntary health insurance) for psychologists in private practice. Some general practitioners
offer specific therapeutic consultations, but their main role is early detection and referral.
International Profiles of Health Care Systems, 2015 41