JANUARY

DENMARK
Social psychiatry and care are a responsibility of the municipalities, which can choose to contract with
a combination of private and public service providers, but most providers are public and salaried. A right
to diagnostic assessment for psychiatry within one month of referral was introduced in 2014. Treatment must be
commenced within two months for less serious conditions and one month for more serious conditions. There
are walk-in units for acute psychiatric care in all regions.
Long-term care: Responsibility for chronic care is shared between regional hospitals, general practitioners, and
providers of municipal institutional and home-based services. Hospital-based ambulatory chronic care is
financed in the same way as other hospital services. Long-term care outside of hospitals is needs-based, and is
organized and funded by municipalities. Most municipal long-term care is provided at home, in line with
a policy initiative to allow people to remain at home as long as possible. Home nursing is fully funded after
medical referral. Permanent home care is free of charge, while temporary home care can be subject to costsharing
if the recipient’s income is above DKK143,300 (USD18,890) for single individuals and DKK215,300
(USD28,380) for couples (Frederiksberg Kommune, 2015). Municipalities are obliged to organize markets with
open access for both public and private providers of home care, and patients may choose between public
or private providers. While this functions relatively well in most municipalities, it has been difficult to attract
private providers to remote areas. A considerable number of the elderly choose private providers. Some
municipalities also have contracted with private institutions for institutional care of older people, but more than
90 percent of residential care institutions (nursing homes) remain public.
Providers are paid directly by municipalities, and no cash benefits are paid to patients. Public providers are
employed by the municipalities. For staying in residential care institutions, patients pay according to the facility’s
costs plus 10 percent of their income (20% of income above DKK188,700, or USD24,880), as well
as heating and electricity charges (Rudersdal Kommune, 2015).
Relatives of seriously ill individuals may take paid leaves of absence from their jobs for up to nine months.
These can be incremental and may be divided among several relatives. A similar scheme exists for relatives
of terminally ill patients who no longer receive treatment.
Hospices, which may be public or private, are organized by regions and are funded by regions and
municipalities. There is free choice of hospice upon referral.
What are the key entities for health system governance?
The general regulation, planning, and supervision of health services, including cost control mechanisms, take
place at the national level through the Ministry of Health and the Danish Health Authority, Danish Medicines
Agency, and Danish Patient Safety Authority. The national authorities are responsible for general supervision
of health personnel and for development of quality management in line with national clinical guidelines and
standards, usually in close collaboration with representatives from medical societies. These authorities also have
important roles in planning the location of specialist services, approving regional hospital plans, and making
mandatory “health agreements” between regions and municipalities to coordinate service delivery. Health
technology assessments are developed at the regional level, while the national authorities do comparative
effectiveness (productivity) studies that are published on a regular basis, allowing regions and hospital managers
to benchmark performance of individual hospital departments (Danske Regioner, 2015).
Regions are in charge of defining and running hospital services and supervising and paying general practitioners
and specialists. Municipalities have important roles in prevention, health promotion, and long-term care. Rates
for general practitioners and practicing specialists are set through national agreements. Doctors’ associations
negotiate with a collective body of the regions, also including state representatives. Regions may enter into
additional regional agreements for specific services.
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The Commonwealth Fund