JANUARY

DENMARK
caregivers. The performance of regions and municipalities in reaching the goals is measured by national
indicators published online (esundhed.dk).
Regions and municipalities have implemented various measures to promote care integration. Examples include
the use of outreach teams from hospitals doing follow-up home visits; training programs for nursing and care
staff; establishment of municipal units located within hospitals to facilitate communication, particularly in regard
to discharge; and the use of “general practitioner practice coordinators.” Many coordination initiatives have
a special emphasis on citizens with chronic care needs, multi-morbidity, or frailty due to aging or mental health
conditions (Økonomi og Indenrigsministeriet, 2013). Municipalities are in charge of a range of services,
including social care, elder care, and employment services; most are currently working on models for
integrating these services better, such as through joint administration with shared budgets and formalized
communication procedures.
Practices increasingly employ specialized nurses, and several municipalities and regions have provided financial
support to set up multispecialty facilities, commonly called “health houses.” Models vary, but often include GPs,
practicing specialists, and physiotherapists, among others. GPs in medical homes are encouraged to function
as coordinators of care for patients and to develop a comprehensive view of their patients’ individual needs
in terms of prevention and care. This principle is commonly accepted and is supported by the general nationallevel
agreements between GPs and regions. GPs participate in various formal and informal network structures
and are included in the health service agreements made between regions and municipalities to facilitate
cooperation and improve patient pathways. All GPs use electronic information systems as a conduit for
discharge letters, electronic referrals, and prescriptions.
What is the status of electronic health records?
Information technology (IT) is used at all levels of the health system as part of a national strategy supported by
the National Agency for Health IT. Each region uses its own electronic patient record system for hospitals, with
adherence to national standards for compatibility. Danish general practitioners were ranked first in an
assessment of overall implementation of electronic health records in 2014 (HimSS Europe, 2014). All citizens
in Denmark have a unique electronic personal identifier, which is used in all public registries, including health
databases. A shared medical card—accessible by all relevant health professionals—has been implemented.
It contains encoded information about each patient’s prescriptions and medication use. General practitioners
also have access to an online medical handbook with updated information on diagnosis and treatment
recommendations. Attempts to develop national clinical databases to monitor quality in primary care
(DataFangst) were aborted in 2015, as they were found to violate privacy rights and to endanger the trust
between GPs and their patients.
Sundhed.dk is a national IT portal with differentiated access for health staff and the wider public. It provides
general information on health and treatment options, and access to individuals’ own medical records and
history. For professionals, the site serves as an entry to medical handbooks, scientific articles, treatment
guidelines, hospital waiting times, treatments offered, and patients’ laboratory test results. The portal also
provides access to available quality-of-care data for primary care clinics, all of which use IT for electronic records
and communication with regions, hospitals, and pharmacies.
How are costs contained?
The overall framework for controlling health care expenditures is outlined in a “budget law,” which sets budgets
for regions and municipalities and specifies automatic sanctions if they are exceeded. The budget law is
supplemented by annual agreements between regions, municipalities, and government that coordinate policy
initiatives to control expenditures. These include direct controls of supply.
Block grants to regions are conditional on annual increases in productivity of 2 percent on the basis of
diagnosis-related groups, and are withheld if productivity demands are not met. Even though the activity-based
International Profiles of Health Care Systems, 2015 45