Danish government rolls out plan addressing tomorrow’s health challenges

Denmark's ruling coalition plans to transform the country's healthcare system. Hundreds of specialist doctors will be trained, Danish hospitals will treat more people at home, and 17 new local health councils will help primary and specialist care services work together.

The Danish coalition government presented its new healthcare reform before the end of September, on schedule.

Although ambitious, aiming to meet the challenges of tomorrow, the reform was not as disruptive as some had expected or feared.

"Two of the three models proposed by the government's own Health Structure Commission in June 2024 implied that the Danish regions would be dismantled and that almost all health and elderly care tasks should be moved from the municipalities to 8-10 new entities with unitary responsibility for health and elderly care," Karsten Vrangbæk, professor of public health at the University of Copenhagen, told Euractiv.

The fourth option

The current Danish healthcare system operates at national, regional and local levels. The state has overall responsibility for financing, regulating and supervising healthcare.

At present, five regions are primarily responsible for operating hospitals, general practitioners and psychiatric care, while the 98 municipalities are responsible for a range of primary care services as well as care for the elderly.

Based on the findings of the Health Structure Commission's report– which presents three alternative organisational models – the government is proposing a new, fourth option in order to create a more unified healthcare system throughout Denmark.

Nationalisation was one of the Commission's alternative models, but this was not chosen as an option by the Danish government.

According to Karsten Vrangbæk, this was due to internal disagreements within the government, where it appeared that only one party favoured a radical centralisation of responsibility at the state level.

Both the Liberal party and Social Democrats have strong representation at the regional and municipal levels, and both were quick to dismiss the idea of moving the responsibility for the elderly from the municipalities," Vrangbæk explained to Euractiv.

Change challenges

While hospitals are strong in Denmark, local primary care is lagging behind, Sophie Løhde, the Danish Minister of Interior and Health (Liberals), explained when presenting the reform, she said: "That is why we must now strengthen the part of the health system that is close at hand so that our health system as a whole becomes much stronger."

The model proposed by the government aims to address key challenges in Danish healthcare similar to those in other Nordic countries.

An ageing population, by 2035, Den:ark will have 50 per cent - or 160,000 more people - over the age of 80.

There is also an increase in chronic diseases; more people will be living with one or more chronic conditions, with high expectations of quality care.

Added to this is a shortage of health workers across the country. It is estimated that in ten years, there could be a national shortage of around 15,000 social assistants and healthcare workers.

Four regions

The government is now proposing that Denmark's five health regions become four, with two merging into one in eastern Denmark. The four will have the main responsibility for healthcare in the region, planning and setting priorities.

At the same time, 17 local health councils run by politicians from both the regions and municipalities will be responsible for expanding close care services.

The government also wants to train hundreds of new specialists in general practice so that by 2035, Denmark will have at least 5,000 GPs or specialists in general practice.

"All citizens should have close / nearby access to a doctor, no matter where they live," the reform proposal states.

More patient involvement

The Danish Patients Association is generally pleased with the government's plan, Emily Schmidt Egede, communications advisor at Danish Patients, told Euractiv.

This is because a number of healthcare tasks currently handled by the municipalities, such as emergency nursing and temporary places, specialised rehabilitation, and parts of advanced rehabilitation, will be transferred to the regions.

"This will ensure better coherence and more uniform and high professional quality throughout the country, as the regions have greater capacity and expertise to handle these tasks," the association explained.

They are also satisfied with the ruling coalition's initiative to provide more hospital care at people's homes, though at the same time, they would like to see more patient involvement in decision-making in Denmark.

"We are generally positive, but we find it worrying that patient involvement is only mentioned a few times in the health reform when it should be central for the future health system," Emily Schmidt Egede said.

Unanswered questions

Camilla Rathcke, president of the Danish Medical Association, also believes that the government is on the right track by training more specialist doctors in general medicine.

"There are many citizens with chronic diseases who do not have their own doctor, and at the same time, there is a shortage of specialists in hospitals," she said, adding that: "A unified region in Eastern Denmark is necessary to create a healthcare system that works as a team. This will not least benefit the patients who need the most help from the health system," Rathcke emphasised.

However, the association of the 98 municipalities, KL– Local Government Denmark, said that many questions remain unanswered.

"It's important that we don't forget the purpose of this reform – to strengthen the local healthcare system, to provide better help for the many Danes with chronic diseases and to move tasks out of the hospitals. The task is not to make super hospitals even more super. That's why it's important that this doesn't end up with even more centralisation of the local healthcare system,' says Martin Damm, president of KL.

The government's reform is now ready to be negotiated with the other political parties in the Danish parliament, Folketinget.

[Edited by Vasiliki Angouridi, Brian Maguire]