Pearls and Irritations

While this puts pressure on health budgets, so does the emergence of informed patients with larger expectations and research, technology and innovation proffering expensive new treatments.

Rethinking healthcare

“About 15 years ago, we realised the solution to these problems is not more hospitals but to think about how we can deliver healthcare in a different way,” says Hans Erik Henriksen, CEO of Healthcare DENMARK.

“We aim to deliver as many services as possible through primary healthcare, municipalities, health centres and outpatient clinics and as little healthcare as possible from our hospitals.

“The future role of the hospital is thought of as the place you go to when you finally need highly specialised healthcare services. The philosophy is to handle all other kinds of problems through primary care and add to the stronghold of the GP, municipalities and clinics.”

In Denmark the GP is the gatekeeper of healthcare, concluding nine out of 10 issues that arise.

Healthcare DENMARK is a public-private partnership organisation, mandated to promote Danish healthcare solutions abroad.

It paves the way for Danish health companies to do business abroad – attend conferences to spread the news of Danish success in healthcare transformation and host visiting delegations to Denmark.

Through its patron, Princess Mary, it has an Australian connection.

When Henriksen showed the Australian audience a slide that boldly instructed patients to “Stay at Home”, a titter ran through the room.

The slogan was from the Danish Ministry of Finance promoting a health system where services are offered at the lowest efficient cost, where there are more nurses and health workers on the ground and in patients’ homes.

“The rationale behind the restructuring of the hospital system is based on quality and productivity. We have learned that if you have hospitals that open the door for any patient and say “come in, let’s see what we can do with you”, you will receive patients for whom the hospital may not have the necessary experience.”

Speciality hospitals

Instead, a map of speciality hospitals has been drawn up across the country and doctors and the ambulance services know whether the patient should go to specialised orthopaedic, cancer or cardiac hospitals.

Restructuring wasn’t easy. “Of course, when you close hospitals there is uproar from the local community. In the beginning it was very powerful and politicians backed down,” he says.

“They kept the hospital open but years later the building was there but its role had changed – it may have become a rehabilitation hospital.”

Tensions eventually eased and after a couple of years the public began preferring specialist hospitals.

He explained how his personal experience of the healthcare system had changed.

“Twenty years ago, if I went to the GP, typically he was sitting alone in his office. If I needed a blood test I’d be sent off to the hospital. Then I would get an appointment two weeks later to see him.

“Today GPs are in groups of four or five, with nurses and labs. I’ll see a GP and then wait maybe 15 minutes before the lab takes my test. Two days later, I’ll see the results in my electronic health record and with it, maybe, notes from the GP telling me what I have to do.

“As a patient, you spend less time travelling around the healthcare system. Many issues are solved through digitalisation and you feel the coherence of the system.”

Denmark has embarked on a new $10.5 billion phase in healthcare reform to develop 16 new super specialised hospitals as the backbone of its future hospital structure.

This phase will see patients as active participants, taking more responsibility for becoming educated about their health, while the system works on making them feel heard.

Denmark’s goldmine of electronic data about the population, going back 30 years, has given it a head start. So has the fact that its healthcare IT strategy is linked to the public sector IT strategy.

By November 2014, all Danes had to get an electronic mailbox because letters from public authorities would no longer be sent by snail mail.

Hendriksen says the elderly have rapidly become online users and one aim was for all Danes to have a doctor in their pocket. This is not smartphone access to Google but an instrument for their digital relationship with their GP.

Crucial to the success of the reform is trust. To date, he says, Denmark has the finest cyber security in the world.