I’m here in Denmark primarily to learn about energy and environmental policy, but visiting a country is always a good time to fire up the old Google and learn about health care policy. 84 percent of Danish health spending is accounted for by the state, with the remaining sixteen percent mostly representing out-of-pocket spending on medicines and dental products. The state just straightforwardly pays for care out of tax revenue. Denmark has the highest taxes in the world, and part of the reason is that they rather efficiently don’t monkey around with a lot of quasi-taxes in which they make employers contribute to health funds or whatever. It’s just straight-up tax and spend.
For the purposes of non-hospital care, all Danes need to choose to be either in Group 1 or Group 2. Children under the age of 15 are enrolled in the group chosen by their parents, and when you turn 15 you’re enrolled by default in Group 1, though you’re free to choose Group 2. In practice, almost nobody chooses Group 2 and Group 1 covers 98.5 percent of the population. The good news for Group 1 patients is that you get to choose your general practitioner and you get to see him (or a substitute if he’s sick or on vacation or if you’re traveling in another town or what have you) for free. You also get to see specialists for free, but only with a recommendation from the GP. In Group 2 you need to pay a portion of the cost of a visit to the doctor, but you have the right to go directly to a specialist.
Denmark has 4,100 general practitioners and 1,200 practicing specialists, which I believe is a way higher GP:specialist ratio than we have in the United States.
Hospitals-wise, Denmark is organized into five regions. The basic idea is that if you need to go to a hospital, you go to one of the ones your region runs. However, certain kinds of services may be so specialized that they’re not available in all regions, so the regions have reciprocity agreements with each other in which you might get sent to an out-of-region hospital. Denmark is also a pretty small country—a population larger than Minnesota but smaller than Wisconsin—so for some rare treatments you may need to go out of the country, and it’s possible to get the state to pay for that.
Denmark also has a private hospital sector. Some of what happens in the private hospitals is that they provide specialized care under contract with the regions. In addition, the ruling center-right coalition introduced a law in 2002 saying that citizens may choose to go to a private hospital or clinic “if the waiting time for treatment exceeds two months and the chosen hospital has an agreement with the regions’ association regarding the offer for treatment.” In 2007 they expanded this initiative by reducing the waiting time to one month.
Denmark spends a relatively large amount on health care, but it’s very close to its fellow small northern European countries. Lately Denmark has been putting more emphasis on preventive health. This is probably a good idea since Denmark’s life expectancy, though slightly higher than America’s, is near the bottom for western Europe.