|Implemented in this survey?|
The purpose of a discussion paper presented by the Government in December 2003 is to support patients' choice of hospital, enabling patients to make informed choices re treatment and facilitating access to information on quality. The main instruments are transparency, quality information provided to patients, and a ?money follows patient? scheme aimed to increase competition over high quality care. The expected outcome is better quality as a result of stronger incentives to perform well.
On December 15th, 2003, the Danish government published the policy/discussion paper "Et åbent og gennemsigtigt sundhedsvæsen" ("An open and a transparent health care system"), a
follow-up on the government's new health care strategy "Strategy for the health care system - the patient first". (see separate report "Patienten først.")
The main objectives formulated in this strategy paper are high or higher quality of treatment, support the opportunity for patients to choose among hospitals (i.e. support the "free choice" scheme), support the opportunity for patients to make informed choices regarding their treatment, equity considerations interpreted as more equal access to information on quality of treatment at hospitals.
The main instruments are transparency and generally a higher level of information provided to patients, increasing use of a "money follows the patient" remuneration scheme and, as a consequence of the previous instrument, increasing competition on quality. As indicated the incentives are partly financial (counties/hospitals are remunerated financially), partly utility-driven (patients choosing based on expected utility). Counties/hospitals are expected to be affected, as are patients.
Partly financial (counties/hospitals are remunerated financially), partly utility-driven (patients choosing based on expected utility).
Patients, Counties, Hospitals
|Degree of Innovation||traditional||innovative|
|Degree of Controversy||consensual||highly controversial|
|Structural or Systemic Impact||marginal||fundamental|
|Public Visibility||very low||very high|
The policy/discussion paper marks a step in the direction of a consumerism attitude. As to the pros and cons of this it suffices to note that this is a much-debated issue.
The government announced its new strategy for the health care sector in the policy paper "Strategi for det behandlende sundhedsvæsen - Patienten først." (Strategy for the health care system - the patient first). In that paper a number of concrete steps were announced one of which was the publication of a discussion/policy paper giving a more detailed account of the planned use of quality indicators. It is this discussion/policy paper which is the topic of the present report.
.Discussion paper with the title ?Et åbent og gennemsigtigt sundhedsvæsen? (?An open and a transparent health care system?)
|Implemented in this survey?|
The government published the policy/discussion paper "Et åbent og gennemsigtigt sundhedsvæsen" ("An open and a transparent health care system") on December 15th, 2003.
It is a follow-up on the governments new strategy for the health care sector (see report on "Strategi for det behandlende sundhedsvæsen - Patienten først." ("Strategy for the health care system - the patient first").
The announced strategy can be interpreted as the present Liberal government's attempt to change the incentives in the sector in the direction of a more market-oriented system.
The approach of the idea is described as:
It is noteworthy that this initiative originates with the central government (the minister of health) and not the counties/hospitals, though it is by no means unique that the central government
engages in the functions as purchaser and provider.
Generally the minister faces an up-hill battle, as neither counties/hospitals, nor the scientific community have been supportive of this kind of consumerism attitude in the sector.
The policy is presented in a discussion paper. It is to be expected that the policy proposed partly will follow the steps takes by the Labour government in England regarding the use of quality indicators and increased degrees of freedom to well performing hospitals.
The possible implementation will be highly depending on the minister of health and his ability to carry the ideas through. Neither the counties/hospitals, nor the ministry itself are supporters of this kind of consumerism. The Ministry of Finance has a tradition of opposing reforms that might affect budget certainty, but will probably play along as long as financial rewards are tied to quality indicators and remuneration decided at the discretion of the ministries.
This particular policy is presented as a discussion paper, which lists a number of questions. No time frame is set for answering these questions. In the presentation of its new strategy (see the report on The government announces its new strategy for the health care sector 1/2004) certain goalposts are presented. Some of these goalposts are not necessarily very ambitious: In fact on such goalpost was the publication of the discussion paper in hand.
Without providing answers it can be noted that this discussion hinges on the basic discussion of how a more market-oriented system will work.
As of yet the policy proposal is only at the discussion stage.
The report is available from the ministry's homepage (www.im.dk) but is in Danish only.
Michael O. Appel