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An open and a transparent health care system

Country: 
Denmark
Partner Institute: 
University of Southern Denmark, Odense
Survey no: 
(3)2004
Author(s): 
Michael O. Appel
Health Policy Issues: 
Quality Improvement, Responsiveness
Current Process Stages
Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no yes no no no no
Featured in half-yearly report: Health Policy Developments Issue 3

Abstract

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.

Purpose of health policy or idea

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.

Type of incentives

Partly financial (counties/hospitals are remunerated financially), partly utility-driven (patients choosing based on expected utility).

Groups affected

Patients, Counties, Hospitals

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Characteristics of this policy

Degree of Innovation traditional innovative innovative
Degree of Controversy consensual highly controversial highly controversial
Structural or Systemic Impact marginal rather fundamental fundamental
Public Visibility very low low very high
Transferability strongly system-dependent rather system-neutral system-neutral

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.

Political and economic background

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.

Change based on an overall national health policy statement

.Discussion paper with the title ?Et åbent og gennemsigtigt sundhedsvæsen? (?An open and a transparent health care system?)

Purpose and process analysis

Current Process Stages

Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no yes no no no no

Origins of health policy idea

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.

Approach of idea

The approach of the idea is described as:
new:

Stakeholder positions

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.

Influences in policy making and legislation

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.

Legislative outcome

n/a

Adoption and implementation

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.

Monitoring and evaluation

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.

Expected outcome

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.

References

Sources of Information

The report is available from the ministry's homepage (www.im.dk) but is in Danish only.

Author/s and/or contributors to this survey

Michael O. Appel

Suggested citation for this online article

Michael O. Appel. "An open and a transparent health care system". Health Policy Monitor, 04/04. Available at http://www.hpm.org/survey/dk/a3/3