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A new Health Care Law

Country: 
Denmark
Partner Institute: 
University of Southern Denmark, Odense
Survey no: 
(5)2005
Author(s): 
Michael O. Appel
Health Policy Issues: 
Others
Others: 
Declaration of overall purposes for and organization of the health care sector.
Current Process Stages
Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no yes no no no

Abstract

The declaration of the general purposes and instruments of the health care sector (similar to e.g. the traditional OECD listing of goals of the health care sector) have hitherto been dispersed in 15 separate bills on particular areas of health care legislation. The new proposal explicitly states the objectives for the health care sector and presents them in one particular bill.

Purpose of health policy or idea

The general purposes and instruments of the health care sector (similar to e.g. the traditional OECD listing of goals of the health care sector) have hitherto been spread around in 15 specific bills on particular areas of health care legislation. The new proposal explicitly states objectives for the health care sector.

The text specifies that the law on health care should guarantee individuals their autonomy and integrety and makes seven objectives explicit:

  1. Easy and equal access to the health care system
  2. High quality treatment
  3. Coordinated services
  4. Free choice
  5. Easy access to information
  6. A transparent health care system
  7. Short waiting times for treatment

The purpose of making the objectives explicit is probably to promote certain benchmarks that will serve as ways to measure the performance of the coming system of regions (see report on new structure of the public sector and the health care system).

Main points

Main objectives

The law is to be the legal framework for the health care sector. The objectives are the ones stated above.

Type of incentives

The explicit statement of the overall objectives of the system does not in itself produce any incentive, but it may make monitoring easier. Though put in broad terms the formulations are not particularly fuzzy and can be developed so that monitoring becomes possible.

Groups affected

Providers, Consumers

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Characteristics of this policy

Degree of Innovation traditional innovative innovative
Degree of Controversy consensual neutral highly controversial
Public Visibility very low low very high
Transferability strongly system-dependent system-neutral system-neutral

In a Danish context it appears innovative. There has been some controversy regarding the wording, but the basic principle - to have the overall purposes explicitly stated and collected in one text - makes to much sense to be abolished. Any country can apply the basic principle.

Political and economic background

This health policy is the formulation of the overall national health policy. The official background for the formulation of the is the restructuring of the public sector. However, the government could have retained the practise of having several laws specifying parts of the sector and not to have any up-front formulation of the most important obejctives for the overall health policy.

Change based on an overall national health policy statement

It is a proposal to an overall national health policy statement

Purpose and process analysis

Current Process Stages

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

Origins of health policy idea

The idea to this formulation was probably generated in the MoH; and in all likelyhood with the Minister of Health as the prime mover. The civil service in the MoH has a strong tradition of great caution, even resistance, to approaches that takes a consumer perspective on the sector.

Initiators of idea/main actors

  • Government
  • Parliament: The position of opposition parties is difficult to summarize as it depends on which particular aspect of the proposed law one focusses on

Approach of idea

The approach of the idea is described as:
new:

Stakeholder positions

The MoH/Minister initiated the formulation of the overall purposes of the health care system. It is very difficult for any stakeholder to out-right and openly oppose the stated purposes. For instance: waiting times statistics and information on waiting times to patients have been unfit for use for several years mainly because counties have had no incentive to provide correct information. Yet, it would be impossible for the Association of Counties to openly declare themselves in opposition to the now stated objectives of easy access to information and a transparent health care system. 

One aspect of the listed objectives has caused concern among opposition parties in Parliament. In the proposal the government makes use of the term "easy and equal access ..." rather than "free and equal ...". Opposition parties have expressed suspicion that the reason for the choice of words is that the government secretly intends to introduce user-charges at a later stage. The government answer is that one cannot use the wording "free and equal ..." in the context of overall purposes since, for instance, dental is not free to day, nor is it planned to be in the future. Later in the proposed text it is specified that access to e.g. hospital services if free of charge.

In addition to the statements on the overall objectives of the health care system the proposed text also includes substantial elements of the proposed bill on the restructuring of the public sector. Since there are disagreements between the political parties on that particular reform those disagreements carry over to the issue of the health care law (for a treatment of proposed restructuring of the public sector please see separate report on that issue).

Actors and positions

Description of actors and their positions
Government
Minister of Healthvery supportivevery supportive strongly opposed
MoH Civil Servicevery supportiveneutral strongly opposed
Parliament
Coalitionpartners in Governmentvery supportivesupportive strongly opposed
Main government supporting partyvery supportivesupportive strongly opposed

Influences in policy making and legislation

The bill has been proposed to parliament.

Legislative outcome

pending

Actors and influence

Description of actors and their influence

Government
Minister of Healthvery strongvery strong none
MoH Civil Servicevery strongneutral none
Parliament
Coalitionpartners in Governmentvery strongstrong none
Main government supporting partyvery strongstrong none
Minister of HealthCoalitionpartners in Government, Main government supporting partyMoH Civil Service

Positions and Influences at a glance

Graphical actors vs. influence map representing the above actors vs. influences table.

Adoption and implementation

The  listing of the overall purposes of the health care system affects all actors in the system and to a certain degree they will all be involved in the adoption process towards implementation.

Monitoring and evaluation

There is no all-including institution/instrument in place to monitor the policy, though there are institutions which are intended to monitor particular areas. 

Results of evaluation

No evaluation yet as the bill is still debated in parliament. 

Expected outcome

To have an explicit statement of the overall purposes of the health care system, and to have them collected in one place, is a major improvement. It makes it easier for the electorate and media to monitor the performance of the government and the politicians responsible for the health care system. It may still be a very troublesome and costly activity for voters and media to monitor the government/politicians but the proposal at least is a step towards making it less difficult. Further steps are certainly needed: though not particularly fuzzy the objectives need to be made even for specific (not necessarily in the present bill, but in separate expositions).

The next question is whether the existing or the planned institutional set-up of the Danish health care system will satisfy the objectives. That is doubtful. The existing system has not produced a transparent system with easy access to reliable information, and the proposed restructuring of the public sector is not likely to change incentives.

Impact of this policy

Quality of Health Care Services marginal neutral fundamental
Level of Equity system less equitable neutral system more equitable
Cost Efficiency very low neutral very high

The policy makes it easier to obtain goals regarding quality, equity and cost efficiency, but only if combined with policies particular aimed at those objectives.

References

Sources of Information

The proposed bill is avaiable in Danish only.

MoH: "Forslag til Sundhedsloven", (L 74), 2005 (presented to parliament on 24. February, 2005.)

Author/s and/or contributors to this survey

Michael O. Appel

Suggested citation for this online article

Michael O. Appel. "A new Health Care Law". Health Policy Monitor, March 2005. Available at http://www.hpm.org/survey/dk/a5/2