Gp in Europe


Denmark

In 1996, public and private expenditures on health in Denmark amounted to DKK60.500 million' or approximately 6.5 percent of the Gross Domestic Product (GDP). The hospital services are mostly financed from public funds. In 1 970, all publicly owned hospitals were transferred to the 1 6 political-administrative authorities, ie, the 14 county councils and the city councils of Copenhagen and Frederiksberg.The primary health service is organised on the basis of automatic insurance with free access for all citizens to the public health services. The act governing national health insurance gives all residents the right to free medical treatment by a medical practitioner or practising specialist. However, access to the public health service is divided into two groups: Group 1 and Group 2 coverage. Every citizen in Denmark may freely choose between these two groups regardless of income. Children under the age of 1 6 are included in the same group as their parents. Approximately 97 per cent of the population is covered in Group 1.Group 1 members receive completely free medical care from their general practitioner and also free specialist care when referred for such treatment by their general practitioner. They have to choose one particular general practitioner whom they must contact in order to get their expenses fully covered. After an initial six- month period, however, they may change doctor. For some specialties, direct access is permitted. The general practitioner treats or refers the patient further in the system, to a specialist or hospital care, free of charge to the patient.Group 2 members must pay a portion of the cost of their medical care, both general and specialist care, but have free choice amongst all general practitioners and are free to change general practitioner without limit. They also have direct access to all specialist care and are not obliged to see their general practitioner first in order to be referred. The amount paid by those insured in Group 2 constitutes whatever their general practitioner or specialist charges over and above the amount paid by a person insured in Group 1.Specialists practising outside hospital receive their fees from the health insurance scheme on the basis of a fee for services rendered. Patients receive subsidies to cover part of the cost of prescribed medicines. These subsidies can be as much as 75 per cent (more in special cases). The social security system also pays part of the costs to the patient of dental care as well as certain other treatments such as physiotherapy. Dental care for children under the age of 1 6 is provided free of charge.

 

Primary healthcare 
Primary healthcare in Denmark covers the services of a wide range of health personnel. Contact with the primary health services takes place on the patient's own initiative. The following are included in those providing primary healthcare:

       general practitioners;

       specialists in practice outside hospitals;

       dentists;

       physiotherapists;

       home visitors and nurses;

       chiropractors;

       chiropodists;

       school health and dental service personnel. 

For cost purposes, the expenditures on primary healthcare in Denmark can be regarded as the total amount spent on public and private healthcare after expenditures on the hospital system have been deducted. Within this definition, primary care accounts for 38 per cent of the total health expenditures; within this total, 55 per cent of the expenditures are met under the social security system and 45 per cent privately.

 

General medical services

The general practitioner is the patient's first contact with the healthcare system. He or  she is the first person to see and treat the patient and to advise and refer the patient for any further contact with the remainder of the system when appropriate. This can take the form of a referral to a practising specialist or to the hospital system.The range of services provided by the general practitioner under the general medical services in Denmark is considerable. As mentioned, the general practitioner is responsible for referrals of patients further in the system. Each general practitioner is also responsible for the routine health requirements of an average of 1,600 patients. Of these, 1,300 will be insured in Group 1. Care is delivered either by consultations at the surgery or by home visits and include such areas as maternal and child care, health examinations, vaccination of children, prescription of appropriate medicines and ordering treatment at the State Serum Institute. 

The general practitioner also participates in the appropriate municipal, social, and health organisations. There are currently 3,300 general practitioners in Denmark. The general practitioner is in contact with each patient six times per year on average.As mentioned, the individual patient chooses whether they wish to be enrolled in Group 1 or 2. At the same time, the individual Group 1 patient chooses which general practitioner they wish to be enrolled with. For Group 1 patients, the choice of general practitioner may be changed at any time. The individual patient chooses from amongst a certain number of doctors within the area of the patient's residence. However, in case of disagreement between patient and doctor, exceptions can be made to this rule and an alternative doctor can be chosen from outside this broad framework. Group 2 patients have a free choice of doctor at any time.The average number of approximately 1,300 Group 1 patients per general practitioner excludes children under the age of 16. A practice is unable to increase the number of patients when the total number exceeds 2,066 other than when no alternative practitioner is available. 

The freedom to set up a new practice is restricted by general agreement between the social security system and the Organisation of General Practitioners in Denmark (Praktiserende Lasgers Organisation), membership of which is obligatory. Under the terms of this agreement, an area where the overall ratio of Group 1 patients to general practitioners is less than 1,306 will normally be declared closed to any new practices. However, a general practitioner may, in principle, practise outside the framework of the public social security system agreement. In such a case, the patient would have to pay the entire fee themselves.Fifty-eight per cent of practices, covering 33 per cent of general practitioners, are run on a single-handed basis. A further 33 per cent of practices are partnerships, and the remainder, consisting of some 181 practices, are group practices.The groups share auxiliary staff and facilities, but not patients unless there is a partnership agreement.Finally, general practitioners are also responsible for the out-of-hours services when acute medical assistance is needed. This has been organised in out-of-hours arrangements in each county. In 1996, approximately 2.5 million patients contacted the out-of-hours services throughout the country. Half of these contacts were dealt with on the telephone, while the other half resulted in home visits or consultations in out-of-hours clinics.

Remuneration of general practitioners 
General practitioners are remunerated partly on a capitation basis and partly according to the services rendered to the patient. In 1996, the average gross income was DKK1,225,000 of which professional expenses would absorb 48 per cent.Out-of-hours service is covered co-operatively by the entire group of general practitioners in the county who, in principle, each take an equal number of duty watches which mostly are divided into eight hour modules. In an eight hour module, the general practitioner is responsible for either referral, consultations, or home visits.

Reference
1. US$1 = approximately DKK 6.0 (1996).

 

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