By Robert Teague, M.D., Physician Advisor, Dell Services Healthcare & Life Sciences
In a country where half of all hospitals, and virtually all primary care physicians, use a nationally networked electronic medical record (EMR)system, Denmark leads the rest of the world in digital care. As other industrialized countries are still catching up in many ways, Danish patients are starting to leverage the system personally through the use of telemedicine to replace weekly hospital visits with home computer monitoring devices and to receive electronic prescriptions
Since the country’s move to adopt an integrated system of EMRs a decade ago, Denmark’s health information system has become the most advanced in the world, delivering significant financial rewards and high levels of patient satisfaction. The Healthcare Information and Management Systems Society (HIMSS) estimates that EMRs alone save Denmark $120 million annually through physician productivity gains. With convenient patient care and a high quality health infrastructure, international studies show that over 90 percent of the population is satisfied with the healthcare system in Denmark — an impressive statistic by any standards.
Why does digital care succeed in Denmark?
Denmark’s healthcare model is a traditional, tax-funded public healthcare system covering 100 percent of the population. Denmark’s relatively small size and homogeneous population contribute to the success of its healthcare model.
Denmark’s adoption of EMRs was driven by the National Healthcare Informational Technology strategy from 2003 to 2007. Today, the country’s national network focuses on a patient-centric approach, which cuts across organizational boundaries. There is also extensive collaboration across Nordic countries, with Norway, Denmark and Sweden linking their national health information networks.
Technology has long been an integral part of Denmark’s healthcare system. As early as 1994, Denmark established the national healthcare data and information network, MedCom, which facilitates communication between healthcare professionals and the social care sector. In 2003, the Danish National Health Portal was established to provide patient services online.
Today, nearly 20 years later, MedCom continues to define common standards for healthcare in Denmark. Its national projects in 2010-2011 included technology initiatives for e-records, common medication cards, telemedicine, surgery medicine and laboratory medicine.
Central governance, local autonomy
The Danish government influences the direction of the healthcare system through national budget allocations. It highlights priority areas and earmarks grants to help regional and municipal authorities achieve their targets. While this may appear to reduce the authority of these bodies, healthcare administration still remains under the local authorities with the Ministry of Health having only a supervisory and coordinating role. In addition, a stringently regulated healthcare system provides the necessary checks and balances to keep healthcare affordable. While taxes keep the system running, most services are free at the point of service.
Denmark’s highly decentralized healthcare administration system plays an important role in ensuring cost effectiveness. While healthcare in Denmark is as expensive on a per capita basis as in many industrialized countries, it remains less expensive for the population because of system efficiencies.
As with other state-run universal healthcare models, pharmaceutical costs in Denmark are regulated by the free market, not controlled by the state. This can sometimes offset the price-control benefits achieved through regulation of the healthcare system. To compensate, about a third of Danes buy voluntary health insurance (VHI) to cover copayments on eyeglasses, dentistry and pharmaceuticals. In these areas, cost barriers to healthcare persist.
Digital care for Denmark tomorrow
Like the rest of Europe, the Danish healthcare system faces budgetary challenges. With rising healthcare costs, the system needs reform. But lack of political will makes policy intervention difficult. Moreover, the Danes’ satisfaction with their current system also means that there is no pressing imperative for change.
There are also other causes for concern as Denmark’s health status has declined over the last two decades. Life expectancy has fallen behind other European countries, while the incidence of breast and lung cancer has increased among middle-aged Danish women.
In addition, while the Danish healthcare information system is celebrated the world over, gaps do remain. The most significant hurdle is the need for common EMR standards, which could increase health information system benefits and reduce the burden on the healthcare delivery system. They will also be critical in creating effective home care technology solutions targeted at the aging Danish population.
While Denmark has achieved many important healthcare milestones over the last 20 years, the hunt for common standards could become one of its biggest challenges in the years ahead. However, if they’re implemented, along with policy reform, Denmark will be in a strong position to remain the global leader in digital healthcare.
Click here to go back to the Washington Report homepage.
Download this week's full Washington Report.
Subscribe to the Washington Report.