“In Denmark, there is a long tradition of public welfare (Vallgårda, 1989, 1999a, 1999b) and decentralized management of welfare tasks. Before the 18th century, landlords and artisan masters were responsible for providing care for their subordinates when they were ill or in need of help in other respects. However, this did not mean that help was always given. Gradually, changes in societal behaviour occurred as a result of the dissolution of feudal social relations and the increasing power of the central state. A new political ideology, namely cameralism, which stressed the importance of a big and industrious population, gained ground in the 18th century and created an impetus towards improving the health of the population. Most of the tasks aimed at health care and relief for the poor were taken over or established in the 18th and 19th centuries by towns and counties, not the central state. The central state laid down the guiding principles, but most welfare measures were carried out by the local authorities, as is still the case. The Danish health care sector was financed mainly by taxes, which were raised by parishes, towns and counties and governed by the same authorities. Philanthropy and charity, organized through the church, only played a relatively minor role in welfare provision in Denmark and the other Nordic countries since the Reformation in 1536, compared with many other European countries. The fact that the public authorities also played the role of benefactors is probably one of the reasons why people’s attitudes towards the state are much more positive in Scandinavia than in most other western European societies. The roots of the Danish welfare state date back to the 18th century, long before the establishment of the Social Democrats and other pro-welfare state parties and the rise of organized philanthropy.”

Source: Olejaz M, Juul Nielsen A, Rudkjøbing A, Okkels Birk H, Krasnik A, Hernández-Quevedo C. Denmark: Health system review. Health Systems in Transition, 2012, 14(2):1 – 192.

“Danish welfare politics in general, and health care policies in particular, have been characterized by a consensus regarding the basic institutional structure (Vallgårda, 1999a). Since the 1940s, there has been agreement among the political parties that access to health care should be independent of where one lives and of economic resources. From 1945 to 1970, health care policy was characterized by a strong medical influence and consensus. Health care matters were discussed in technical rather than political terms. Since the 1980s, however, controversies have been much more frequent, as in several other countries over this period. Differences between the political parties also became more visible in this area, as they began to include specific health policies in their programmes. Hospital management has also changed in recent years following the appointment of more professional managers, such as economists, lawyers, political scientists and other university-educated administrators. This has affected hospital power structures and it is claimed by doctors to have reduced the influence of clinical practitioners. Economic rationale plays a more prominent role in the system today, both as a result of the focus on cost-containment and the introduction of new performance measures. The 1970 reform of the political and administrative structure reduced the number of counties and municipalities. It also placed the responsibility for the largest part of the health care sector on the counties, whereas previously this responsibility had been divided between the towns, counties, state and the health insurance schemes. In 2007, a reform was implemented reducing the number of municipalities to 98 and establishing five regions with the responsibility for providing hospital and outpatient care for citizens. The municipalities received more responsibility for rehabilitation, disease prevention and health promotion, as well as for the care and treatment of disabled people, and alcohol and drug users. Municipalities contribute to the regions through payments both per capita and by activity, the latter according to citizens’ utilization of the regional health services (see Chapter 6 for more on the 2007 reform). The Acts on health care mainly set out the general legislative framework, letting the local and regional authorities decide on matters relating to actual performance, but the Acts also created a certain degree of recentralization. Ensuring local self-governance has for a long time, and in many different respects, been given a higher priority in formal legislation than ensuring an equal level of quality and provision of health care. This, however, changed with the 2007 reform, which holds equal standards of care throughout the country as one of its main priorities. Further recent initiatives such as the Danish Healthcare Quality Programme (Danske Kvalitetsmodel (DDKM)), which is now being rolled out to the entire Danish health system, the use of clinical guidelines and the use of clinical patient pathways have further tried to standardize the delivery of health care.”

Source: Olejaz M, Juul Nielsen A, Rudkjøbing A, Okkels Birk H, Krasnik A, Hernández-Quevedo C. Denmark: Health system review. Health Systems in Transition, 2012, 14(2):1 – 192.

“Since the 1990s, health care expenditure has again risen. The debate on prioritization has subsided and the focus has shifted to efficiency and quality, inspired by the “new public management” wave. Since the early 1990s, more economic incentives have gradually been introduced into the hospital sector. In 1993, free choice of hospital was introduced and in 1998 it was decided that hospitals should be reimbursed according to diagnosis-related groups (DRGs) for patients living in other counties. Since 1973, hospitals have received resources according to their budgets; however, in 1999, it was decided that 10% of resources would be allocated in relation to activities based on DRGs; from 2004 this figure changed to 20% and later to 50% (see section 3.7.1). Quality assurance methods, including accreditation, have played an increasing role in hospital management. Patient rights have also been strengthened through legislation on rights and complaint systems (see section 2.9). Additionally, waiting times have been a big political issue since the mid-1990s. As such, a maximum two-month waiting guarantee from diagnosis to treatment was introduced in 2002 and then reduced to one month in 2007. As a result, if the patient cannot be guaranteed treatment within one month, he or she may choose to be treated at another hospital, including private hospitals and hospitals in other countries, in so far as a prior agreement has been reached between the patient’s region and the treatment facility. Overall, a change in the role of hospitals towards one providing more diagnosis and treatment and less care is seen in trends such as a decrease in the number of hospitals and hospital beds and in the length of stay; an increase in the number of doctors and nurses; a slight increase in admissions; and a steep increase in outpatient visits, both to hospital outpatient departments and GPs.”

Source: Olejaz M, Juul Nielsen A, Rudkjøbing A, Okkels Birk H, Krasnik A, Hernández-Quevedo C. Denmark: Health system review. Health Systems in Transition, 2012, 14(2):1 – 192.

“Public hospitals were built during the 19th century in almost all Danish towns by the towns and counties themselves and financed primarily by property taxes and, to a lesser extent, charity and user charges (which were sometimes paid by the patients themselves but more often by their employers or the authorities for relief for the poor). Originally, hospitals were intended for and used by the poor, but this gradually changed at the end of the 19th century. While the lower social classes still constitute the majority of hospital patients, this is mainly because of the greater burden of poorer health among the lower social classes (Steensen & Juel, 1990). Hospitals aimed at a specific disease or group of diseases have been rare in Denmark, with the exception of psychiatric, fever and tuberculosis hospitals. From the 1930s onwards, the state has subsidized hospitals to an increasing degree, but county councils continued to be responsible for hospitals. The state has exerted only little formal influence in this area. Of the private hospitals, a few Catholic hospitals existed on a non-profit-making basis; however, they have been gradually taken over by the counties, as have the very few hospitals owned and managed by the state, including Rigshospitalet in Copenhagen.”

Source: Olejaz M, Juul Nielsen A, Rudkjøbing A, Okkels Birk H, Krasnik A, Hernández-Quevedo C. Denmark: Health system review. Health Systems in Transition, 2012, 14(2):1 – 192.

Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and sixteen other nations.

Page last updated Nov. 19, 2022 by Doug McVay, Editor.