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“Controlling public spending on health care has been an important political aim since the 1980s. Many economic steering mechanisms have been applied to this end. However, the main instrument continues to be a tight control of budget adherence and a combination of global budgeting and some performance-based funding (see Chapter 3). 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. Waiting times have been a major political issue since the mid-1990s. Overall, a change in the role of hospitals towards providing more diagnosis and treatment and less care is reflected in trends such as a decrease in the number of hospitals, hospital beds and 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: Birk HO, Vrangbæk K, Rudkjøbing A, Krasnik A, Eriksen A, Richardson E, Smith Jervelund S. Denmark: Health system review. Health Systems in Transition, 2024; 26(1): i–152.

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“Denmark has a high proportion of generic and parallel import products on the market. Parallel importing of pharmaceuticals has been permitted since 1990. Generic products make up a significant proportion of the Danish usage of prescribed pharmaceuticals measured as defined daily doses.

“In 1999, the National Institute for Rational Pharmacotherapy (a part of the Danish Health Authority) was founded to guide doctors in rational prescribing. It also elaborates on treatment guidelines. Each region employs local groups of pharmacists and GPs to monitor prescription patterns and advise GPs on rational prescribing.

“Half of the prescriptions in 2020 used brand names, but the pharmacy dispensed one of these only in 6% of cases – the others were substituted. Price competition for generics manufacturers implies that they seek to be cheapest at a tender every 14 days. As pharmacies must offer customers the cheapest variant of a drug, the cheapest supplier secures almost the entire market for 14 days. This system creates fierce competition and some of Europe’s lowest prices for generics, which make up two thirds of medicines dispensed. Generic substitution reduced the potential cost of prescription medicines by DKK 3.2 billion (€429.1 million) in 2020, which is DKK 450 million (€60.3 million) more than in 2019. On average, patients save DKK 213 (€28.6) per prescribed item.”

Source: Birk HO, Vrangbæk K, Rudkjøbing A, Krasnik A, Eriksen A, Richardson E, Smith Jervelund S. Denmark: Health system review. Health Systems in Transition, 2024; 26(1): i–152.

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“There is a general policy to promote the generic substitution of pharmaceuticals, and all regional authorities have implemented policies that monitor and influence the use of drugs in their health facilities. Efforts to reduce the general costs of drugs have not been particularly successful, in spite of some positive results in terms of drug pricing. Any potential savings have been more than counterbalanced by wider use of new and more expensive drugs and by changes in the treatment indications for hypertension, high cholesterol and so on. The most important efficiency drive has been a massive, and largely successful, effort to convert inpatient treatment to outpatient or ambulatory treatment, similar to trends in many other European countries.”

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.

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“Knowledge about the Danish Vælg Klogt initiative was sparse both among PA [Patient Associations] and ScS [Scientific Socities]. Among the PA, 81% (13/16) reported that they had no or little knowledge. The corresponding figure was 72% (38/51) for the ScS. When asked, 25% of PA and 29% of the ScS answered that they believe that Vælg Klogt may contribute to a change in practice and thus contribute to reducing overuse. However, for the PA, the belief in a potential effect of VælgKlogt hinges on the recommendations from Vælg Klogt being included in national guidelines.

“‘It (the effect of Vælg Klogt) depends on whether it will form part of the national guidelines’ (PA 15)

“For the ScS, any effect will depend on what tests, treatments or procedures are chosen and how the implementation is organised.

‘Something like this has been tried many times before. Changing habits is a slow process’ (ScS 2)

“Furthermore, for both the ScS and the PA, the success of VælgKlogt depends on whether the healthcare system is able to reduce the fear of making mistakes or being blamed.

‘… because defensive medicine permeates the way we think and act nowadays’ (ScS 22)

“The PA and ScS agree that the primary purpose of VælgKlogt is to reduce overuse and secondarily to optimise public healthcare spending.” Table 3 shows other suggestions as to the purpose of the initiative.”

Source: Malling, B., Høffer, M., Raft, C. F., & Axelsen, S. (2021). The Danish Choosing Wisely concept. Danish medical journal, 68(10), A11200889.

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

Page last updated February 10, 2025 by Doug McVay, Editor.