8 PERSPECTIVES ON BUSINESS AND ECONOMICS | VOL 41 | 2023 Ensuring the long-term sustainability of the Danish health-care system Laura X. Duffany Denmark has one of the most comprehensive and well-funded public health-care systems in the world; however, internal communication issues, shortages of health-care professionals, and an emerging private sector threaten the long-term sustainability of the system. This article analyzes the current organizational structure, economic model, and patient demographics of the Danish universal health-care system and proposes a new, integrative model that efficiently prioritizes the quality of patient care. Introduction Fostering trustful collaboration in public health will make the world a safer and healthier place. The Danish universal health-care system is an excellent demonstration of this mentality, as all citizens have been entitled to publicly financed care since 1973 (Ministry of Health, 2017). Under this system, 84% of the country’s health-care expenditure is publicly financed, while the remaining 16% is attributed to patient copayments (Tikkanen et al., 2020). The Danish health-care hierarchy is organized such that each level of the public system, whether municipal, regional, or national, focuses on its own internal tasks and resources. This separation leads to each level overlooking the bigger picture, thus jeopardizing the system’s long-term sustainability. Because of Denmark’s commitment to modern and equal access to health care (Ministry of Health, 2017), the Danish system sets a global standard for medical treatment; however, integrative refinements to the country’s current education and staffing policies for physicians are necessary for Denmark to improve working conditions for health-care professionals and increase the efficiency of the public system overall. Current economics One of the unique aspects of Danish public health is the coordinated division of finances between the three levels of its hierarchy (national, regional, and municipal/local). Regional funding bridges the national and municipal levels of health care, as each of the five regions receives an annual national block grant as well as activity-based subsidies from the 98 municipalities (Tikkanen et al., 2020). Every year, the municipality subsidies are obliged by the Ministry of Health (MOH) to meet the regional budgets within a 1.5% margin (Schmidt et al., 2019), and their amounts vary depending on hospital activity in each region. Thus, the economics of the Danish health-care system are systemically linked: local patient groups and individual characteristics, including diagnoses, treatments, and demographics, affect the amount of national funding received for each region. Given the efficient financial linkage between the health-care hierarchy, Denmark’s gross public spending in health has consistently been comparable to that of the EU. For example, in 2019, the EU average of gross public spending in health care was 75%, while Denmark fared well at 83% (OECD, 2021). Therefore, prospective financial improvements for the Danish health-care system should focus on efficiently allocating resources within the public sector to sustain a happy and healthy workforce. Over the past decade, a rocky dynamic has developed between the public and private sectors of health care as public institutions lose their staff to higher-paying opportunities in private hospitals (Pederson, 2022). This loss of workers in the public sector has led to higher demand for private care and the corresponding insurance to cover it, threatening the overall financial health and sustainability of the public system. Under the public insurance system, Danes are offered a choice between Group 1 or Group 2 healthcare coverage. For a one-time fee of 215 Danish kroner (approximately $31), citizens can switch groups, provided they have had at least one year of enrollment in their current plan (City of Copenhagen, 2023). Group 1, chosen by 98% of the population, assigns a general practitioner (GP) to the patient and minimizes out-of-pocket copayments (Tikkanen et al., 2020). Meanwhile, Group 2 coverage, chosen by the remaining 2% of Danes, allows Danes the freedom to choose their own GP, although high copayments apply (International Student Insurance, 2023).
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