9 MARTINDALE CENTER FOR THE STUDY OF PRIVATE ENTERPRISE Regardless of which group option is chosen, access to hospitals and almost all forms of specialized care are granted only upon referral by GPs (Healthcare DENMARK, 2023). While the public system covers GP visits, hospital care (including inpatient prescription drugs), mental health services, and dentistry for children under age 18, private insurance is necessary for coverage of pharmaceutical drugs at the municipal level as well as adult dental care (Schmidt et al., 2019). Enrollment in private voluntary health insurance (VHI) coverage has sparked political debate because of the potential for private corporations to introduce unequal access to care (Olejaz et al., 2012). Nevertheless, approximately 40% of Danes in 2012 carried additional insurance in 2012 to help cover medications and specialized or private care not paid for by their public insurance group (Olejaz et al., 2012). This growth in the private sector has occurred alongside declining conditions of the public system. An article in the local Copenhagen newspaper Berlingske reported that approximately 10% of the hospital beds in each of the three major hospitals of the Greater Copenhagen region1 has been lost due to staff shortages over the past decade (Pederson, 2022). Pedersen went on to explain the situation by noting a staffing competition between the public and private sectors of health care, where qualified nurses in the public system were recruited for higher-paying jobs in the private sector. Evidently, better allocation of funds within the public health-care sector is necessary to mediate the competition from private institutions and sustain its current workforce. Organizational structure While the economics of the public system are systemically linked, internal organizational issues have prevented coordination between the three administrative levels of public Danish health care. Figure 1 shows these administrative levels, beginning with the MOH as the overarching administrative entity at the national level. The MOH is composed of six branches that are separately responsible for creating annual legislation within their respective areas (Healthcare DENMARK, 2023). Below the MOH, regional care is provided in the five geographic regions of Denmark, each with elected councils that coordinate the operations of general and specialized health-care services. In this way, each region owns, manages, and finances their own health-care facilities. At the local level, each of the 98 municipalities is responsible for disease prevention and health promotion through outpatient rehabilitation services, home care, health education services, dental treatment, and services for elderly people (Tikkanen et al., 2020). Coordination issues between the three levels of the health-care hierarchy overburden GPs at the regional level and compromise patient quality of care at the local level. Therefore, it is imperative that public collaboration between local, regional, and national health workers takes place to increase workplace efficiency and complement the previously discussed efforts to properly allocate public funds and ensure the long-term success of the system. National administration The MOH was not established as a governmental body until 2015. Since then, it has become a comprehensive source of information for the country’s public health, with online informative reports2 of the qualitative and quantitative considerations for passing annual legislation (Ministry of Health, 2017). Healthcare DENMARK (2023) is a gateway organization that coordinates international networking in the health-care and life sciences industries; its website is linked to the MOH site, reflecting the Danish commitment to transparency and global networking in health care. These administrative bodies collectively provide a summary of national goals, emphasizing the importance of safety, collaboration, and equality, while also providing citizens with updates on how the country is taking actionable steps to advance these principles. There are six separate branches of the MOH that work on health-care legislation within specific sectors (see Fig. 1). The Health Authority is responsible for dissemination of public health information, while the Medicines Agency is responsible for managing pharmaceutical companies through the process of selling medicine in Denmark, clinical trials and medical device authorization included. The Patient Safety Authority advocates for patients’ rights by implementing laws for the prevention of malpractice, while the Health Data Authority provides access to health data for professionals and administrators at both the regional and municipal levels. The Statens Serum Institut includes the country’s biobank and is responsible for the surveillance, prevention, and control of infectious diseases, congenital disorders, and biological threats. The sixth branch of the MOH 1The three major hospitals mentioned in the article are Rigshospitalet, Bispebjerg, and Herlev-Gentofte. 2The collection from 2021 includes a report outlining the assessment by the Integrated Regulatory Review Service of the Danish nuclear safety and security that year, a report highlighting the country’s promotion of personalized medicine, an agreement on the strategy for life science, and an informational packet for the proposed “super hospital programme.”
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