11 MARTINDALE CENTER FOR THE STUDY OF PRIVATE ENTERPRISE through the national database about their patients’ health-care journey, including any hospitalization events as well as their interactions with municipal specialists (Forde et al., 2017). Given GPs’ comprehensive knowledge of their patients’ lives, primary care specialists are essential to the Danish holistic approach to medical treatment. However, this system of heavy reliance on GPs leads to overwhelming caseloads for these practitioners and compromises the overall quality of patient care. Regional patient advisors protect patient legal rights, guiding Danes through any diagnosis, treatment, choice of hospital, access to treatment abroad, or complaint submissions (Healthcare DENMARK, 2023). They work closely with national officials in the Patient Safety Authority and thus are essential to the systemic efficiency of Danish public health care. However, recent patient complaints reveal that communication between levels of the Danish health-care hierarchy is lacking. A 2022 study utilized the Healthcare Complaints Analysis Tool to analyze a national sample of Danish compensation claims about emergency care, ultimately revealing that the patients experienced unacceptably long delays between receiving care by general practitioners and seeing a specialist (Morsø et al., 2022). As one patient explained, I was hit by a truck in high speed and my car suffered total damage. Shortly after the accident I was admitted to the hospital. A very superficial examination was performed and despite a swollen foot and leg and pain in my back and neck no further examinations were done…four months later I was told that I had a complicated fracture in my ankle and the doctor apologized that they hadn’t found out earlier…I now have a permanent foot drop (Morsø et al., 2022, p. 274). It is evident that the Danish health-care system requires reforms to expedite the referrals of severe cases and reduce the waiting time for diagnosis; these adaptations will ensure that quality of care is not compromised by preventable systemic delays. Specific suggestions for improving patient care are discussed as part of the proposal at the end of this article. Local (municipal) clinics Health care at the municipal level includes home care (i.e., nursing and rehabilitation services) accessible within all 98 municipalities of Denmark free of charge and without prescription by a doctor (Healthcare DENMARK, 2023). Professional recommendations for these municipality providers are issued by the national Health Authority for specific patient groups and health-care providers. In this way, municipal health care is a convergence point for all three sectors of Danish medicine. Regional GPs provide referrals to municipality (local) specialists, who follow national guidelines. Patients may provide feedback about their care to their regional patient advisor along the way; this information then flows upward to the national level, playing a role in the making of future health-care legislation. In theory, this is a healthy cycle, conducive to consistent and systemic forward thinking; however, the practical impacts of demographic inequalities for both physicians and patients in Denmark inhibit workforce collaboration and compromise the overall quality of patient care. Demographic issues Prominent demographic issues shed light on the social disparities that have an impact on the Danish health-care system. Denmark’s aging population, physician shortage, and competition by the private sector jeopardize the sustainability of the public system. All these factors considered alongside the extended waiting time for patients between GP referral and specialist diagnosis point to the need for improvement at each level of the health-care hierarchy to optimize workforce collaboration and ensure proper allocation of resources. Aging population The Danish population has been trending older since the beginning of the twentieth century. The median age is 42, and 20% of Denmark’s population is above the age of 65 (Statistics Denmark, 2022; World Bank, 2022). Danish statistics from 2018 show that hospital utilization steeply increases for individuals above the 45- to 49-year-old age group, with the highest number of hospitalizations occurring for individuals in the 70- to 74-year-old age group (Fig. 2). A study by Oksuzyan et al. (2020) showed a 42% increase in the projected total number of hospital days per year between 2013 and 2050, from 4.66 to 6.72 million days, with the largest change projected to occur for population groups aged 70 years and above. With fewer young adults contributing taxes to the system, there is less financing available for public services, including health care. With the aging population, it is notable that in 2015, 30% of all GPs were at least 60 years old and almost 60% at least 50 years old, so there are additional concerns for sustainability of the physician workforce, which affects the overall health-care system and patient quality of care. An increased volume of geriatric cases is associated with chronic disease and multimorbidity (Forde et al., 2017), underscoring the necessity for adjustments
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