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They are financed by the State and the municipalities. The regions own and run hospitals and prenatal care centres, and they also finance GPs, specialists, physiotherapists, dentists and pharmaceuticals. Reimbursements for private practitioners and salaries for employed health professionals are agreed through negotiations between the Danish Regions and the different professional organizations.

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Municipal level The 98 municipalities are also governed by councils elected every four years at the same time as regional council elections. They are responsible for providing services such as nursing homes, home nurses, health visitors, municipal dentists, prevention and health promotion, and institutions for people with special needs i.

These activities are financed by taxes, with funds distributed through global budgets, and carried out by salaried health professionals. Salaries and working conditions are negotiated by the National Association of Local Authorities and the different professional organizations. With the exception of a few central state hospitals, health care in Denmark has been the responsibility of the towns and counties since the beginning of the 18th century, so there is a long tradition of decentralized administration in the health sector see Section 2.

The reform Note: a The Danish regions and the National Association of Local Authorities are not part of the formal political and administrative system.

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The associations provide counselling for their members and negotiate with professional organizations and the central Government. While many state tasks were transferred to the counties, responsibility for the hospitals moved from local hospital boards to the county councils. The reform allocated new tasks and responsibilities to both the State and the municipalities, and thereby involved a certain level of both centralization and decentralization.

In , responsibility for psychiatric hospitals and care for disabled people was decentralized from the State to the counties as part of an effort to develop closer coordination between somatic and psychiatric care, and, more generally, to establish smaller units that would be closer to the population. The counties also developed closer coordination with municipal social services, which gradually led to their handling the special needs of psychiatric patients. The process of decentralizing psychiatric treatment is continuing today, with the aim of delivering flexible and well-coordinated services.

Deconcentration of state functions in health care is rare.

One of the few examples of this is the case of public health officers, who have been employed by the State from the beginning of the 18th century and who work at the regional level. GPs were initially A serious consequence of decentralization is the unequal access to health care across the different counties. Danish politicians appear to consider local self-governance and its potential for innovation to be more important than geographical equity. Decentralization in Denmark has been shown to lead to differences in waiting times, in the availability of medical technology and in the rates of specific diagnostic and curative activities, such as systematic screening for breast cancer or the use of expensive drugs for ovarian cancer.

One of the goals of the reform is to ensure equal standards of care throughout the country by increasing the power of the state bodies in planning and quality management. Denmark has a tax-based, decentralized health care system providing universal coverage for all residents in the country. However, to be entitled to free access to health care an individual must be registered as a resident for more than six weeks. All those who have the right to tax-financed health care receive a health certificate card. The right to health care services is regulated by law with no option of opting out of the publicly funded system.

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People over the age of 16 who have the right to tax-financed services can choose between Group 1 and Group 2 coverage see Subsection 2. Children under the age of 16 are covered by the same form of coverage as their parents. A considerable proportion of the Danish population is covered by additional voluntary health insurance VHI see Subsection 4. Special rules for accessing health services apply for tourists, foreigners, legal immigrants, asylum seekers and illegal immigrants. Tourists and foreigners temporarily staying in Denmark must pay for health care services on a feefor-service basis.

To receive reimbursement, a European Health Insurance Card or evidence of private health insurance must be shown at the point of use Ministry of the Interior and Health d. Legal immigrants are covered by the tax-financed system and they have the same rights as residents with Danish citizenship. Asylum seekers are not residents and do not have these entitlements; they may be treated by basic primary services and emergency hospital services, but they would have to apply for specialized treatment in the case of lifethreatening and painful chronic diseases, which are all financed by the Danish Immigration Service.

All Danish residents have free access to GPs, ophthalmologists, ear, nose and throat specialists, and emergency wards.

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  8. Access to specialists and hospital care is free at the point of use with a referral from a GP. Free access includes ambulance transport and palliative care. In Denmark, treatment is left up to medical judgement and there is no minimum package of care. There have been some efforts to establish a list of priorities but an explicit priority-setting system has not been implemented. Formal restrictions on access are decided by the Parliament and the individual hospitals, and they only exist for a few treatments i.

    Entitlement to some vaccinations, health examinations for children and pregnant women, and health visits to elderly residents are also regulated by law. Co-payments exist for long-term nursing home care, dentists, physiotherapists, pharmaceuticals, and so on. Eyesight tests and glasses are paid for by patients; however, hearing tests and aids are free.

    People with low income may be reimbursed for co-payments by the social security system. An increasing number of Danes buy private insurance to cover these co-payments, to gain access to private hospitals and clinics and as an extra financial safeguard in case of sickness.

    Many employers offer private insurance to their employees, which is a contributing factor to the overall increase in private insurance see Subsection 4. Treatments not authorized by the National Board of Health are not reimbursed by the public system or by most private insurance companies. Sickness pay is the responsibility of the employer during the first two weeks of absence and the responsibility of the municipality thereafter. Many employees have a collective agreement which entitles them to their salary for a longer period, although sickness pay from the municipality generally stops after 54 weeks.

    It is more common for salaried people to have an agreement with their employer that entitles them to their salary during sickness and maternity leave, than wage earners. All pregnant women are entitled to maternity benefits from the municipality for four weeks before the expected birth and 14 weeks after the birth. The For maternity leave, many employees have an agreement to be paid their salary for 26 weeks or more. Relatives of chronically or terminally ill patients are entitled to salary or compensation from the community. In the case of disability and reduced working capability, a national supplementary disability pension is granted.

    This type of pension may be temporary or permanent and it is co-financed by the State and the municipalities. Insurance bodies and pension funds often offer their members supplementary benefits in case of disability and acute serious disease. Health checks are often required before taking out insurance or entering a pension fund and membership may be denied. Insurance companies are not allowed to ask for or to see predictive genetic testing.

    However, they are allowed to ask and should be informed about serious diseases in the family, including those that are hereditary. Currently, there are no plans for changing the entitlements and coverage of publicly financed health care and benefits. The rules about entitlement are decided by the Government and their implementation is decided by health care institutions and individual health professionals.

    The role of HTA and other forms of evidence guiding these decisions are not regulated by the authorities.

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    When it comes to health care, it is principally a medical judgement that decides entitlement. Private insurance coverage is decided through contracts between the companies and the policy-holders. Patient choice Since residents over the age of 16 have been able to choose between two coverage options known as Group 1 and Group 2.

    Group 1 members have free access to general preventive, diagnostic and curative services.

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    Patients may consult emergency wards, dentists, chiropractors, ear, nose and throat specialists or ophthalmologists without prior referral, but their GP must refer them for access to all other medical specialties, physiotherapy and hospital treatments. Consultation with a GP or specialist is free of charge, while dental care, podiatry, psychology consultations, chiropractice and physiotherapy are subsidized. Patients seeking care from specialists other than ear, nose and throat specialists or ophthalmologists, and without a GP referral, are liable to pay the full fee.

    An individual in Group 1 has the possibility to change GPs after six months and after contacting the local authority.

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    In Group 2, individuals are free to consult any GP and any specialist without referral. The region will subsidize the expenses up to the cost of the corresponding treatment for a patient in Group 1. The same rules apply to treatment by podiatrists, psychologists, dentists, chiropractors and physiotherapists.

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    Hospital treatments are free. Changing group is possible once an individual has been in either Group 1 or 2 for 12 months Association of County Councils The majority of hospitals in Denmark are general hospitals. There are very few specialized hospitals other than psychiatric hospitals. A legislative reform in gave patients the freedom to choose to be treated at any hospital in the country as long as treatment takes place at the same level of specialization.

    This is in accordance with the fundamental principle that health services should be provided at the most appropriate level of specialization i. This legislative reform was a key step towards allowing patients more influence over their care and treatment. In , a new piece of legislation regarding waiting time guarantees was implemented.

    Patients who are not offered treatment at public hospitals within two months of referral are free to choose treatment at private hospitals or clinics anywhere in the country and at hospitals abroad. In , this guarantee was As a precondition for the use of the extended free choice, the chosen non-public hospital or clinic has to have an agreement with the region Association of County Councils In the case of cancer and certain other diseases i.

    If the hospital is unable to do this, then the case is referred to the National Board of Health for assistance in seeking alternative solutions within the case time limits, which are defined by the waiting time guarantees. However, due to heavy public and political criticism of the lack of fulfilment of these procedures, the Director of the National Board of Health resigned from his post in November The new legislation states that the patient must be referred to a highly specialized health service, if a qualified medical judgement is carried out and considers accordingly that the patient needs such treatment.

    Currently, only patients with strictly defined needs for specialized treatment are accepted at the highly specialized health services. Information for patients Patients are informed about the age and gender of GPs before choosing a doctor, but other than this, no information is available. A patient that needs hospital treatment has a few different options available for them to obtain information about hospital characteristics e. When the patient is referred to a hospital, the hospital is obliged to send a notice letter to the patient. If the waiting time exceeds one month, then the hospital provides patients with information about the option of choosing another hospital, including those that are private or based abroad.

    Patients can also obtain information and guidance on hospital choice and waiting times through their GP and through patient offices, which exist in every region. A number of web sites have been established by the National Board of Health, the Danish Regions and the Ministry of Health in order to give patients further access to information. The sites provide information regarding public and The typical content of the information includes waiting times in weeks to examination, treatment and after-care in the different hospitals and the number of operations conducted at specific hospitals Ministry of the Interior and Health Information on quality aspects of hospitals has been published on the home page of the Ministry of Health since November This information includes ratings 1—5 stars based on patient satisfaction, and standards of hygiene, safety, and so on.

    This rating system, however, has been criticized for its limited scope, unclear weighting of the different elements, and its ratings of hospitals as a single unit rather than as individual departments.