The financing of health care services
In
Denmark the vast majority of health services are free of charge for the users. Of
the total expenditure on health care in Denmark in 2000, public expenditure constituted
81% and private expenditure approx. 19%. Private health care expenditure mainly
covers user payments for medicinal products, dentistry and physiotherapy. The
total public and private health care expenditure corresponds to roughly 6% of
the gross national product (GNP). The total public expenditure on health
care measured in fixed prices has increased by 26% from 1988 to 2000. Expenditure
in the primary sector has risen by 22%; hospital expenditure has risen by 39%
and the citizens' own health services expenses have risen by 52% in the pe-riod
1988 to 2000. The large increase in primary sector expenditure is mainly due to
the sig-nificant increase in expenditure on medicinal products. In spite of the
growth in real health care expenditure, the proportion of GNP spent on health
care has remained constant between 1988 and 2000. In most health care services
throughout the world there is a "third party payer" who deals with the
actual payment of the health services. This is partly based on a wish to safeguard
against unforeseen health expenditure, partly to ensure that even people who cannot
pay have access at least to urgent treatment. The "third party payer"
can be an insurance company, a public au-thority or a similar financial source. As
far as the publicly paid part of the health services is concerned (81%), "third
party payers" are the counties or the local authorities. The counties and
the local authorities finance the health care services partly through taxes, which
they levy themselves, partly through block grants from the Government. The block
grants are allocated to the counties and the local au-thorities according to objective
criteria, which among other things include demography. Most private expenditure
on health care is paid directly to the service providers. However, about 28% of
the population is covered by private health insurance, which reimburses part of
the patient's own expenditure. Among other things private health insurance reimburses
most of the expenses regarding medicinal products and dentistry. Most providers
of health care services in Denmark are salaried employees in public institu-tions.
Those who provide health services for the Health Care Reimbursement Scheme are
self-employed people who work for the public services on a contract basis. Hospitals'
budgets are set by the counties, and hospitals are expected to organise and conduct
their affairs within the limits of these budgets. All employees within the health
care sector, in-cluding doctors, are salaried according to collective agreements
between the County Councils Association and the respective unions.
Under the Health Care Reimbursement Scheme services are provided
by selfemployed professionals such as general practitioners, specialists,
dentists, physiotherapists, etc. These ser-vices are provided
in accordance with collective agreements between the counties
and the relevant unions. Collective agreements include the prices
of individual services which are covered by the Health Care Reimbursement
Scheme. They also include the extent to which the service is covered
by the Health Care Reimbursement Scheme, either in full or in
part. If there is only part cover, the balance is paid by the
patient. The provider of a service is not permitted to demand
extra payment in addition to that stipulated by the collective
agreement.
General practitioners are paid partly through capitation and
partly through fees for their services. Specialists, dentists,
and others who provide services under the Health Care Reim-bursement
Scheme are paid fees for their services.
Pharmacies
operate on the basis of public authorisations which are allocated by the Minister
for the Interior and Health. The total number of these authorisations is limited,
and they are therefore allocated so that they give balanced geographical coverage
throughout the country. For prescribed medicinal products, the pharmacies only
charge the patients the amount in ex-cess of the public subsidy.
Pharmacists charge the same price for medicinal products throughout
the country. This is ensured by the Ministry of the Interior and
Health which regulates the calculation of consumer prices of medicinal
products. The pharmacists' collective profit is set for two years
at a time in negotiations between the Ministry of the Interior
and Health and the Danish Pharmaceutical Association.
Municipal health services
are governed by framework budgets, in the same way as hospitals. Employees are
also salaried according to collective agreements between the National Associa-tion
of Local Authorities and the respective unions.
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DENMARK