HC Sector Organization

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Featured in half-yearly report: G-politik in Industrieländern 1

Abstract

When the present center-right government took office in fall 2001 it established an Advisory Committee on the Health Care Sector. The committee looked into possible ways of improving efficiency and effectiveness of the health care sector. On January 8, 2003, the second report was presented, dealing with increased hospital autonomy, DRG reimbursement, and decentralization issues. A first report had analysed possible barriers to more efficient working practices in hospitals, e.g union contracts.

Purpose of health policy or idea

When the present center-right government took office late fall 2001 it established an Advisory Committee on the Health Care Sector. The committee's mandate was to look into possible ways of improving efficiency and effectiveness of the health care sector. Members were independent experts. In February 2002 the Committee published its first report on possible barriers to more efficient working practices at the hospitals, in particular union contracts and rules.

On January 8, 2003 the second report was published at a press meeting hosted by the minister of health. The report addressed the following areas:

• More autonomy to hospitals based on an arm's length principle to the political system, i.e. the county councils
  • The possibility for establishing private wings in public hospitals
  • A more 'relaxed' attitude to the involvement of private hospitals in solving publicly financed hospital services
  • Compulsory accreditation of hospitals
• Increased used of activity based reimbursement of hospitals, i.e. less reliance on capped budget and more reliance on DRG-based financing, however, nowhere near 100%
• Reduction in the number of counties (the counties being responsible for financing, planning and operating health care in Denmark)
• Increased powers to the National Board of Health to ensure a professionally relevant development of the health care sector

Most of the ideas were well-received by the Minister of Health who declared that apart from the merger of counties he would set in motion planning of relevant initiatives, including legislation, to implement the ideas put forward by the Advisory Committee. - The report has been positively received by most political parties and interest groups. - The issue of merger of counties has been relegated to a separate committee, expected to publish its report year end 2003.

Groups affected

Hospitals, Counties

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral

Political and economic background

Despite a rather well-functioning health care sector, dissatisfaction with among other things waiting time constantly raises the question of reforms. In addition, the future role of the counties in general and in particular their role in health care is being questioned.

This unease/dissatisfaction (not among a majority) stems from two rather different sources:

The junior party in the present government, and another political party, have argued for several years that the county system should be abolished all together, in part because they think a three-level public sector (state, county, municipalities) is to complex and creates too much bureaucracy.  The many activities carried out by the counties should be moved either to the state or the municipalities.  Hence, this group's dissatisfaction is not (only) related to health care. 2.  The other group - a somewhat diffuse group across the political spectrum - finds that the counties do not manage the health care system well. 

It is, however, important to note, that at present there is no clear parliamentary majority for abolishing the county level.

Based on this background, the Advisory Committee decided - independent of the minister of health - to address the general topic of 'the counties and the health care sector' - leading to the above mentioned report.

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Origins of health policy idea

The ideas were the result of discussions in the Advisory Committee, visits to Norway, Finland, and France, literature surveys etc.

Stakeholder positions

The Association of County Councils and the individual counties are the major parties (potentially) affected by the report. To a considerably extent they have taken most of the recommendations to heart.

Influences in policy making and legislation

Some legislation may be required. Other ideas may be part of the upcoming annual (summer) negotiation of fiscal frames and objectives for the next calendar year.

Adoption and implementation

The counties and the hospitals will be the most important parties involved in the possible implementation of the proposals.

Monitoring and evaluation

Not at present. However, several researchers are already trying to prepare research projects on the implementation of the ideas.

Expected outcome

Too early to pass judgement. However, potentially far reaching consequences.

References

Sources of Information

Reports of the "Advisory Committee on the Health Care Sector" available in Danish only.

Author/s and/or contributors to this survey

Mickael Bech, Kjeld Moeller Pedersen, Terkel Christiansen

Empfohlene Zitierweise für diesen Online-Artikel:

Mickael Bech, Kjeld Moeller Pedersen, Terkel Christiansen. "HC Sector Organization". Health Policy Monitor, May 2003. Available at http://www.hpm.org/survey/dk/a1/5