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HEALTHCARE SYSTEM IN DENMARK

Updated: Aug 23

Healthcare system in Denmark is public divided into national, regional and municipal levels. The administration is decentralized with the planning and management occurs at regional and municipal levels.


  • State level is responsible for framing the legal framework for healthcare services, coordinating and administering the healthcare services delivery regional and municipal levels

  • The delivery of primary and secondary healthcare services are the responsibility of five regions

  • Physicians are mostly privately employed and are paid by the regions

  • Municipalities are responsible for home care and nursing homes, general prevention, healthcare promotion, and rehabilitation care


Drug approval, pricing and reimbursement in Denmark




Source of finances:

The source of income is taxes and the majority of the revenues are from special national health care tax. National Health Act makes it mandatory for the total or partial coverage for the charges of physicians, dentists, physiotherapists, and reimbursement of pharmaceuticals.


Danish National Health Act ensures that all the citizens of the country are covered.


Private healthcare practitioners need to register to get the reimbursement. The reimbursement of pharmaceuticals is through taxes.


In Denmark, there are two groups of people

  • Group 1: Patients visit general practitioner first and he refers to the specialis. 97% of the patient population opt this

  • Group 2: Patients can visit either a general practitioner or specialist. The patient can visit the specialist without visiting the general practitioners. 3% of patient population opt this. The patients must make a small co-pay

However, both the groups get the same reimbursement on pharmaceuticals.

Patients can opt for private insurance for further coverage. Health Insurance “Denmark” is the only private insurance company that provides private insurance and is a non-profit organization.


Decision makers

The key decision makers in the Denmark Healthcare System is

• Ministry of Health

• Danish Health Authority

• Danish Medicines Agency

• Danish Parliament


Other bodies

• Danske Patienter (Danish Patients)

• Forbrugerrådet (Danish Consumer Council)


Ministry of Health:

• Responsible for making the framework for the pharmaceutical system

• Announces the reimbursement level every year


Danish Health and Medicines Authority:

The Danish Health and Medicines Authority was divided in to

• The Danish Health Authority

• The Danish Medical Agency

• The Danish Patient Safety Authority


Danish Health Authority and the Danish Medical Agency are liable for monitoring healthcare systems. These two bodies are involved in advising the Ministry of Health.


The two boards have 8 divisions

1. Hospital Services & Emergency Management

2. Disease Prevention & Local Health Services

3. Elderly and Dementia

4. National Institute of Radiation Protection

5. Pharmacies and Reimbursement

6. Medicines Licensing & Availability

7. Pharmacovigilance & Medical Devices

8. Medicines Control and Inspections


Regions are involved in managing the hospital including the pharmaceuticals that need to be purchased.


Amgros’s: The five regions in Denmark purchase the pharmaceuticals through

Amgros’s which a centralized purchasing. It purchases nearly 99% of the pharmaceuticals in Denmark for hospitals. It is also involved in price negotiation.

Coordination Council for Placing in Service of Hospital Medicine (KRIS) decides which new pharmaceuticals are to be used in the hospitals.


The Danish Council for the Use of Expensive Hospital Medicine (RADS) makes the decision on purchasing the high-cost pharmaceuticals, drugs which has a major economic burden. This body is involved when there is a need for consensus between the regions.


The Reimbursement Committee's (MTN) advices the Danish Medicines Agency on

reimbursement decisions.


The Danish Pharmacovigilance Council makes the suggestions on adverse reaction and safety issues to the Danish Medicines Agency.


The Medicinal Products Committee has involved in suggesting the Danish Medicines Agency on the market authorization.





Decision-making process


Regulatory approval:

Drug approval is through the European Medical Agency. The Danish Medical Agency needs information regarding the pharmacy purchasing price (PPP).


Reimbursement:

The Danish Medicines Agency decides regarding the reimbursement status of pharmaceutical products. It makes the decision regarding which products need to be reimbursed.


Reimbursement procedure: The pharmaceutical company needs to submit the reimbursement application to the Pharmacies and Reimbursement department in the Danish Medical Agency. Reimbursement committee makes the recommendations for the decision making.

The decision is based on

Efficacy

Safety

Additional value versus comparator

Health Economic Evaluation: Danish Medicines Agency provides pharmacoeconomic evaluation guidelines (however, this is not mandatory)

Once the products are appoved, the reimbursed price is deduced from the retail price at the retail stores.


Channels for pharmaceuticals entry into Denmark:

Hospital sector: Amgros is involved in tendering and purchasing the pharmaceuticals. Drugs that are dispensed from the hospitals are free of cost and is financed by regions.

Primary sector: The drugs are distributed through two wholesalers (Nomeco and Tjellessen Max Jenne). Patients purchase the drugs and are reimbursed based on the regional reimbursement regulations.


The rate of reimbursement depends on pharmaceutical expenses for 12 months.

• < 925: 0%

• 925-1515: 50%

• 1515-3280: 75% reimbursement

• >3280: 85% reimbursement

• >3830: 100% reimbursement


For generic products, the prices of the least available generics will be reimbursed.


Pricing:

  • The pharmaceutical pricing is unregulated as per law in Denmark. The company needs to inform the Danish Health and Medicines Agency of the pharmacy purchasing price (PPP). However, there are voluntary pricing agreements between the Ministry of Health, the Danish Regions and The Danish Association of the Pharmaceutical Industry in order to regulate the prices and keep them under check. The pharmaceutical drug prices can be adjusted every 14 days

  • But recently the Danish government came up with a new system of pricing

  • Danish government moved from external price referencing to internal price referencing.




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