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 preparing the legal framework for healthcare services, coordinating and administering the healthcare services
The delivery of primary and secondary healthcare services is the responsibility of five regions
Physicians are mostly privately employed and are paid by the regions
Municipalities are responsible for home care, nursing homes, general prevention, healthcare promotion, and rehabilitation care
OVERVIEW
Denmark has a universal healthcare system. The government collects taxes and grants revenues to the regions and municipalities, which are responsible for delivering the healthcare services. All the residents of Denmark get automatic enrollment in public finance healthcare. Primary, specialist, hospital, mental health, preventive, and long-term care services are available free of cost in Denmark.
Patients get supplementary insurance to cover the outpatient pharmaceuticals cost, dental care, and other services.
In Denmark, there are two groups of people
Group 1: Patients visit general practitioners first, and he/she refers to the specialist. 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 the patient population opt for this. The patients must make a small co-pay
However, both the groups get the same reimbursement on pharmaceuticals.
STAKEHOLDERS
GOVERNMENT
National government:
The federal government is responsible for the regulation, supervision, planning, and monitoring of the healthcare services.
Parliament and four government agencies are responsible for regulation, planning, and management.
The Health Authority: Responsible for monitoring and regulating healthcare
The Medicines Agency: Responsible for market access
The Patient Safety Authority: Responsible for handling patients complaints and compensation
The Health Data Authority: Responsible for data collection and processing
The Danish Agency: Responsible for patient complaints
Regional:
Five regions governed by elected bodies are responsible for delivering the specialized services. Regions own hospitals, and are responsible for financing hospitals. Municipalities:
Municipalities are responsible for delivery of the healthcare services, including home care and nursing homes, general prevention, healthcare promotion, and rehabilitation care
SOURCES OF FINANCES
Public expenditure
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. Patients can opt for private insurance for further coverage. Health Insurance “Danmark” is the only private insurance company that provides private insurance and is a non-profit organization.
Private expenditure:
Patients can opt for private insurance for further coverage. Health Insurance "Danmark" is the only private insurance company that provides private insurance and is a non-profit organization. 2.45 million patients have opted for private insurance.
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ORGANISATION AND DELIVERY
Primary care:
The GPs are self-employed. Rate is usually negotiated between the physician associations and national agreements.
The clinics pay nurses.
The average income of a GP in Denmark is $149,500 in 2012.
Outpatient specialty care:
Outpatient specialty care is delivered by clinicians or doctors in the hospitals or by self-employed physicians in private facilities.
Self-employed doctors are paid on a fee-for-service basis. The prices are determined based on the negotiation between the regional representatives and physician associations.
Patients enrolled in the Group 1 insurance don't need to pay at specialty care centers'. However, patients have to make a copayment for pharmaceuticals.
Hospital care:
Almost all the hospitals in Denmark are public-owned. Funding is provided based on the diagnosis-related groups. The Ministry of Health at the federal level is involved in calculating the rates for DRGs.
Physicians who are working for public hospitals are salaried.
Long-term care:
Long-term care is provided by regional hospitals, GPs, municipal hospitals, and home-based services. In Denmark, long-term care is provided at home, in-line with the recommendation to provide long-term care at home as long as possible.
Municipalities pay the providers.
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DRUG REGULATION AND REIMBURSEMENT IN DENMARK
OVERVIEW
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.
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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 approved, the reimbursed price is deduced from the retail price at the retail stores.
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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.