Objective: To assess the strengths, weaknesses, opportunities, and threats to the Danish health system by comparing approaches and performance with the U.S. health care system.
Design: In-depth interviews with federal and county health officials in Denmark, hospital managers and clinical leaders; site visits to Danish hospitals, primary care practices, and "off-hours" service; literature review of Danish health system performance; analysis of comparative international surveys and data.
Main outcome measures: Health expenditures, public satisfaction with health care; expert perceptions of quality, access, equity, and efficiency of Danish health system.
Results: Primary care is much more accessible in Denmark than the U.S. A mixed capitation-fee-for-service method of paying generalist physicians in Denmark assures that everyone has a primary care physician, and generalist physicians are responsive to providing services quickly, typically same day appointments. An organized off-hours service assures accessible care 24 hour a day, 7 days a week care. Denmark has the highest public satisfaction with health care, reflecting the value placed on accessibility of primary care. Inpatient hospital care consumes a disproportionate share of Danish health expenditures. Global hospital budgets provide little incentive for hospital or surgical productivity. Long waits for hospitalization, especially surgical procedures, and cancellation of scheduled surgery are a source of patient dissatisfaction. Women's health, patient health risk counseling, and coordination of preventive and primary care are major weaknesses of the Danish health system. Patients have choice of primary care physician within a given geographic area, and may go to a hospital of their choice. However, patient surveys and feedback are underdeveloped, and very little effort has been made to make services responsive to patients' preferences. While innovations in electronic prescribing are noteworthy, further development of health information technology is needed.