Dennis: "Hej! Dänemark ist wirklich ein Traumland für Pflegekräfte. Die Arbeitsbedingungen sind exzellent und die Arbeitskultur ist sehr auf Zusammenarbeit und das Wohlbefinden der Mitarbeiter ausgerichtet. Hier wird viel Wert darauf gelegt, dass man eine gute Balance zwischen Arbeit und Freizeit hat. Die Löhne sind hoch, was die hohen Lebenshaltungskosten in Kopenhagen wettmacht. Die Hierarchien sind flach, jeder ist hier gleichberechtigt, was positiv ist. Ich fühle mich hier wirklich geschätzt. Außerdem ist das Gesundheitssystem stark digitalisiert, was positiv ist, aber auch einen gewissen Technologiedruck erzeugt."
Denmark's healthcare system is a publicly funded, universal system known for its high standards and efficiency. It is primarily financed through taxes, providing all residents with free access to most healthcare services, including primary care, hospital services, and specialist treatments. The system is highly decentralized, with regions responsible for hospital services and municipalities managing primary and preventive care.
Key features:
· Universal Access: All residents, including immigrants and EU citizens, have access to health careservices, ensuring equitable care across the population.
· Funding: The healthcare system is funded through national and local taxes, with the government allocating significant resources to maintain high-quality care.
· Quality of Care: Denmark is known for its high-quality healthcare services, with a strong emphasis on preventive care and patient-centered approaches. The system is supported by a well-trained workforce and advanced medical technology.
· Primary Care Focus: General practitioners (GPs) play a crucial role as gatekeepers to the healthcare system, coordinating care and providing the first point of contact for patients.
· Integration and Coordination: There is a strong focus on integrated care and coordination between hospitals, GPs, and municipalities to provide seamless services for patients, particularly those with chronic conditions.
· Digitization and Innovation: Denmark is a leader in health IT, with extensive use of electronic health records and digital communication between patients and healthcare providers, enhancing efficiency and patient engagement.
· Challenges: The system faces challenges such as an aging population, rising healthcare costs, and regional disparities in service availability. There are ongoing efforts to address these issues through reforms and innovations in care delivery.
Background information about…
Long-term care facilities are varied and numerous in Denmark. In addition to conventional nursing homes, there are psychiatric nursing homes, small apartments (providing basic medical care and located adjacent to nursing homes), group homes and foster homes.
The municipalities deliver social services, including social welfare allowances (sickness allowances and disability pensions), care for older people, and care for disabled people and people with chronic conditions, including those with mental health disorders. Municipalities are also responsible for providing housing for people with learning disabilities. To provide more cost-effective services, contracting with private non-profit-making agencies is becoming increasingly common. Privately contracted services include long-term inpatient care in nursing homes, care in day-care centres and social services for people with a chronic condition/disability or older people. Some additional services, such as catering and cleaning, are often contracted out to private commercial firms. According to complex assessments of their financial situation, nursing homes and sheltered housing are co-financed by their residents. Low-income residents pay using a proportion of their old-age pension allowance.
Since the mid-1980s, the municipalities have increased the number of home nurses and decreased the number of nursing homes. Between 2010 and 2022, the number of adults aged 75 years and over living in nursing homes fell from 58 000 to 51 800. During the same period, the number of people in this age group increased by 47 % (2022b). At the same time, the number of older people who receive home help has also been declining. In 2010, 148 955 persons aged 65 years and over received home help compared with 122 470 in 2018 (Danmarks Statistik, 2019). In 2015, an average of 3.7 hours of home help per week was given. By 2019, that number had dropped to 3.3 hours of help per week – a decrease of 10.8 % (Danmarks Statistik, 2020b).
Municipalities have developed a wide range of services to accommodate the preference of senior citizens to remain independent for as long as possible in their own homes, as this is also the most cost-effective approach. These services include care and assistance with cleaning, shopping, washing, preparing meals and personal hygiene. Home care can also be used to assist or relieve family members with caring responsibilities. Two forms of home care are available: long-term and temporary. Long-term care is free, whereas temporary home care visits may warrant individual payment, depending on the recipient’s income. All individuals with care needs can have an emergency or safety phone system installed in their home that provides direct 24-hour contact to a public health nurse.
When older people need an alternative living arrangement for health reasons, a more suitable residence is offered. An array of possibilities is available for this, based on the individual’s needs and wishes. Senior citizen residences, gated communities, assisted living units and nursing homes are all designed especially for older and disabled people, offering one- or two-room apartments, elevator services, emergency and contact systems and social activities. These residences often differ in their management and administration, and some are associated with nursing homes that supply health aids. Day care centres are available for those who do not wish to move permanently but still require extra care. Transportation to and from the daycare centre is arranged. There is also the option of using a nursing home for respite care.
The regions are obliged to offer treatment in hospitals, including palliative care. Palliative care is organized at two levels: basic and specialist. Basic palliative care is directly integrated into the mainstream health system, including GPs, municipality home care and hospital departments. Specialist palliative care includes palliative care teams, hospices and palliative care units. The executive order on operating agreements between regional councils and self-governing hospices of 2006 obliges the regions to establish contracts with hospices concerning a certain number of hospice beds across the country and to fund the total costs of running these private (self-owned, non-profit) institutions, implying that it is free for the patient.
Hospice stays are subject to the rules of free choice of hospital, but in general, there is a shortage of hospice places, so the patient may find that there is no space when and where they need it. In 2021, there were 19 hospices, with a total of 257 beds at their disposal (44.3 hospice beds per million inhabitants), two hospices for children with room for eight children and their families, and a telemedicine hospice (Hospice Forum Danmark, 2021). Furthermore, there were 14 palliative care teams without bed capacity, 12 teams with bed capacity (93 beds in total), and one palliative care team for children and young people in each region (REHPA, 2019). The palliative care units and teams are all organizationally based at a hospital. Some include a broad range of health professionals (social workers, psychologists, physiotherapists, occupational therapists, complementary therapists, speech therapists, etc.). Volunteers work at all the hospices, and one in three palliative care teams has volunteers attached.
Patients with palliative care needs must be referred by a GP, who functions as a gatekeeper to specialist care and treatment, including palliative care. In principle, however, patients can contact some Danish hospices independently and be admitted without a referral. When asked about their referral criteria, all hospices, palliative care teams, and units respond that they use criteria such as being incurably ill and having complex symptomatology (REHPA, 2019).
Implementing the national recommendations for palliative care in both the regions and municipalities has been slow (Sundhedsstyrelsen, 2017). By 2020, nearly half of the patients who died of cancer received specialized palliative care. For non-cancer patients, it was 2%. Thus, patients with a cancer diagnosis are almost the only ones admitted to hospices.
Quelle: WHO/European Observatoryon Health Systems and Policy Monitor (HSPM) (https://eurohealthobservatory.who.int/monitors/health-systems-monitor/compare)
