This report is the third of a new series of publications reviewing the quality of health care across selected OECD countries. As health costs continue to climb, policy makers increasingly face the challenge of ensuring that substantial spending on health is delivering value for money. At the same time, concerns about patients occasionally receiving poor quality health care led to demands for greater transparency and accountability. Despite this, there is still considerable uncertainty over which policies work best in delivering health care that is safe, effective and provides a good patient experience, and which quality-improvement strategies can help deliver the best care at the least cost. OECD Reviews of Health Care Quality seek to highlight and support the development of better policies to improve quality in health care, to help ensure that the substantial resources devoted to health are being used effectively in supporting people to live healthier lives.

Denmark is rightly seen as a pioneer in health care quality initiatives among OECD countries. Over many years, it has developed a sophisticated array of quality assurance mechanisms. Yet, like all other countries, it faces a number of health care challenges including increasing public and political expectations around the continuity of care; increased specialisation in the hospital sector, which translates into shorter stays and earlier discharge back into the community; and a rise in the number of elderly patients with multiple long-term conditions, requiring safe and effective co-ordination of care and avoiding unnecessary hospitalisation. This quality review assesses how well Denmark’s quality assurance mechanisms are placed to address these challenges.

Denmark has traditionally been a leader in policy development for quality of care among OECD countries. The Danish health care system is decentralised and largely publicly run, with successive governments and regions having prioritised equal access and responsiveness to community needs. However, co-ordination across multiple levels of government and multiple actors remains an ongoing challenge that needs to be successfully negotiated if Denmark is to make the most of the good programmes it has in place to monitor and improve the quality of health care.

This chapter summarises the many policies and activities that are in place in Denmark to assure and improve quality of care, highlighting how policies to monitor and improve quality in the Danish health system should move from a focus on quality management of hospital services, towards quality improvement of the health care system as a whole. After describing the quality governance structure and the roles of the central government and its agencies, the regions and the municipalities, the chapter focuses on the assurance of the quality of professionals, pharmaceuticals and devices, and health care facilities. Safety policies are listed in a separate section, as are the various ways to shape the Danish information infrastructure to support the measurement and management of quality. Specific attention is given to policies aimed at strengthening the role and perspective of the patient. This chapter concludes that Denmark has a sophisticated and highly developed set of quality assurance mechanisms already in place, but that challenges remain to create more linkages and synergy between the many activities to realise quality of care not just for specific services but especially for the health care system as a whole

Denmark faces a number of health care challenges including increasing public and political expectations around the continuity of care; increased specialisation in the hospital sector, which typically translates into shorter stays and earlier discharge back into the community; and a rise in the number of elderly patients with multiple long-term conditions, requiring safe and effective co-ordination of care and avoiding unnecessary hospitalisation.

This chapter assesses how well positioned Danish primary care is to meet these challenges, particularly the challenge of integrated care. The chapter begins by describing the current configuration and outcomes associated with primary care in Demark, and the quality initiatives implemented by the sector. A section focussed on integrated care follows, before closing with an assessment of the gaps and opportunities in Danish primary health care quality.

Whilst Danish GPs have actively developed a number of in-house quality initiatives, enthusiasm for cross-sectoral working is much less evident. The sector is well placed, however, to modernise its offer, including new ways of working such as making better use of advanced nurse practitioners. Better information infrastructure is key, as will be combining national vision with local freedom to innovate.

This chapter examines recent reforms to drive further specialisation in the Danish hospital sector. It begins by providing an overview of the hospital sector and broader reforms to the structure of government responsibilities in health in Denmark. The key elements of the hospital specialisation reforms are argued to be: greater involvement of central government by setting guidelines for where certain specialist services should be located; a major capital investment programme; and regional governments driving the redesign of hospital services on the ground. The hospital specialisation plan is argued to have an impact on the structure of the hospital sector that is well beyond simply high-specialised services. Though the specialisation plan is still in the process of implementation and thus difficult to evaluate, the decisions of policy makers were driven by the clinical judgements of experts as the scientific literature on quality and volume offers limited insights to guide decision making in practice. Looking ahead, the challenge for the government shall be how to best use the new structure of hospital services to drive improvements in the quality of care in Denmark.

Whilst health equity is a stated priority of the Danish health care system and the current Danish government, until recently there have been few policies or interventions designed to safeguard equity, or to address inequity. There are indications that health inequalities in Denmark are rising, and although gaps in data make it difficult to get a full picture across all areas, evidence suggests that there are disparities in health status, access to health care and health outcomes. This chapter examines Denmark’s need to build upon the principle of equity that is a cornerstone of the Health Act, and work across all levels of government to put in place appropriate policies that promote equity across the health care system. The chapter suggests that policies that prevent structural inequalities should accompany existing initiatives targeting health risks, and that close examination should be given to possible barriers to equitable access to services. Efforts to promote equity in health and health care will be most successful with a comprehensive data infrastructure, and recommendations about strengthening areas of data weakness are made. Changes and improvements in policies around quality of care, the primary care system, and the hospital system all have the potential to impact upon equity, and the analysis and recommendations made in this chapter are closely tied to those of the three preceding chapters.