Denmark: Hospital revolution on a grand scale
Role model or not?
GD – 12/2018
Denmark has been in the process of restructuring
its hospital system for around eleven years. The system was once seen as a role
model for other countries but is now known for its long waiting lists and
shortage of doctors. In the future, there will be up to 18 ‘super hospitals’
with massive bed numbers that will treat up to a hundred thousand patients per
year in about 1,150 beds and 44 hospital departments.
Aarhus University Hospital is the current
flagship project, one of the many new locations planned as part of implementing
structural reform. Construction of this hospital for around 4,000 patients is
expected to be completed soon and is scheduled to start operating in March
This was preceded by a decade-long structural
reform of an already 100% state-run system. First, with the stroke of a pen, the
number of municipalities was reduced from 270 to only 98 in 2007. At the same
time, the Danish 'counties' (Danish: amter),
which were previously responsible for healthcare, were abolished. Instead, the
whole kingdom is now divided into five regions which have taken over
responsibility for healthcare.
An accompanying programme reduced the
number of public hospitals from around 100 in 1999 to just 32 today. According
to the visionary Danish hospital planners, this process of consolidation will
continue to intensify with the increase in telemedicine. The long-term goal in
the land of the super hospitals is one hospital for every 300,000 citizens. In
Germany, this figure is about 42,500.
One of Denmark’s goals is to reduce the amount
of inpatient care by improving outpatient treatment in hospitals. The average length
of stay in a Danish hospital is 3.7 days; in Germany, it is almost twice as
The public investment cost of more than
€5.7 billion, together with significantly longer distances to the next ‘super hospital’,
will be made more palatable by effective, high-quality medical care in single-room
comfort – which contrasts with people’s memories from earlier times.
However, despite all the Danish enthusiasm
for this ‘feat’, there is no lack of criticism. For example, questions have
been raised about the ability to build these huge construction projects, in
what are often literally ‘greenfield’ locations, so that they are all
operational by the middle of the next decade as planned. Other critics doubt
that the construction budgets are actually sufficient, others are unhappy about
the long travel times that patients will face in the future.
As is always the case when there is
something new to marvel at in another country, there has been a lot of interest
in Germany, at least where theory overshadows practice. If you were to apply
the Danish model to Germany in quantitative terms, the current number of 2,000
hospitals here would be reduced to just 330. According to the online service
SHZ from Schleswig-Holstein, the public investment needed would be an eye-watering
Our neighbour’s upstream redistribution of competence
in the municipal and county sector could not be realistically done in Germany’s
federal system. Nor would it fully take into consideration the differences between
our two healthcare systems, such as not-for-profit health insurance funds.
Many people are, quite rightly, questioning
whether this over-reliance on telemedicine could create more distance between
doctor and patient. Denmark already encourages online consultations in the
outpatient area, simply due to a lack of doctors. It is seriously doubtful whether
it really serves the cause of ‘direct human assistance’ to patients if they do
their rehabilitation exercises with a 'tin' telemedical application instead of with physiotherapists.
Who on earth would I possibly share my experiences of pain with during
Despite these concerns, the main character
of the hospital in Denmark remains part of a new treatment consideration – there
are hardly resident physicians in Denmark like we have. High-intensity medicine
as a short-term intervention in the ‘one-stop-shop’ hospital, then off to home you
go and then possible contact via ‘telemedicine’. Many people are already
complaining about a loss of direct human support, especially for multimorbid
and seriously ill patients who frequently are admitted to hospital.
Given that the situation in Germany means
that the Danish system would be almost impossible to put in place here, it may
be that other Scandinavian countries are interested in Denmark. Sweden desperately
needs to reform its hospital system and has been experiencing one annual supply
crisis after another. Investments like those in Denmark would certainly be
welcome there. Even wealthy Norway could learn from the Danish example, although
its geographical situation makes travel difficult compared to its relatively
flat neighbour. Even in Denmark, some believe, it still must be seen whether travel
distances of around 60 km for demonstrably better-quality healthcare will be