regional health insurance funds into a single one
covering almost the 80 % of the population.
Savings in administration and efficiency gains
are expected.
Could you present two/three elements on
the impact of such reforms on hospital and/
or healthcare sectors that your organisation/
country has identified?
A significant reform activity was the development
of a new approach to the provision of primary
healthcare, which is traditionally provided by
individual general practitioners working alone in
private practices, contracted to one or more social
insurance funds. In 2017, the Primary Health Act
was adopted, laying down uniform requirements
for the new primary care across Austria. In the same
year, the establishment of a total of 75 multi-
professional and interdisciplinary primary care
centres and networks, respectively, by the end of
2021 was agreed. The new primary care units are
to be achieved by attracting existing GPs and
other health professionals working together in
teams, thus being able to provide more
comprehensive services and more opening hours
for the patients while, coincidently, the working
time is better distributed between the team
members, favouring a better work–life balance.
A few primary care units are already in operation
and are well accepted by the patients. The
medical staff also seems to be satisfied. In order
to promote the new concept, appropriate
contractual agreements are under negotiation
and start-up programmes are being developed.
Strengthening primary care is crucial as the
Austrian health system has still a strong focus
on hospital (inpatient) care.
The introduction of the Electronic Health
Record (ELGA), together with its e-medication and
e-report applications, is making good progress.
Since the end of 2015, ELGA is being rolled-out
in stages, starting with public hospitals. Between
March 2018 and September 2019, ELGA and
e-Medication are being made available step by
step to doctors in private practices, group
practices, pharmacies and outpatient clinics. The
aim of ELGA is to reduce organisational barriers,
improve coordination and strengthen patients’
rights.
Whether the recent reform of the
organisational structure of the health insurance
funds will affect the healthcare system will only
become apparent in the coming years.
DENMARK
Mrs Eva M Weinreich-Jensen
HOPE President, Danish Regions
Could you describe the last hospital and/
or healthcare reforms implemented in your
country in the past 5 years?
A major reform of the Danish healthcare sector
took place in 2007. Following the reform, the
number of hospitals was heavily reduced and
concentrated, and the specialised hospital
services were centralised. Whatever has been
done after 2007 has been an attempt to add to,
and to adjust, the 2007 reform.
One example is the National Strategy for
Personalised Medicine 2017–2020, involving
a national infrastructure working on both
treatment and research. Moreover, regional data
support centres will be established, providing
researchers, clinicians and health personnel with
reliable data. 1
Another example is the National Digital Health
Strategy 2018–2022, based on 25 specific
initiatives empowering patients by giving them
a complete overview of their digital health data
and by offering them a digital copy of their health
records. 2
A third example is the National Strategy for
Cyber and Information Safety in the Healthcare
Sector 2019–2022, which aims to make the
digital system in health secure and trustworthy,
given the amount of patient data handled.
At the moment, the Danish Region is looking
at a national wish to reform the outpatient
system and to make patients’ paths easier and
more flexible while ensuring a better
coordination of care. The focus shall be also on
how to face the demographic challenges by
changing the structural mind-set. This may come
in the form of defining health communities
around 21 acute hospitals; an increased
cooperation between general practitioners and
the hospitals and an overall strengthening of the
pre-hospital effort and the acute functions. The
overall trend is a change from focus on treatment
activity and volume, to prevention and quality
treatment (outcomes). The basic goal is to give
In Austria, the
growing pressure
on health
systems during,
and in the
aftermath of the
economic crisis
gave impetus for
a reform aiming
to overcome
the traditional
fragmentation
and to improve
coordination and
policy coherence
DENMARK
Total current health expenditure as % of Gross Domestic Product (GDP)
General government/compulsory current health expenditure as % of total current health expenditure
Hospital current health expenditure, as % of total current health expenditure
Household out-of-pocket health expenditure as % of total current health expenditure
All hospital beds per 100,000 inhabitants
Acute care hospital beds per 100,000 inhabitants
Acute care admissions/discharges per 100 inhabitants
Average length of stay for acute care hospitals (bed-days)
Practising physicians per 100,000 inhabitants
Practising nurses per 100,000 inhabitants
15
HHE 2019 | hospitalhealthcare.com
2002 2008 2016
8.7%
9.5%
10.4%
83.8%
84.0%
84.1%
43.9%
44.5%
44.3%
14.7%
14.1%
13.7%
429.0
351.0
260.0
426.0
629.0
252.0
14.2
13.1
n.a.
3.7
3.5
n.a.
304.0
349.0
368.0
1347.0
1490.0
1690.0