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Change is happening in the Danish health care system. The country’s new coalition government has appointed a structural commission to examine how we can create what the prime minister's Responsiblity for Denmark publication calls “a health care system that is cohesive across all clinical areas and geographical locations.”
The challenges faced by the Danish health care system make clear the need for change, and many of these challenges are universal. An aging population suffers from multiple illnesses and puts increasingly greater pressure on hospitals. We are having problems with recruiting enough health care workers.
In Region Zealand, the southernmost administrative region in Denmark, we have the highest proportion of patients with chronic illnesses in the country, and many have comorbidities. We also have a higher incidence of hospital admissions than other regions, and the average life expectancy is the lowest in Denmark. In addition, patients living in rural areas have to travel farther to get medical care.
These factors are driving the transformation underway in Region Zealand. With so many vulnerable people in our population, we are facing challenges that require innovative solutions. This means thinking more holistically and strengthening the primary sector.
We know that patients can feel lost in what is sometimes called “The Bermuda Triangle” of going back and forth between their local primary care physician, hospitals managed by the region, and housing for older adults or rehabilitation facilities run by the local authorities. Ideally, patients should experience a cohesive and less stressful process. Better cooperation between hospitals and other parts of the health care sector is needed so we can become more patient-centred, provide better care, and reduce inequality. We also recognise the need for improved health care programmes in hospitals, with clear quality guidelines and corresponding investment, both in terms of local authority care and support for the elderly.
COVID as Catalyst
The need to focus our testing and vaccination programme on those at most risk of serious illness from COVID — older adults and those with chronic illnesses — highlighted how siloed systems make the most vulnerable members of our community even more vulnerable. To receive care, people are too often sent from pillar to post between many different health care delivery sites that are frequently based in different parts of the country. What we have seen during the pandemic has made it clear that we cannot accept that some members of society will have their quality of life reduced and die earlier because the health care system is not geared to meet their needs.
Our experience during COVID has taught us that multiple changes must be made to make care better for everyone:
- Work together across sectors. Responding to COVID resulted in the greatest public health care action in the region’s history. This included giving more than 1.8 million COVID-19 vaccinations to a population of 821,000 between December 2020 and December 2022. We could only have overcome the enormous and urgent challenges we faced with strong cooperation. For example, the local authorities made sure people experiencing homelessness and those dealing with severe substance abuse issues were offered tests and vaccines in safe shelters.
- Bring care closer to those who need it. The success of providing at-home COVID testing and vaccination helped reinforce the idea that — instead of the patient having to come to the health care system — more care should go to the patient. This is not only what many people want, it also helps combat inequalities for patients who otherwise have to travel great geographical distances to get care.
- Provide what fits people’s lives. In addition to people's homes, teams brought testing and vaccines to schools, universities, older adult housing, prisons, and shelters for those experiencing homelessness. These teams also worked evening hours and weekends. Regional teams offered interpreters for those who speak little or no Danish.
One Telephone Number - One Health Care System
The holistic, interdisciplinary, and cross-sectoral approach supports the way we have planned and implemented 1-8-1-8, Region Zealand’s new number to call when help is needed for illnesses, injuries, or mental health admissions or consultations that are urgent but not life-threatening. Previously, we had six different numbers for emergencies in the region.
Making 1-8-1-8 work requires cooperation between doctors, nurses, and paramedics and health care partners across the region’s children’s wards, emergency departments, and mental health providers. Care is provided in people’s homes by a doctor and paramedic who arrive in a fully equipped emergency vehicle with Point-of-Care measuring equipment, including electrocardiogram machines. In many cases, a patient can get treatment or a diagnosis in their own home without having to be taken to a hospital. If a patient does require hospital admission, the team will already have much of the necessary information on the patient’s condition before arrival. While we do not yet have solid data documenting the success of the program, many patients report they much prefer getting treatment at home instead of in a hospital.
Let’s make it easier to prevent and live with illness by making care available when and where it is needed most. Danish hospitals are world class. Our hospitals are staffed by highly skilled specialists who use the latest equipment. But hospitals must not stand alone. Now is the time for resources and quality to be shared throughout the health care system to benefit all patients and to ease pressure on the hospitals. To accomplish this, we will need to strengthen the primary sector, think holistically, and work collaboratively across all sectors.
Lone Lindsby is Director, Region Zealand. Trine Holgersen is Managing Director, Primary and eHealth Care, Region Zealand. To learn more, join the Region Zealand site visit on May 15, 2023, at the IHI/BMJ International Forum on Quality & Safety in Healthcare in Copenhagen, Denmark (15-17 May 2023).
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