Context
The Danish government announced a political agreement on a healthcare reform on 15 November 2024, backed by a broad coalition of the three governing parties (the Social Democratic Party, the Liberal Party, and the Moderates) and four additional parties from across the political spectrum. Two comprehensive reports from expert commissions, presented in November 2023 and May 2024, form the basis of the agreement.
Impetus and main purpose of the reform
The agreement is a response to the emerging challenges related to changing demographics and shortages of healthcare professionals in some areas. The reform is an effort to move focus and resources from hospitals and specialized care towards primary, digital, and home-based care.
Main components
- The number of regions will be reduced from 5 to 4, with the Capital Region and Region Zealand merging into one large region covering Zealand and adjacent islands. The new Region East Denmark will have 2.7 million inhabitants, approximately half of Denmark’s population.
- A new governance structure of 17 collaborative “health councils” (Sundhedsråd) is added to the existing structure. Comprising politicians from regional and municipal councils, they will function as sub-councils to the regional councils, from which they will receive funding. A significant portion will be earmarked for developing primary, local, and digital care as well as supporting the transition from hospital care. The health councils will assume operational responsibility for health and hospitals from the regional councils and specialized home nursing, rehabilitation, and local acute care from municipal councils. The regions remain responsible for hospital planning.
- General practice will remain a key component as gatekeepers and care managers in the new structure. The state will play a stronger role in planning the distribution of general practitioners (GPs) and specialists to ensure nationwide coverage. The government is planning several initiatives to tackle GP shortages, including educating 1500 new GPs, bringing the total to 5000 by 2035. Furthermore, the regions will be allowed to establish region-owned clinics or use public bidding for vacant clinics. The GP remuneration model will also be adjusted to differentiate fees according to demographic and health risk profiles.
- The delivery of specialized home nursing, rehabilitation, and local acute care will be moved from the municipalities to the regions.
- Chronic care packages will be developed for COPD, diabetes, lower back pain, cardiovascular diseases, and patients with complex multimorbidity.
- A national agency will be established to oversee digital health, data infrastructure, and innovation projects.
- Psychiatric and somatic care will be integrated organizationally, with the regional and health councils taking the lead in advancing the implementation of a 10-year psychiatry plan.
- A new national public health law will be introduced.
- A National Prioritization Council will be established to promote cross-sector, transparent, and systematic prioritization across primary and specialized healthcare.
- New patient rights will be introduced, extending to primary healthcare and digital services.
Implementation steps taken
The new administrative structure will take effect on 1 January 2027. The reform’s success will depend on the implementation of the many initiatives and attracting healthcare professionals to take positions outside major urban areas. Another key challenge will be whether the health councils effectively prioritize the development of local and primary care. The earmarking of new funds can support this ambition.