Can the U.S. Learn from the Danish Primary Care Model?
Healthcare should be a right for all citizens, not a commodity that only the wealthy can afford. Unfortunately, it is a service that many Americans are unable to easily access, due to barriers including high cost of care, inadequate or no insurance coverage and lack of availability of services. These barriers cause minor health issues to become larger problems if left untreated, which ultimately lead to a financial burden on individuals and society. The 12.2% of U.S. adults without health insurance are those most vulnerable to not receiving adequate care. They are more likely to have poor health status, have conditions diagnosed at a later date, die prematurely, and less likely to receive medical care. Though the United States is one of the most medically advanced countries in the world, quality healthcare is not easily accessible for many Americans.
When studying developed countries and their health care systems, Denmark, as well as the rest of the Scandinavian countries (Norway, Sweden, Finland and Iceland), are at the opposite end of the spectrum compared to the United States. The Danish health care system is universal and is based on the principles of free and equal access for all citizens, funded by taxes. Denmark’s extensive public healthcare system offers free consultations and treatment at local doctors’ offices, emergency wards and public hospitals. Denmark provides more healthcare services for its citizens than the United States, yet the United States spends a higher percentage of its GDP on health expenditure, due to factors such as higher prices for medical services. According to the most recent data from the OECD, in 2016 Denmark spent 10.4% of its GDP on health expenditure while the U.S. spent 17.2%. These figures indicate that the U.S. has the potential to provide more healthcare for its citizens if the government uses its resources more efficiently.
Due to differences in size, population, demographics and equality, the Danish system would be extremely difficult to implement in the United States. However, there are certainly features from the Danish system that could be integrated into U.S. healthcare system to help reduce costs of care and increase patient coverage. One aspect that has the potential to work well in the U.S. is the Danish primary care model.
The core of the primary care model is the Danish General Practitioners (GPs). A GP is comparable to a family doctor in the U.S., except every citizen of Denmark is assigned to a GP based on their geographical location. Danes also have the option to change their GP and pick a new one by paying a fee equivalent to about $30. GPs serve as gatekeepers- before going to the hospital or seeing a specialist, patients must first go to their GP. Their GP will give them a referral if the services of a specialist are necessary. Each GP has about 1,600 patients and are self-employed, getting paid through capitation and fee-for-service in their contracts with the regions they serve. The GPs are embedded in the universal tax-funded healthcare system, so patients pay nothing at the time of use. Everyone pays into the system, so everyone has free care.
The equality of care does not diminish its quality. Danes are happy with their healthcare —91% give positive assessments of their GP, compared to the European Union average of 84%. If they are unhappy with their care, they have the option to pay for treatment in the private healthcare system. However, the private sector is much smaller than the public sector. The primary health care model is the foundation of the Danish healthcare system and delivers the same quality of care as the U.S. but at a much lower cost.
The United States government spends almost double the amount of money on healthcare per person per year than Denmark. In 2017, Denmark’s health expenditure per capita was $5,205 and the U.S.’s was $9,892. Spending is so much higher in the U.S. compared to Denmark and other high-income countries because Americans are greater consumers of medical technology such as MRIs, CT scans and pharmaceuticals. Often times, these services prove to be unnecessary. Additionally, health services and pharmaceuticals are more expensive in the U.S. compared to other countries. If the U.S. adopted a primary care model, healthcare costs would diminish greatly. The role of a GP (or a family doctor) as a gatekeeper would ensure that treatment takes place at the lowest effective care level to minimize costs.
Between 1996 and 2010, emergency delivery services accounted for over 47% of hospital related care in the United States. This costly and unnecessary use of hospital resources could be greatly reduced by a primary care model. Many Americans are now visiting the ER for simple checkups to avoid long waiting periods and to have minimal co-pay. If the U.S. had a GP system like Denmark, patients would have a shorter waiting period, which would ideally help reduce the overuse of emergency delivery services.
The lack of healthcare coverage to vulnerable groups in the U.S. is a moral hazard that is of utmost importance. If the U.S. adopts a system similar to the Danish primary care model, healthcare would become more efficient and U.S. healthcare expenditure would be reduced. Additionally, with the money saved by efficiency, the U.S. could divert more resources to Medicaid expansion to allow more citizens to be eligible for the program and lower co-pays. The United States should look to Denmark’s healthcare model for guidance and strive to adopt a healthcare system that is accessible to everyone.