Moderniseringsreformer og incitamenter i det danske sygehusvæsen

Bjørn Langbakke & Karin Lornsen

Student thesis: Master executive thesis


The choice of subject for our dissertation is based on observations of social trends with regard to the Danish health service, where an increase in the degree of privatization is apparent. The Danish public health service is under increasing pressure at present and has to meet a series of challenges in the form of increasing population age with a consequent increase in the need for treatment and a shortage of personnel resources. We experience a struggle for these resources be-tween the public and private hospitals service. In 2007 the government passed a law on patients` rights to extended free choice of hospital, which guaranteed patients free hospital treatment within four weeks in either a public or private hospital. By passing this law the government made clear its intention to increase efficiency in the public health service by encouraging private enterprise in an effort order to ensure real competition. With a clear political desire to maintain free access to health services, ensure freedom of choice and maintain a moratorium on taxes, the health sector, along with other services in the public sector, has undergone several modernization reforms with a view to increasing efficiency in the health service. This series of reforms and initiatives is referred to by the term New Public Management (NPM). With these views taken into consideration our focus of enquiry (problem description) aims at inves-tigating and understanding the consequences, which may be directly attributed to this health policy agenda: What consequences has NPM had, as a modernizing reform, on the Danish health service? The following subsidiary questions will also be addressed: • What consequences can be seen in relation to the use fixed charge financial control in the Danish health service, including the advantages and disadvantages of fixed charge financ-ing, consequences in relation to quality and increased activity and productivity in public hospitals? • Does the present DRG accounting system encourage price competition between public and private hospitals, and if this is not the case, what conditions are required to achieve price competition? • What consequences does the government’s privatization policy have for the hospital service, concerning, amongst other things, objectives for high quality of treatment and allocative and technical efficiency? The chosen problem areas will be investigated and analyzed using NPM, economic theory and in-terviews with leaders of two neuro-surgical clinics from the private and public sector, respectively. The conclusion of the dissertation is that the modernization reforms have had a marked effect on both management and financial control in the health service, which now appears as a mixture of public and private sector. Experience with fixed charge financial control has led to a greater degree of transparency in areas such as production costs and activity, but does not seem to have lead to a significant increase in activity. Furthermore, we conclude that under the law on extended free hospital choice, contracts with pri-vate hospitals did not seem to have lead to increased price competition but rather to competition concerning waiting lists. It was only after the law had been suspended and tenders were invited for surgical services, that one can speak of true competition between private and public health service providers being achieved, with a subsequent real drop in prices. Regarding the question of efficiency, it would seem that both the allocative and technical efficiency were affected in a negative direction by the law. This was mainly because of a lack of transparency with regards to the costs of production and included higher salaries and the possibility of skimming patients by the private sector. Finally, it is concluded that there was no real competition regarding quality between public and pri-vate hospital services, as the contracts made with the private hospitals did not address the question of quality objectives. The question remains, whether the government’s guarantees about waiting lists achieve the greatest amount of health in relation to resource expenditure, or whether it would be better to prioritize ser-vices, so that guarantees are differentiated with regard to individual treatments.

EducationsMaster of Public Administration, (Executive Master Programme) Final Thesis
Publication date2009
Number of pages117