Lighedstegn mellem tillidsbaseret ledelse og offentlig – privat partnerskabsmodeller: Region Hovedstadens Hospitalsplan som case story

Michael Lange

Student thesis: Master executive thesis


The Danish government has adopted a quality reform which shall create a better public hospital service through good public service. As part of the reform the five regions have been given the task to prepare regional plans for the health service. In total the Danish government has earmarked a total of 25 billions to investment in the hospital services of the five regions. The capital region has made a plan which shall ensure the 1,63 million citizens of the region a hospital service that is characterised by high quality, good service and collaboration between the different units. The plan is to collect a number of different treatment options at fewer centres and to create a foundation for an optimised operation with an efficient use of the economical resources. The plan for the hospital service has a total investment budget of 15 billions. In addition, collection of different treatment options at fewer centres shall create operational savings of op to 350 millions. The two main players, The Danish Regions and the Danish government each have their ways of for economical calculations as well as steering of the changes. I would hereby like to summaries the differences of the management and steering forms that govern the hospital services. Additionally, I would like to discuss the possibilities for a Public Private Partnership (PPP) financial basis for the hospital building and the operation maintenance, with special attention to the capital region’s plan for the hospital service. In summary the Danish government partly uses a top-down managed model with some confidence based management to control the health service. The government determine and control the overall discourse of the quality reform but let working groups/ smaller organisations to prepare the principles for good public service. Of the 25 billions that the Danish government has earmarked to investments in the hospital services of the five regions the capital region gets 6.5 billions which mean that the 8.5 billions are lacking compared to the investment budget of 15 billions. The large deficit is primarily due to the fact that the capital region has not followed advices giving by specialists on expected benefits of prioritizing investments in the four main hospitals and giving a lower priority of the seven smaller hospitals in the region. Another issue is that the collection of different treatment options at fewer centers is only expected to create operational savings of op to 350 millions which gives a investment return of only 2,5 % - a very small amount compared to such a large public investment. A number of the investments are new office buildings and parking areas; areas which are not considered core business for the regions but only supportive functions. These costs can partly or fully be financed by PPP and thereby removed from the investment costs of the main hospitals. The Region could also consider selling the buildings of the smaller hospitals as these are neither regarded as core business; a PPP model would reduce the expenses and in return give raise for a better service at smaller costs. The challenges of this proposal are the restrictions in the Danish law, e.g. the rules for deposits, which disable the capital region to make use of PPP set-ups. The Danish government should eliminate the rules for deposits when it concerns the building of new hospitals; in this way the government would show confidence in the work of the Regions. By using less control and more confidence based management the government could both be monitoring the hospital service as well as using PPP set-ups to finance some of the new investments.

EducationsMaster of Public Administration, (Executive Master Programme) Final Thesis
Publication date2009
Number of pages80