Fra aktivitetsbaseret til værdibaseret styring i det danske hospitalsvæsen: Et spørgsmål om ledelse?

Mikkel Malby Schoos

Student thesis: Master executive thesis

Abstract

The Danish healthcare system is publicly financed and operates across three levels: the state, the regions and the municipalities. While the state holds the regulatory and supervisory functions, five regions are responsible for the hospitals, the general practitioners and for psychiatric care. The municipalities are responsible for primary healthcare services and elderly care. Regional financing of healthcare expenditure is secured by a block grant, an activity-based subsidy from the government and co-financing from the municipalities. The activity-based subsidy from the government is based on the amount of patient related activity within the hospitals of the region. Health care systems are increasingly challenged by megatrends that act as fundamental drivers of escalating healthcare costs. They include an ageing population, greater prevalence of chronic multimorbidity, expenditures for medicines, improved treatment possibilities and increased treatment demand. For these structural reasons, publicly financed healthcare based on activity steered subsidies is in a midterm perspective economically unsustainable. A reform of healthcare delivery is needed and hospital systems in Denmark are currently testing value-based health care concepts, based on Michael E Porter’s strategies for health care reform. This is a qualitative study based on semi-structured interviews with central healthcare agents engaged with hospital based projects that exempts healthcare delivery from the standard activitybased healthcare financing model. Instead, selected hospital entities receive block grants without commitments to levels of patient related activity. The project results indicate that non-activity based financing of health care delivery may entail increased outpatient clinical activity with a subsequent decreased need for acute hospital admission. For this reason, hospital bed capacity can be reduced, while maintaining equal or improved quality of health care delivery. These results are achieved through health care innovation with the development of flexible outpatient clinics. The outpatient clinics are enabled by subacute day-to-day scheduling for selected diagnoses in patients treated in affiliated emergency rooms, who thereby avoid admittance, secondly by increased use of telecommunication for medical consultation, both between patients and hospitals based specialists and between general practitioners and hospitals based specialists. Third, digital risk adjusted models, based on patient reported outcome measures, improve patient selection for treatment regiments. The exemption from activity-based healthcare financing has furthermore removed an 5 explicit management frame for health care managers, which through decades has delineated medical leadership and now opens a leadership vacuum. The value-based Danish healthcare reform therefore calls for an intensified focus on medical professionals as healthcare governors that unite innovative healthcare management with clinical insight to steer a needed structural and cultural

EducationsMaster of Public Administration, (Executive Master Programme) Final ThesisMaster of Public Governance, (Executive Master Programme) Final Thesis
LanguageDanish
Publication date2018
Number of pages58
SupervisorsAllan Hansen