OxHA participates in launch of Danish patient reform report
On 10 January 2007, Stig Pramming took part in a press conference in Denmark to launch a new report, The Users’ Healthcare System – Suggestions for Patient Reform. Others participating included: the Danish Patientforum (an umbrella organisation of the 10 largest patient organisations in Denmark), Danish Regions (organisation representing district governments), the Innovation Council, MondayMorning, and representatives from the Danish municipalities, private healthcare providers, unions, insurance companies and pharmaceuticals.
The report concluded that patient reform is necessary if the Danish healthcare system is to survive in its present form – reform must adapt the healthcare system to the demands and expectations of future patients and others. Public healthcare provision has been a dominant feature of the Scandinavian welfare model, but if no action is taken, a growing number of people will turn to the private sector to fulfil their healthcare needs. The reform primarily targets heavy users of the health system, such as patients with chronic diseases.
The report was published the day before the Danish government’s second meeting to discuss quality reform of the healthcare sector. The suggestions in the report focus on how the quality of healthcare provision can be improved by increasing user involvement.
The urgency of reform
The report warns that it is becoming progressively more difficult for the Danish healthcare system to handle the variety of ‘cross-pressures’ it is experiencing. On the one hand, the healthcare sector faces greater demands for efficiency and the introduction of new treatments. On the other hand, the sector is increasingly expected to involve patients and their families in treatment processes. However, studies have shown that these demands are not currently being met – in a number of areas, the healthcare sector lacks the ability to meet the needs and expectations of patients.
During the last few years, the healthcare system has implemented a number of different initiatives in an attempt to solve the problem, but these have been uncoordinated and have not had the anticipated results. Therefore, a single general, coordinated and highly prioritised effort is required, if the healthcare system is to be preserved in anything approaching its current form.
The goal of the suggested reform is to place the patients themselves at the centre of health care. For example, one suggestion in the reform report is to develop a ‘treatment contract’, to balance the expectations of patients and relatives with the expectations and resources of the healthcare system. The contract will outline waiting times, the course of treatment, surgery and rehabilitation, and will be updated as the treatment progresses. Over time, the contract will become, in effect, the patient’s medical record. Once treatment has ended, the ‘treatment contract’ will evolve into a ‘quality of life contract’ on rehabilitation and optimal quality of life.
Six initiatives
The reform report suggests the adoption of six key initiatives:
- Improved knowledge of patients’ needs: The healthcare sector currently has only limited knowledge about the needs of patients. It is therefore necessary to implement a project to improve and systematise knowledge about what quality in health care means for different patient groups.
- The development of new incentives for healthcare providers: The healthcare sector values efficiency when deciding on the optimal course of treatment, but does not address compassion and empathy. This is the primary reason why the healthcare system has been slow to react to the needs of patients. To improve the situation, a new ‘incentive structure’ should be put in place for all those working in the healthcare sector, under which compassion should be given the same priority as efficiency.
- Developing new competencies: To meet the needs of patients in the future, the healthcare sector must develop new competencies. The report suggests that reform must address the acute problems of the shortage of those experienced in working across sectors, as well as the general shortage of physicians and health staff. Competencies must also be developed to address the future needs of patients and other users of the healthcare system.
- Using relatives as a resource: Relatives of patients are an important resource, but studies show they are currently systematically excluded by medical staff from taking a role in decisions on treatment. The report suggests that clear goals must be formulated to involve relatives throughout treatment.
- Motivating patients to take greater responsibility for their own health: Without actively using patients’ own knowledge and experience, it is not possible to develop a user-oriented healthcare sector. Active involvement also gives patients a greater feeling of responsibility for their own health. Therefore, clear goals should be developed to involve patients in all phases of their treatment.
- Ensure equality of access to healthcare treatments: One of the biggest challenges for the healthcare system will be to ensure equal access to treatment. Placing the user at the centre of the healthcare system can lead to the socio-economically and educationally disadvantaged gaining less from the reforms. It is therefore important to develop a plan to ensure that the healthcare system adapts to the different levels of resources available to patients.
For patient reform to succeed, the healthcare sector will need to adopt a new culture in which the patient is placed at the centre of the system. The financial implications of this reform are not known, but it is expected that initial investment will be needed to offset the greater costs of treatment. However, the long-term expectation is that there will be clear financial gains for society.
Over the next few months, these proposed reforms will be discussed by different sectors of the Danish healthcare system, and will be developed at a follow-up conference.