Abstract
BackgroundTo inform Danish health care reform efforts, we compared health care system inputs and performance and assessed the usefulness of these comparisons for informing policy.MethodsRetrospective analysis of secondary data in the Danish Health Care System (DHS) with 5.3 million citizens and the Kaiser Permanente integrated delivery system (KP) with 6.1 million members in California. We used secondary data to compare population characteristics, professional staff, delivery structure, utilisation and quality measures, and direct costs. We adjusted the cost data to increase comparability.ResultsA higher percentage of KP patients had chronic conditions than did patients in the DHS: 6.3% vs. 2.8% (diabetes) and 19% vs. 8.5% (hypertension), respectively. KP had fewer total physicians and staff compared to DHS, with134 physicians/100,000 individuals versus 311 physicians/100,000 individuals. KP physicians are salaried employees; in contrast, DHS primary care physicians own and run their practices, remunerated by a mixture of capitation and fee-for-service payments, while most specialists are employed at largely public hospitals. Hospitalisation rates and lengths of stay (LOS) were lower in KP, with mean acute admission LOS of 3.9 days versus 6.0 days in the DHS, and, for stroke admissions, 4.2 days versus 23 days. Screening rates also differed: 93% of KP members with diabetes received retinal screening; only 46% of patients in the DHS with diabetes did. Per capita operating expenditures were PPP$1,951 (KP) and PPP $1,845 (DHS).ConclusionCompared to the DHS, KP had a population with more documented disease and higher operating costs, while employing fewer physicians and resources like hospital beds. Observed quality measures also appear higher in KP. However, simple comparisons between health care systems may have limited value without detailed information on mechanisms underlying differences or identifying translatable care improvement strategies. We suggest items for more in-depth analyses that could improve the interpretability of findings and help identify lessons that can be transferred.
Highlights
To inform Danish health care reform efforts, we compared health care system inputs and performance and assessed the usefulness of these comparisons for informing policy
Kaiser Permanente (KP) physicians are salaried employees; in contrast, Danish Health Care System (DHS) primary care physicians own and run their practices, remunerated by a mixture of capitation and fee-forservice payments, while most specialists are employed at largely public hospitals
Observed quality measures appear higher in KP
Summary
To inform Danish health care reform efforts, we compared health care system inputs and performance and assessed the usefulness of these comparisons for informing policy. Affordable health care is a universal goal, health care systems vary considerably in their approach. Comparisons of health systems could help identify successful strategies and models for achieving this goal and provide useful benchmarks for change [1]. A structural reform of the Danish healthcare system (DHS) was undertaken in 2007 with the goal of performance improvement and increasing effectiveness of care. We looked to other health systems for transferable practices, and Kaiser Permanente (KP) had been described as providing effective care at costs comparable to those of the UK National Health Service [2]. Of particular interest was KP's experience with developing care for chronic conditions, for which prevalence rates are high and increasing in Denmark
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