3 things that could be improved in Danish health care

May 17 Written by

The Danish health care system has a great reputation and is widely known as being one of the best in the world. And don’t get me wrong, any system that provides even the most basic care for all of a country’s residents is a good system in my eyes. Denmark, and especially Copenhagen, has a high density of doctors and hospitals, and nobody needs to worry that they won’t be treated or that the treatment for a longer-term illness would cost them their live savings. There is emergency care, everyone has a general practitioner, and there are specialists available for every area of health. If you need advanced diagnostics or even surgery, there are a number of very good public hospitals, and aftercare in will be provided, for example in the form of physiotherapy.

This is “sophisticated whining” – I know that there are many, many places in the world where people can only dream of having a health care system and coverage like we do here. But after living here for a couple of years, during which I’ve been unfortunate enough to have a number of run-ins with the Danish health care system, I’ve noticed a couple of things that I think could be handled better. In short:

The Danish health care system is good, but not perfect. Here are three things that I think could be improved:

Inrease the focus on prevention

This is probably my biggest issue with the Danish health care system as a whole. Basically, as soon as there is something wrong with you, everyone will jump through hoops to take good care of you – but not a second earlier. I’m used to going to different specialist doctors for regular check-ups, like once a year or so. But here, that seems to be considered completely unnecessary (I think my GP probably thinks I’m a hypochondriac). The first question when asking for an appointment is always, “what’s this about?” – and my reply that it’s just a check-up is met with skepticism and dismissal. As an example, a couple of years ago I had to get a birth mark removed because it was considered to be at risk. Ever since then, I’ve gotten preventive skin cancer screenings at the dermatologist on an annual basis. The first time I mentioned this to my doctor, he said that he didn’t think that was necessary – I should just check my birth marks myself, and if I see anything odd, I could come in and have him look at it. This was despite me mentioning my history of having a suspicious birth mark removed.

Everyone gets basic insurance in Denmark (you’re covered if you’re a legal resident and have that yellow insurance card), but you can buy extra insurances with better coverage, which many companies do for their employees. Through my work, I have an excellent insurance, which allowed me to get my back surgery last year at a private hospital and avoid the long waiting times in the public system. But even this amazing insurance does not cover any prevention! It’s completely mind-boggling to me. I haven’t compared health care system costs for different countries, but I simply can’t imagine that it’s more expensive to do a 15min skin cancer screening on a bunch of people than to treat one person who actually has skin cancer.

Don’t give the “own doctor” all the power

Once you register in Denmark with a CPR number, you’ll get your yellow health insurance card and will be asked to choose your “egen læge” (“own doctor”) – a GP who will be your first point of contact for anything health-related. The GP also refers you to specialists, if and when deemed necessary. Generally, I don’t think there’s something inherently wrong with that. A certain level of screening is smart to ensure specialists aren’t flooded with non-cases and can spend their time on those patients who really need their help. But, and this is a big but, it all depends on your GP. Some GPs will write you a referral if you request it by email (I’ve heard). Others, like mine, unfortunately, apparently suffer from a little bit of a God complex and will not refer you, because they think they can do everything themselves. See for instance my earlier example about the dermatologist, where my GP suggested that I come in to see HIM when I see something suspicious, and HE would then determine whether I need to see a dermatologist. So in that case, my health depends on two people who aren’t dermatologists noticing an irregularity. Sounds super safe!

For us women, it gets even worse, as apparently it is totally common to do your gynecology exams at your GP’s office. Say whaaaaaa?! First time I heard that, I was completely in shock. When I asked my GP for a “henvisning” (referral), he dismissed me and said, “no, we can just do that here”. Eeerm – I may be in the minority here, but I’d much rather get checked by an actual gynecologist, thankyouverymuch. I ended up talking him into giving me the referral, but that experience was very humiliating – I think that doctors should just respect my right to be treated by someone I feel comfortable with, especially for such a private matter. A word of advice for fellow expats – you can look for gynecologists that accept “selvbetalere” (self-payers), which means you can opt to pay for the check-up, if your GP refuses to refer you.

The best bit about this whole thing is the following. When I needed a referral to a specialist, I called my GP’s office and asked if they could give me one. The nurse said I had to come in and see the doctor, otherwise they couldn’t. Then, the GP gave me this whole spiel about how it costs the Danish state DKK 110 every time I ask for a referral – erm, yes, and who do you think pockets that, my good sir? It’s YOU, because you make me come in and see you before! I found that pretty hypocritical.

Improve dental care coverage

Finally, Danish basic insurance doesn’t cover dental care. Well, it does pay a little bit of a “subsidy”, but be prepared to pay up every time you get your teeth checked. Again, I might be spoiled by the German system, where you can get an annual check at the dentist for free, but I still think a first world country should care about its citizens’ teeth! I go twice a year to get a check and dental cleaning, and every time I’m out of pocket about DKK 600. I’m happy to pay that, because I care about my teeth, but not everyone can afford it (or wants to pay) – I’ve talked to Danes who haven’t been to the dentist in years! I’m pretty sure more people would go if they could get a free check every once in a while.

What are your experiences with the Danish health care system? What do you like and dislike about it? And what would you like to see improved? Share in the comments below!

A foreigner’s perspective: Danish health care

Jan 25 Written by

I’ve lived in Denmark for about one and a half years now, and during this time, I’ve made some observations about things I dislike (not to be repetitive, but COLD!) and of course also about things I like – the beaches, bakery goods, Christmas traditions, language, cuisine, and so much more. Today I’d like to share some thoughts and observations about the Danish health care system that, unfortunately, I’ve had more contact with than I would have hoped – although most of it was actually quite positive.

First of all, when you get officially registered as an “immigrant”, and get your CPR number (the central persons registry), you also choose your “egen læge” (own doctor, basically your primary physician or “Hausarzt”, in German). That struck me as quite odd, because I was shown a list of doctors who had practices closest to my address, and no further information (other than their age and gender, interestingly) and was then told to choose one. I had no idea if the doctors were competent or nice, so I had to base my choice purely on location. I did select a practice with multiple doctors, both male and female, so I’d at least have a chance to switch between them if I didn’t like the first one. This “egen læge” is then also named on your health insurance card.

Sundhedskort - health insurance card

Sundhedskort - health insurance card

To make an appointment, you call the practice, so that’s quite normal. Lots of doctors and practices have “akut tid”, which means that you can call early in the morning and they have a couple of hours set aside each day for emergency patients, e.g. when you just contracted the flu and need some medication asap. Many doctors (including mine) also have a website with a central booking system that lets you choose the doctor, shows availabilities for the desired date, and also lets you book your appointment right away. This is the public system, mind you, not some snobby private clinic! If you then go to the doctor and get medication prescribed, you don’t get a printed out prescription that you have to carry to the pharmacy (I have lost many of those in bottomless purses over the years!). In most cases, my doctors just ordered the medication via a central server, and then I just went to any pharmacy, identified myself with the health insurance card, and they could see what pills were prescribed to me and with which dosage etc. Easy, you say? It gets even easier! All this information is stored on my doctor’s online “self service” site, so whenever I need a refill of painkillers, I can simply log on to the system, see all medication that’s been prescribed so far, and click “renew” – then the practice will send me an email or text message confirmation of the renewal, and I can pick up the medication without any hassle. That’s what I call forward-thinking and efficient, especially if you’re on a longer-term medication therapy!

 

 

One time, I also needed to get a blood sample taken and analysed. In Germany, the people working with the doctors in their practices are a mix of nurses and secretaries – they do the scheduling and answer the phone, but they also do smaller nurse duties like taking blood or measuring blood pressure. Not in Denmark. Instead, my doctor ordered a blood test for me, again via the almighty server, and specified exactly what values the lab should test for. Then I had to go to one of the labs (there’s a whole business behind this called Københavns Laboratorier, with several locations to choose from). You pick the one closest to you and just show up there during opening hours. Then you draw a number (the Danes LOVE that number-drawing system, you find it virtually everywhere, it’s so orderly and fair!) and wait for one of the nurses to call you. The entire procedure takes about 2 minutes, and it would be quicker if only your stupid blood could flow out of your arm a little faster! I felt a little uneasy in that lab – it basically consisted of one large room full of randomly (un)arranged chairs, five or six cabins for the actual blood-taking (separated with curtains) and a counter for registration. Even though I arrived a couple of minutes before the afternoon opening time, there were already about 20 people in line ahead of me. “Great”, I thought, “I’ll be here the entire afternoon!” But in reality, I was out of there in about half an hour. Very efficient, but not very “customer friendly”… What was really nice, though, was that I got my results via email, with a note from the doctor saying that everything was fine, so I didn’t even have to come in again to get the results (of course, I could have made an appointment, if desired).

 

 

All in all, I think the level of efficiency and digitalization is quite impressive, forward-thinking and tailored to people’s needs. I can hardly remember any German doctor I’ve been to actually using a computer – making appointments online, getting information via email, unthinkable! I am fully aware that this perception is very subjective, and that I’m not discussing the Danish health care system as a whole in terms of effectiveness, costs, etc. This is merely my perception of the elements I’ve come in contact with, and I’ve been pretty impressed by them so far!