Health care in Denmark
The Kingdom of Denmark has 5.6 million inhabitants and is a member of the EU. Physicians who are licensed in Sweden or Norway will usually be licensed in Denmark without any major difficulties. A medical education and speciality credential from a European country are recognized in Denmark, but there are specific national requirements which have to be fulfilled in order to get a Danish license.
Denmark has total health care expenses per inhabitant comparable with the majority of developed countries. The health care system in Denmark is almost fully state-regulated. All citizens are members of the National Health Service system (Sygesikringen) which subsidises important medication and the fee for Hospitalizations and Doctors' visits.
Cardiology in Denmark
The speciality of cardiology in Denmark is a sub-speciality of general internal medicine, but in general the majority of educational time is in cardiology. To obtain credentials as a cardiologist one has to serve at least 6 years in an introductory position and in junior jobs in cardiology / internal medicine. This has to be followed by subspecialisation in the different cardiology subspecialities. There are at present approximately 450 specialists in cardiology. Amongst these, the number of cardiologists in private practice is at present 17 (4 of these part-time).
All cardiologists in private practice are automatically members of the Danish Society of Cardiology DCS). Hitherto the practicing cardiologists have been individual members of DCS, but more recently we have been organized as a Council of practicing cardiologists in the auspice of the DCS.
We have 2 annual meetings only for the practicing cardiologists, but participate of course in Danish and international meetings and educational sessions. In the future we plan to have informational sessions at the yearly meeting of the DCS.
Regional health care manage all health care
Denmark is divided into five regions (The Capital, Zeeland, Funen and southern Jutland, middle Jutland and northern Jutland.), with the primary aim to organize the health care system. These have political elected boards.
At the first level, the regions are responsible for primary care. Primary care physicians have to obtain a permission for practice, most often this is bought from retiring primary care physicians.
The primary care physicians are paid by the regions, partly with a fixed basis salary according to the number of persons on their patient list, and partly based on visits and procedures. Only to a very little degree there will be direct patient’s fees.
The second level of health care, which is for all specialised health care, comprises all the hospital and out-of-hospital specialists, and is also managed by the 5 regions. The role for the practicing specialists (as cardiologists) are partly to serve as a gate-keeper for the much more expensive hospital system, partly to diagnose, treat and follow-up cardiac disorders which do not warrant admission to hospital.
Each of the regions has been given a limited budget to cover the expenses in the health care system. – both hospitals, general practitioneers and contract-bound specialists in private practice.
Out-of–hospital physician-specialists, such as cardiologists, are closely regulated
Access to the cardiologist for the public is not free. The Danish general practitioner has a gate-keeper function and has to send a letter of referral to the specialist.
In theory, any cardiologist with a valid license can set up a private practice and treat patients. However, without a contract with the regional health care system, the patients would have to pay the whole fee from their own pocket, unless they have Health Insurance paying this.
To work in an out-of-hospital based specialist practice one has to obtain a contract with the regional health care system, which in general can decide upon the geographic location of the practice. There are only a limited number of such contracts available. Currently there are 17 concessions given out to cardiologists in the whole of Denmark. New contracts are very rare.
When a specialist retires, he / she can sell the practice, including the contract to practice. The physician who obtains the contract has to pay the previous owner a sum for equipment and good-will. There is also a special arrangement which enables a specialist aged over 60 to gradually include a partner over a transition period of 5 years. When above 70 years the specialist can still practice, but there is an improved surveillance.
Having obtained a contract, the specialist will obtain reimbursements for each consultation and for procedures performed, according to a national scheme, which is negotiated every second year. The patient has no expenses for visits to doctors. With this income, the cardiologist has to pay out for office rent, expensive equipment, wages to nurses and secretaries and so on.
The license allows for fellow cardiologists to replace the owner of the license on a temporary basis, for reasons such as illness or education. For specialists with a special need for this (age, educational, scientific or administrative work) it is possible to be allowed a part-time substitute.
Typically a cardiologist in a private practice, in a year will see approximately 1500 new patients per year, with a total number of consultations of approximately 6000, and perform approximately 2000 echocardiographies, 1000 exercise tests and 1200 Holter monitorings / event recordings.