Summary so far: Denmark has an extensive safety net and high taxes. As per usual, the situation is a lot more complicated than the buzz. So we’re going to take a closer look, starting with the health care system. As previously advertised, Denmark provides “universal health care”. What does this mean? It means “primary health care” is available to everyone. It doesn’t mean that health care it totally free. Most patient still have co-payments for things like medication and physical therapy. And it doesn’t mean you get to see whomever you want, at least if you’re counting on the government paying. For instance, if you want to see a specialist, a general practitioner has to make the referral (much like the Kaiser Permanente system).
Denmark does do a good job of containing healthcare costs, at 11% of GDP, compared to 17% in the US. The government has reined in costs through economies of scale and the elimination of malpractice litigation (replaced by a national system of modest compensation for medical mistakes). Under this system, there’s less incentive for doctors to over-refer, over-test or over-treat. The budget for physician salaries is smaller because GPs are paid less than specialists and most doctors in Denmark are GPs (80%, compared to just 31% in US). Further savings result from the extensive use of non-physicians (e.g., midwives) for procedures typically performed by physicians in the US. And drugs are cheaper thanks to the government’s negotiating power. So between efficient administration, less waste in patient care, cheaper doctors, greater use of non-doctors, and lower drug costs, Denmark’s universal health care system has managed to be about 6% cheaper than the not-quite-universal system we have in the US.
There is a down side to the Denmark’s system, however. Lack of quick access to specialists appears to be a factor in a couple of bad stats: compared to other Europeans, Danes don’t live as long and have lower cancer survival rates after diagnosis. While the healthcare system isn’t responsible for the incidence of cancer (that, perhaps, is due to certain lifestyle factors: the Danes have high rates of drinking and smoking), delays in getting to specialists (and the hospitals where they work) results in later diagnoses and time is of the essence when treating cancer.
Overall, then, I’d say Denmark’s healthcare system is pretty good – not perfect. The US could certainly benefit from trying out bits of the Danish model. I’d start with looking at ways Denmark contains costs, since the feasibility of universal care in the US is partly a matter of affordability. Perhaps some states could experiment with replacing a litigated malpractice system with a state-run system, similar to how workers’ compensation works. The US should also do whatever it takes to increase the number of General Practitioners, while expanding the roles of both GPs and non-physicians in patient care. As it is now, the shortage of GPs means a lot of patients can’t see their doctors on a timely basis, which has lead to an increase in emergency room visits, even though more patients have medical insurances thanks to Obamacare. What is the use of universal care if you can’t get an appointment to see your doctor?