Public Health Reimagined
Denmark’s total health expenditure as a share of GDP has increased moderately over the past decade with the country spending 278 billion KKR (37.2 billion euros) in 2024, of which 83% was financed directly from government health schemes. Yet despite the country’s well-earned reputation for delivering high quality ‘cradle to grave’ universal healthcare that is largely free at the point of use, Danish policymakers recently embarked upon a radical reform of the nation’s public healthcare apparatus.
“Maintaining the status quo has frankly not been a realistic option, as our country is afflicted with many of the same healthcare challenges common across most OECD members: notably the rise of chronic illnesses, demographic shifts, workforce shortages, and exponential demand for healthcare services,” explains Jakob Nielsen, CEO of Healthcare Denmark, a non-profit public-private partnership promoting Danish healthcare solutions.
“Our aged 80+ population is set to proliferate over the coming years, while the number of younger people entering the workforce will simply not keep pace, which means we are forced to identify creative ways to continue delivering high-quality health services, but at greater scale and with fewer resources such as doctors and nurses,” elaborates Helene Probst, Health Director for Danish Regions, a body tasked with providing professional services and advisory to the political leadership of the country’s five regions.
Following the conclusions of numerous public enquires into the matter – notably those of the Resilience Commission charged with analysing the robustness of the health sector, and the Healthcare Structure Commission mandated to examine the structural sustainability – it was determined that Denmark had been focusing too heavily upon hospital-based care in a manner that could no longer be sustained in the years to come.
“Basically, the studies were indicating that over half the Danish population visits a hospital every year when many of those same services offered might be more efficiently delivered elsewhere: such as in primary and ambulatory care settings or even from within the home,” recalls Probst.
Care Proximity
Indeed, what has followed has been a concerted effort to future-proof and reorientate the country’s public healthcare by localizing care delivery as far as possible, optimizing resource allocation, and strengthening primary care capacity with a view to preventing unnecessary hospital admissions.
For a start, the acute care system has undergone massive consolidation with the number of acute hospitals reduced from 40 to 21, including the formation of six ‘super hospitals.’ Meanwhile, over 4 billion DKK (536.2 million euros) has been invested in the establishment of 25 new clinic-style entities nationwide equipped to provide specialized outpatient procedures from diagnostics to chronic care.
Søren Granhøj Pedersen, Managing Director for Denmark and Iceland at the American innovative drug developer, MSD sees a lot of sense in the reforms. “The shortage of general practitioners across the country is well recognised, and hospitals were becoming visibly stretched by growing patient demand. This dual challenge required a systemic response, and the country has been resolute in enacting structural reforms that properly prepare the country for higher volumes of older and chronic care patients,” he opines.
Naturally the changes will have profound implications for how pharma companies conduct business too. “While many of our treatments, especially in oncology, have traditionally been administered in specialised hospital settings, we are expecting to see a gradual transition toward more decentralised, primary care-oriented models and this will mean engaging with a new set of stakeholders,” he predicts.
Peter Jorgensen, Director of the Danish Generic and Biosimilar Medicines Industry Association (IGL) is even more forthright. “There’s a strong political ambition to move more treatment closer to people’s homes, switching some of the care that currently takes place in hospitals into the community and this shift could have a direct impact on how medicines are used and distributed,” he predicts. “For example, more products could become available at community pharmacies instead of being administered in hospital settings. That sounds simple, but actually introduces significant complexity, especially for biologics,” he warns.
Co-opting Medtech
It is perhaps in the medtech sector that the changes will be felt most keenly, however. “These reforms place medical technology developers in a really pivotal position,” affirms Mads Koch Hansen, Director of Medicoindustrien, the national association for medical device companies. “As clinical contact becomes more decentralised, technology becomes essential – not merely complementary – for maintaining safe, continuous care. Devices that enable remote monitoring, support self-management, and ensure timely clinical intervention are increasingly central to the success of this transition,” he explains.
Indeed, thanks to IoT-enabled wearable devices and remote monitoring solutions, individuals with chronic conditions can potentially manage their health from home, only requiring clinical input when alerts are triggered. Likewise, equipped with telemedicine and digital healthtech, post-surgical patients could conceivably recover in a safe, monitored environment outside hospital walls.
“We are already witnessing this in areas such as diabetes, where AI-driven sensor and pump systems allow families to manage the condition with greater confidence and less disruption to daily life. Parents no longer need to constantly monitor their child’s blood sugar; instead, smart alerts prompt them only when necessary. This kind of technological support enables a near-normal routine and significantly reduces the emotional and logistical burden of chronic disease,” confirms Hansen. “Similarly, in oncology, there is increasing potential for technology to address persistent effects of treatment, such as neuropathy or oedema, by enabling patients to manage symptoms more proactively at home,” he elucidates.
Many medtech developers are also spying fresh opportunities as healthcare integrators. “Companies like us have an unprecedented chance to shift from a predominantly product-centred approach to one that places patients and clinical decision-makers at the core of our thinking,” believes Francis Van Parys, President and CEO at Radiometer, a homegrown Danish multinational specializing in the design of markets solutions for blood sampling, blood gas analysis, transcutaneous monitoring, and immunoassay testing.
“At Radiometer, we perceive digital solutions not as adjuncts, but as integral to how the country can respond to these challenges. Moreover, unlike hardware, digital platforms offer the ability to scale quickly and deliver differentiated value to customers in ways that transcend traditional instrumentation,” affirms Van Parys.
Building Integrated Pathways
Certainly, care integration is high on the agenda of Denmark’s healthcare reformers. “For emergencies like a heart attack or stroke, coordinated pathways are in place that ensure patients can move swiftly and efficiently through the layers of the healthcare system. However, the picture is quite different when we look at care for elderly patients with chronic diseases and multi-morbidities,” details Danish Regions’ Helene Probst.
“Their care tends to be fragmented. It’s not so much that they lack access to professionals, in fact, they see the general practitioner, emergency nurses, paramedics, hospital staff, and potentially many other stakeholders, but there is extremely little coordination across these touchpoints. The ambition of the reform is precisely to change that: ensuring that one hand knows what the other is doing, and that public health can be delivered in a joined-up way along a seamless care continuum,” she asserts.
Indeed, since fall 2022, so-called health clusters have been in operation tasked with enhancing collaboration across hospitals and primary and local care, especially for older people and those with chronic conditions and mental health needs.
Moreover, one of the more strategic aspects of the reform process has been the creation of health councils as standing committees under the regional authorities that include politicians from both regional and municipal levels. They shall each be responsible for producing a local primary healthcare plan tailored to local population needs that is simultaneously aligned with national and regional policies. “What we’re striving for is a change of mentality in which decision makers embrace a population health approach. The health system, and particularly doctors, must move from focusing solely on the individual in front of them to also thinking about the broader needs of the community they serve,” urges Probst.
Underpinning all of that will be greater dependence on big data to make precise and well-informed decisions. Presently, Denmark’s healthcare apparatus enjoys a strong digital infrastructure, such as the centralised electronic health record, and extensive patient data collection at the hospital level. However, this mine of information is often underutilized and its communication between sectors remains underdeveloped.
Smarter Resource Allocation
A further consequence of the structural reconfiguration and uptake in data-informed decision making has been an ongoing re-evaluation of how the country’s healthcare resources should best be allocated. “When it comes to procurement, there has been a definite move away from a two-sector view of healthcare towards a more unified system,” notes Flemming Sonne CEO of Amgros, the state-owned body responsible for purchasing medicines, and certain medical devices such as hearing aids, on behalf of the public health apparatus.
“In the future, instead of differentiating between the hospital, primary care, and even private sectors, we hope to be able to support access wherever patients are treated. I expect our role in procurement and negotiation will increasingly extend across the whole care pathway,” he forecasts.
Meanwhile, a new Danish Health Prioritization Council, born out of what was previously the Danish Health Technology Council, is expected to play a lead role in guiding future resource allocation across the healthcare system, and the pharma and medtech industries alike have high hopes for its future impact.”
“While its full mandate is not yet defined, we are very much hoping that the new Prioritization Council will adopt a forward-looking view that recognises prevention not simply as a cost to be managed, but rather as a strategic investment in system sustainability,” confides MSD’s Søren Granhøj Pedersen. “Today, the benefits of prevention are often distributed unevenly across stakeholders, leading to incentive misalignments that hinder adoption. A more holistic and integrated prioritisation model would seriously help address this gap and bring prevention closer to the centre of healthcare planning,” he argues.
Pedersen identifies significant scope for supporting the reform’s goals, particularly through the preventative potential of vaccines, so long as the requisite financing can be secured. HPV vaccination, for example, helps prevent cancers before they ever enter clinical pathways, while pneumococcal vaccination could significantly reduce the approximately 29,000 hospital admissions Denmark sees each year for pneumococcal disease. “These are not just reductions in hospital visits, they represent patients who never enter the system, and therefore easing pressure at every level. Emphasizing prevention would align closely with the reform’s aim of moving care upstream while simultaneously unlocking long term value gains,” he insists.
“A key priority moving forward must be a shift from procurement based solely on price to one grounded in long-term value,” concurs Medicoindustrien Mads Koch Handsen. “While many purchasing decisions still default to the lowest-cost option, this approach fails to recognise the broader benefits that innovative technologies can deliver over time. A slightly higher initial investment often translates into improved outcomes for patients, more efficient healthcare delivery, and ultimately, greater societal benefit,” he notes.
Public Health Paragon
What is for certain is that Denmark’s neighbours will be keenly watching the reform’s progress. “There is growing international interest in Denmark, particularly because of our proven ability to achieve high-quality healthcare outcomes at comparatively moderate cost,” concedes Jakob Nielsen of Healthcare Denmark, who points out that in Newsweek’s latest ranking of the top 100 hospitals globally, two Danish public hospitals made the top 20 with Aarhus University Hospital ranked number six and Rigshospitalet in 19th place. “This is remarkable given our small population of six million and healthcare expenditure hovering around 10 percent of GDP. It demonstrates that we manage to deliver a lot of value for the investment,” he contends.
Especially right now, with its willingness to be a first mover in pioneering a future-fit public healthcare apparatus of tomorrow, “Denmark can credibly be regards as a sort of healthcare research studio or case study, not necessarily to be copied wholesale, but certainly to be learned from and adapted,” he reasons.
