Article
Denmark’s hospital reform – the political process behind it from an objective to implementation
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Authors
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Christoph Reichebner
- Technische Universität Berlin, Fachgebiet Managment im Gesundheitswesen, Berlin, Deutschland
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Elke Berger
- Technische Universität Berlin, Fachgebiet Managment im Gesundheitswesen, Berlin, Deutschland
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Astrid Eriksen
- Technische Universität Berlin, Fachgebiet Managment im Gesundheitswesen, Berlin, Deutschland
| Published: | September 25, 2020 |
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Outline
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Background and current state of (inter)national research: The German hospital landscape is characterized by a decentralization of the range of services provided, low levels of specialization and significant overcapacity. This leads to over-, under- and misuse of hospital care, which is not least evidenced by wide variation in quality in the system. In Denmark, since the early 2000s, a continuous restructuring of the hospital landscape has been undertaken. Among other things, hospitals have been rebuilt, many smaller hospitals have closed and the number of emergency rooms has been halved. Research focused so far on the political process behind the preceded structural reform. In order to contribute to a clear understanding of the circumstances facilitating Denmark’s reform, this study aims to assess the political process behind the reform and to examine the conditions that have to be created to be able to incorporate parts of the Danish reform into German hospital care, and to leverage these for improved patient care.
Research questions and objectives: This study will answer how different key factors, such as relevant actors, political and social processes and other associated developments contributed to enabling this large-scale reform in Denmark. The findings will be put in to context to further assess what potential implications could be derived.
Methods or hypothesis: To analyze the political process behind Denmark’s hospital reform two different sources will be used:
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- A qualitative content analysis of 17 semi-structured expert interviews with political scientists, journalists, politicians, among others and
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- an analysis of the literature about the reform. Tsebelis’ (1995) Veto-player theory will be applied to identify key actors and their positions.
Using Kingdon’s (1994) multiple stream framework the reform process will be analyzed looking at the developments in the three different streams – the political, the policy and the problem stream, as well as at potential political entrepreneurs resulting in a window of opportunity facilitating the reform.
Results: Key actors and their positions, as well as institutional settings were important factors enabling the reform in Denmark. Further, several key factors were identified regarding the three streams and political entrepreneur, opening up a window of opportunity and finally leading to reform implementation. With respect to health system differences, implementation guidance and recommendations for the German context will be developed.
Discussion: There are distinct differences between Denmark’s healthcare system and other systems. In order to derive correct implications and recommendations such differences need to be taken into account when assessing the reform. Further, associated developments (e.g. demographics, digitalization) and external effects (financial crisis, pandemics) need to be considered when analyzing the effects of the reform.
Practical implications: The findings from this analysis can provide important and practical recommendations for the necessary reform of the hospital landscape in Germany, thereby improving hospital care in the long term.
