Denmark

This chapter offers an in-depth look at health politics and the tax-financed, universal health system in Denmark. It traces the development of the Danish healthcare system, characterized by an evolving division of labor between central authorities and decentralized municipal and regional governments. Since the late 1980s, Danish health policy has seen a number of gradual changes and a major structural reform passed in 2005 that amalgamated municipalities and regions and changed healthcare financing rules, thus shifting the balance of shared power toward the center. Other healthcare issues have been cost containment, patient rights, and promotion of local integrated health services. A negotiated policy style contributes to efficient implementation of reforms once a decision has been made.

Strategies of stratification: Regulating market access in the era of personalized medicine

Personalized medicine raises the stakes of pharmaceutical market regulation. Drawing on pragmatist valuation studies and science and technology studies literature on personalized medicine and pharmaceutical markets, this article demonstrates how complex negotiations about the value of a pharmaceutical can constitute a market in various ways, while also shaping the concerned patient populations. Tracing the path of a pharmacogenetic treatment, Spinraza, from its approval by the European Medicines Agency to its adoption in the publicly funded Danish healthcare system, we show how the market was formatted through particular stratifications of the patient population. We conceptualize these seemingly technical moves as strategies of stratification, that is, the application of techniques to assemble and divide data – and what data are meant to represent – into groups delineated by certain characteristics. We argue that stakeholders’ use of strategies of stratification has important implications not only for market access, but also for the delineation of diseases and patient populations. Hence, it is crucial to make intelligible the mutual constitution of pharmaceutical markets and patient populations and the political efforts of delineating and connecting the two.

Anti-SARS-CoV-2 seropositivity among medical students in Copenhagen

BackgroundHealthcare workers are at a higher risk of getting infected with SARS-CoV-2 than the general population. However, detailed knowledge about medical students and exposure to SARS-CoV-2 is lacking. Thus, we measured the prevalence of SARS-CoV-2 antibodies in a cohort of Danish medical students.MethodsWe invited all medical students at the University of Copenhagen (UCPH) to participate. A venous blood sample was drawn along with completing a self-report questionnaire. Blood samples were analyzed for total antibodies to SARS-CoV-2 and related to symptomatology, social behaviour, and work-life. Seropositive samples were screened for IgM, IgG, and IgA antibodies.ResultsBetween October 19th and 26th 1,120 students participated in questionnaire, of these 1,096 were included in the study. Of all included 379 (34.58%) of the participants were seropositive. The risk of seropositivity was significantly increased for participants attending two parties at UCPH, on February the 29th and March 6th 2020 (OR 5.96 (95% CI 4.34-8.24, p<0.001). Further, 461 students (42.06%) worked with COVID-19 patients, which was significantly associated with risk of seropositivity (OR 1.38, 95% CI 1.03-1.85, p=0.033). The symptom most substantially associated with seropositivity was loss of smell and/or taste (n=183 of all, 31.35%) with an OR of 24.48 (95% CI 15.49-40.60, p<0.001).ConclusionMedical students have the highest reported seropositivity in the Danish healthcare system. The risk of SARS-CoV-2 transmission amongst the students appear to be partly related to working with COVID-19 infected patients, but to a greater extent, their social behaviour.MainpointsMedical students have the highest reported seropositivity in the Danish healthcare system. The risk of SARS-CoV-2 transmission amongst the students appear to be partly related to working with COVID-19 infected patients, but to a greater extent, their social behaviour.

A Shot at a Healthy Future

In this article, we present an extended case analysis of the unruly reception of the HPV vaccine in Denmark. More specifically, we explore what happens to visions of a healthy future when high levels of social trust in a public vaccination programme are suddenly infused with uncertainty and doubt. Capturing the Danish public in 2013-2015, national news and social media platforms shared dra-matic stories of young women confined to their beds following their HPV vaccinations. The Danish healthcare authorities reacted to this seemingly accelerating problem by setting up HPV clinics to care for the women. Simultaneously, HPV vaccination uptake plunged. Based on long-term ethno-graphic field research, we present the experiences of two main interlocutors, who both find them-selves in difficult situations and having to revise their visions of the future: Sophie, a young woman with suspected HPV vaccine side effects and Martin, a physician working in an HPV clinic. Overall, their accounts shed light on situations emerging during a challenging period in the 2010s in which the Danish healthcare system was adjusting to a new information and media landscape. We show that the promise of a healthy future – sustained by welfare and vaccine technologies – is indeed a communal venture that is vulnerable to suspension and even collapse. When sufferings (such as pain or fatigue) were publicly paired and un-paired with the vaccine, it generated and sustained pervasive uncertainties and painful feelings of being doubted by others – reflecting and highlighting inherent tensions of preventative medicine and the Danish welfare society, including the subtle acts of power and resistance that occur within it.

Responsibilities for patients? A comparison between US-based VA and the Danish healthcare system

Background The European healthcare systems aim to leave no one behind. Responsibility for the patients may nevertheless be less clearly placed, even in a welfare context such as the Danish healthcare system (DHS). Contrastingly, the Veterans Affairs (VA) in the US is known for their high quality of care and strong care coordination. To understand how responsibility for patients is understood in VA and DHS, we investigated how health providers in the two healthcare systems view their responsibilities to the patients and which tools are used to support responsibility for patients. Methods Semi-structured face-to-face interviews with 23 managers and healthcare providers in VA and DHS were conducted in 2013 and 2014. The interviews were of 42-82 minutes of duration and transcribed verbatim. Data were analysed using thematic analysis. Results The responsibility for the individual patient was clearly placed on the general practitioner in VA, and VA providers felt responsible for their enrolled patients and not just the patients who seek care. In DHS, the responsibility of the treatment was often divided between several providers and this often created dissonance on who is responsible for the care. VA providers made a systematic and active effort to reach out to the individual patients who do not turn up for an appointment as well as for clinical outliers who had pronounced medical needs. In DHS, the responsibility of seeking and attending healthcare laid upon the individual patient. DHS providers seldom played an active part in contacting no-show patients resulting that vulnerable patients may not get the care they need. Conclusions Learning from VA suggests that a clear placement of responsibility will help patients, especially vulnerable patients, to get timely and well-coordinated care. Patient outreach is an important tool to grasp vulnerable patients who are likely to fall between two stools or who need the care the most supporting high quality of care. Key messages Clear placement of responsibility for patients will help vulnerable patients to get timely and well-coordinated care. Patient outreach is an important tool to grasp vulnerable patients who are likely to fall between two stools.

Challenged assumptions and invisible effects: an explorative case study of a health education intervention addressing immigrants

Purpose The purpose of this paper is to examine any unanticipated effects of an educational intervention among newly arrived adult immigrants attending a language school in Denmark. Design/methodology/approach A qualitative case study was conducted including interviews with nine informants, observations of two complete intervention courses and an analysis of the official intervention documents. Findings This case study exemplifies how the basic normative assumptions behind an immigrant-oriented intervention and the intrinsic power relations therein may be challenged and negotiated by the participants. In particular, the assumed (power) relations inherent in immigrant-oriented educational health interventions, in which immigrants are in a novice position, are challenged, as the immigrants are experienced adults (and parents) in regard to healthcare. The paper proposes that such unexpected conditions for the implementation – different from the assumed conditions – not only challenge the implementation of the intervention but also potentially produce unanticipated yet valuable effects. Research limitations/implications Newly arrived immigrants represent a hugely diverse and heterogeneous group of people with differing values and belief systems regarding health and healthcare. A more detailed study is necessary to fully understand their health seeking behaviours in the Danish context. Originality/value Offering newly arrived immigrants a course on health and the healthcare system as part of the mandatory language courses is a new and underexplored means of providing and improving newly arrived immigrants knowledge and use of the Danish healthcare system.