Private healthcare in Denmark has grown, following the introduction of a rule which means that anyone on a waiting list for more than a month can opt to go private, according to Karsten Vrangbaek, a researcher at the University of Copenhagen.
He says that similar rules, but with less strict deadlines, have been passed in Norway and Sweden. Vrangbaek is working with a team of academics to produce a book for the WHO on the Nordic system.
In a joint presentation with Richard Saltman from Emory University, the two academics said that it was possible to talk of a common Nordic healthcare system, but they differentiated between Norway/Denmark and Sweden/Finland.
The former two have moved to centralise healthcare spending and decision making, and have also amalgamated regions, whilst in Sweden and Finland the system remains much more decentralised, with a lot of power and ownership still at municipal level.
Vrangbaek and Saltman felt that the Norway/Denmark model might be better suited to changes in technology, favouring larger units. They noted that in 2002 Norway created regional hospital groups, which function as 'public firms'.
Our Analysis: Vrangbaek and Saltman reckon that the Nordic model will basically remain one of public provision. But they acknowledge that there is quite a lot of private activity. We see this particularly in outsourcing of primary and domiciliary care and care homes in Stockholm, and in the way that Finnish municipalities are moving to outsource primary and care homes.
They also see the changes in Norway and Denmark as a way for politicians to ensure that they control healthcare policy more closely, and that, if anything, it is likely to militate against further privatisation.
Centralisation does make sense; leaving secondary healthcare and care homes in the hands of Finnish municipalities with 5,000 to 10,000 inhabitants is nuts. But we don't think it automatically militates against privatisation. Operators in Finland tell us that bigger municipalities are more willing to take brave, rational decisions.
