Does a public single payer system deliver integrated services? A national survey study among professional stakeholders in Denmark

BACKGROUND: Integrated health care delivery is a goal of contemporary health systems; however, the achievement of this goal is rarely quantified. The Danish health care system provides an interesting case study, as a setting with a formally integrated financing and delivery system. PURPOSE: To measure the level of integration of care and conceptual sub dimensions in the Danish health system, using a major professional stakeholder (MaPS) approach. In addition, organisational and management factors associated with delivery of integrated care are investigated. DESIGN: A survey addressed to: all county administrative managers (N=15); all hospital managers (N=44); and randomised selected samples of hospital department physician managers (N=200) and general practitioners (N=700). RESULTS: Several initiatives on administrative and functional levels have been implemented in Denmark to improve the delivery of integrated services. Still most physicians agree that only half of all patients experience well coordinated pathways. Clinical integration is a strategic priority at the managerial levels, but this is not visible at the functional levels. Financial incentives are not used to encourage coordination. The information communication technology to facilitate clinical integration is perceived to be inadequate. CONCLUSION: Seen from the perspective of major stakeholders at the professional level the formally integrated health care delivery system in Denmark does not deliver fully integrated services. However, the scope for improvement is high due to the inherent structural composition of the system and the one payer system approach. The MaPS approach suggest that alignment of the financial incentives, increased managerial stewardship, structural reorganisation, and expanded use of information technology to link sub-organisations will be a way to move the system forward to its explicit goal of providing an integrated delivery of services which could ultimately benefit the recipients of the Danish health care services.