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A retrospective analysis of health systems in Denmark and Kaiser Permanente

BACKGROUND: To inform Danish health care reform efforts, we compared health care system inputs and performance and assessed the usefulness of these comparisons for informing policy. METHODS: Retrospective analysis of secondary data in the Danish Health Care System (DHS) with 5.3 million citizens and...

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Autores principales: Frølich, Anne, Schiøtz, Michaela L, Strandberg-Larsen, Martin, Hsu, John, Krasnik, Allan, Diderichsen, Finn, Bellows, Jim, Søgaard, Jes, White, Karen
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2008
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2630928/
https://www.ncbi.nlm.nih.gov/pubmed/19077229
http://dx.doi.org/10.1186/1472-6963-8-252
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author Frølich, Anne
Schiøtz, Michaela L
Strandberg-Larsen, Martin
Hsu, John
Krasnik, Allan
Diderichsen, Finn
Bellows, Jim
Søgaard, Jes
White, Karen
author_facet Frølich, Anne
Schiøtz, Michaela L
Strandberg-Larsen, Martin
Hsu, John
Krasnik, Allan
Diderichsen, Finn
Bellows, Jim
Søgaard, Jes
White, Karen
author_sort Frølich, Anne
collection PubMed
description BACKGROUND: To inform Danish health care reform efforts, we compared health care system inputs and performance and assessed the usefulness of these comparisons for informing policy. METHODS: Retrospective analysis of secondary data in the Danish Health Care System (DHS) with 5.3 million citizens and the Kaiser Permanente integrated delivery system (KP) with 6.1 million members in California. We used secondary data to compare population characteristics, professional staff, delivery structure, utilisation and quality measures, and direct costs. We adjusted the cost data to increase comparability. RESULTS: A higher percentage of KP patients had chronic conditions than did patients in the DHS: 6.3% vs. 2.8% (diabetes) and 19% vs. 8.5% (hypertension), respectively. KP had fewer total physicians and staff compared to DHS, with134 physicians/100,000 individuals versus 311 physicians/100,000 individuals. KP physicians are salaried employees; in contrast, DHS primary care physicians own and run their practices, remunerated by a mixture of capitation and fee-for-service payments, while most specialists are employed at largely public hospitals. Hospitalisation rates and lengths of stay (LOS) were lower in KP, with mean acute admission LOS of 3.9 days versus 6.0 days in the DHS, and, for stroke admissions, 4.2 days versus 23 days. Screening rates also differed: 93% of KP members with diabetes received retinal screening; only 46% of patients in the DHS with diabetes did. Per capita operating expenditures were PPP$1,951 (KP) and PPP $1,845 (DHS). CONCLUSION: Compared to the DHS, KP had a population with more documented disease and higher operating costs, while employing fewer physicians and resources like hospital beds. Observed quality measures also appear higher in KP. However, simple comparisons between health care systems may have limited value without detailed information on mechanisms underlying differences or identifying translatable care improvement strategies. We suggest items for more in-depth analyses that could improve the interpretability of findings and help identify lessons that can be transferred.
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spelling pubmed-26309282009-01-27 A retrospective analysis of health systems in Denmark and Kaiser Permanente Frølich, Anne Schiøtz, Michaela L Strandberg-Larsen, Martin Hsu, John Krasnik, Allan Diderichsen, Finn Bellows, Jim Søgaard, Jes White, Karen BMC Health Serv Res Research Article BACKGROUND: To inform Danish health care reform efforts, we compared health care system inputs and performance and assessed the usefulness of these comparisons for informing policy. METHODS: Retrospective analysis of secondary data in the Danish Health Care System (DHS) with 5.3 million citizens and the Kaiser Permanente integrated delivery system (KP) with 6.1 million members in California. We used secondary data to compare population characteristics, professional staff, delivery structure, utilisation and quality measures, and direct costs. We adjusted the cost data to increase comparability. RESULTS: A higher percentage of KP patients had chronic conditions than did patients in the DHS: 6.3% vs. 2.8% (diabetes) and 19% vs. 8.5% (hypertension), respectively. KP had fewer total physicians and staff compared to DHS, with134 physicians/100,000 individuals versus 311 physicians/100,000 individuals. KP physicians are salaried employees; in contrast, DHS primary care physicians own and run their practices, remunerated by a mixture of capitation and fee-for-service payments, while most specialists are employed at largely public hospitals. Hospitalisation rates and lengths of stay (LOS) were lower in KP, with mean acute admission LOS of 3.9 days versus 6.0 days in the DHS, and, for stroke admissions, 4.2 days versus 23 days. Screening rates also differed: 93% of KP members with diabetes received retinal screening; only 46% of patients in the DHS with diabetes did. Per capita operating expenditures were PPP$1,951 (KP) and PPP $1,845 (DHS). CONCLUSION: Compared to the DHS, KP had a population with more documented disease and higher operating costs, while employing fewer physicians and resources like hospital beds. Observed quality measures also appear higher in KP. However, simple comparisons between health care systems may have limited value without detailed information on mechanisms underlying differences or identifying translatable care improvement strategies. We suggest items for more in-depth analyses that could improve the interpretability of findings and help identify lessons that can be transferred. BioMed Central 2008-12-11 /pmc/articles/PMC2630928/ /pubmed/19077229 http://dx.doi.org/10.1186/1472-6963-8-252 Text en Copyright © 2008 Frølich et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Frølich, Anne
Schiøtz, Michaela L
Strandberg-Larsen, Martin
Hsu, John
Krasnik, Allan
Diderichsen, Finn
Bellows, Jim
Søgaard, Jes
White, Karen
A retrospective analysis of health systems in Denmark and Kaiser Permanente
title A retrospective analysis of health systems in Denmark and Kaiser Permanente
title_full A retrospective analysis of health systems in Denmark and Kaiser Permanente
title_fullStr A retrospective analysis of health systems in Denmark and Kaiser Permanente
title_full_unstemmed A retrospective analysis of health systems in Denmark and Kaiser Permanente
title_short A retrospective analysis of health systems in Denmark and Kaiser Permanente
title_sort retrospective analysis of health systems in denmark and kaiser permanente
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2630928/
https://www.ncbi.nlm.nih.gov/pubmed/19077229
http://dx.doi.org/10.1186/1472-6963-8-252
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