Co-payments for general practitioners in Denmark: an analysis using two policy models

BACKGROUND: The increasing health expenditure for general practitioners (GPs) in Denmark requires that other ways of financing the health system are investigated. This study aims to analyse possibilities for implementing out-of-pocket payments to GPs in Denmark. METHODS: The study was conducted as a literature review with 11 articles included. The Health Policy Triangle and the Kingdon Model were used in analysing and discussing the implementation of a cost-sharing policy with an emphasis on the out-of-pocket payments method. RESULTS: The Danish Parliament has expressed mixed opinions about out-of-pocket payments, whereas the Danish population, the GPs and the media are against introducing payments. The public debate and the fact that Danes are used to healthcare being free of charge both work against introducing co-payments. However, experiences from Sweden, Norway and OECD countries serve to promote implementation, but at the expense of decreased accessibility for the most vulnerable population groups. CONCLUSIONS: Introducing out-of-pocket payments in Denmark may lead to decreased health expenditure, but also increased inequalities. Due to a lack of support from the relevant policy actors in the country, in addition to a lack of a policy window, it may not be possible to introduce out-of-pocket payments for GPs in Denmark in the short term.