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Hospital centralization and performance in Denmark—Ten years on


  • Christiansen, Terkel
  • Vrangbæk, Karsten


Denmark implemented a major reform of the administrative and political structure in 2007 when the previous 13 counties were merged into five new regions and the number of municipalities was reduced from 271 to 98. A main objective was to create administrative units that were large enough to support a hospital structure with few acute hospitals in each region and to centralize specialized care in fewer hospitals. This paper analyses the reorganization of the somatic hospital sector in Denmark since 2007, discusses the mechanisms behind the changes and analyses hospital performance after the reform. The reform focused on improving acute services and quality of care. The number of acute hospitals was reduced from about 40–21 hospitals with new joint acute facilities, which include emergency care wards. The restructuring and geographical placement of acute hospitals took place in a democratic process subject to central guidelines and requirements. Since the reform, hospital productivity has increased by more than 2 per cent per year and costs have been stable. Overall, indicators point to a successful reform. However, it has also been criticized that some people in remote areas feel “left behind” in the economic development and that hospital staff are under increased workload pressure. Concurrent with the centralization of hospitals municipalities strengthened their health service with an emphasis on prevention and health promotion.

Suggested Citation

  • Christiansen, Terkel & Vrangbæk, Karsten, 2018. "Hospital centralization and performance in Denmark—Ten years on," Health Policy, Elsevier, vol. 122(4), pages 321-328.
  • Handle: RePEc:eee:hepoli:v:122:y:2018:i:4:p:321-328
    DOI: 10.1016/j.healthpol.2017.12.009

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    References listed on IDEAS

    1. Søgaard, Rikke & Kristensen, Søren Rud & Bech, Mickael, 2015. "Incentivising effort in governance of public hospitals: Development of a delegation-based alternative to activity-based remuneration," Health Policy, Elsevier, vol. 119(8), pages 1076-1085.
    2. Pierson, Paul, 2000. "Increasing Returns, Path Dependence, and the Study of Politics," American Political Science Review, Cambridge University Press, vol. 94(2), pages 251-267, June.
    3. Christiansen, Terkel, 2012. "Ten years of structural reforms in Danish healthcare," Health Policy, Elsevier, vol. 106(2), pages 114-119.
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    Cited by:

    1. De Regge, Melissa & De Pourcq, Kaat & Van de Voorde, Carine & Van den Heede, Koen & Gemmel, Paul & Eeckloo, Kristof, 2019. "The introduction of hospital networks in Belgium: The path from policy statements to the 2019 legislation," Health Policy, Elsevier, vol. 123(7), pages 601-605.
    2. Hald, Andreas Nielsen & Bech, Mickael & Burau, Viola, 2021. "Conditions for successful interprofessional collaboration in integrated care – Lessons from a primary care setting in Denmark," Health Policy, Elsevier, vol. 125(4), pages 474-481.
    3. Laudicella, Mauro & Li Donni, Paolo, 2021. "The dynamic interdependence in the demand of primary and emergency secondary care: A hidden Markov approach," DaCHE discussion papers 2021:1, University of Southern Denmark, Dache - Danish Centre for Health Economics.
    4. Baier, Natalie & Geissler, Alexander & Bech, Mickael & Bernstein, David & Cowling, Thomas E. & Jackson, Terri & van Manen, Johan & Rudkjøbing, Andreas & Quentin, Wilm, 2019. "Emergency and urgent care systems in Australia, Denmark, England, France, Germany and the Netherlands – Analyzing organization, payment and reforms," Health Policy, Elsevier, vol. 123(1), pages 1-10.
    5. Livio Garattini & Michele Zanetti & Nicholas Freemantle, 2020. "The Italian NHS: What Lessons to Draw from COVID-19?," Applied Health Economics and Health Policy, Springer, vol. 18(4), pages 463-466, August.
    6. Livio Garattini & Michele Zanetti & Nicholas Freemantle, 0. "The Italian NHS: What Lessons to Draw from COVID-19?," Applied Health Economics and Health Policy, Springer, vol. 0, pages 1-4.

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    More about this item


    Government health policy; State and local taxation; State and local budgets and expenditures; State and local government – health; Clinical specialization; Acute health care;
    All these keywords.

    JEL classification:

    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • H71 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Taxation, Subsidies, and Revenue
    • H72 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Budget and Expenditures
    • H75 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Government: Health, Education, and Welfare


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