The health-care system in Denmark couldn't be more different from the one we are all too familiar with in the Republic. Access to GPs, consultants and surgeons is provided free of charge.
Private-patient access to public-hospital facilities via insurance schemes such as the VHI or BUPA would be illegal in Denmark. In the Republic, one-third of public-hospital space is taken up by private patients, according to a recent ESRI report.
If the waiting list for treatment at your nearest hospital in Denmark is too long, you can demand service at another hospital where the waiting time is shorter. There is now also a guarantee in law that you will see a specialist within a fortnight and have surgical treatment within four weeks if a life-threatening illness is diagnosed.
The Danes complain about waiting lists, but most are measured in weeks and few extend beyond four or five months, with the worst delays stretching to 12 months. Doctors and surgeons are expected to work 37 hours a week, just like everyone else, and it is frowned upon for consultants to maintain private practices alongside their public practices in hospitals.
There are two key features of the Danish health-care system that define its structures. Care is provided free for all, without reference to personal income, and the system is decentralised, with each regional authority running its own hospital and health services.
Both of these are experiencing a degree of transition, however, according to John Erik Pedersen, head of the policy division of the Danish ministry of health.
There are three private hospitals in Denmark, looking for business by offering a way around the relatively short waiting lists. "Hospitals have always been public in Denmark," he says. "There are a few hospitals owned over the years by charities, but they have been included in the public system. For-profit hospitals are quite a new phenomenon."
It is government policy to maintain socialised medicine against a rising tide of commercially driven health care. "The social-democrat government holds the view that the public system is necessary to maintain a free and open medical system," says Pedersen.
The nascent private system "is still a very small sector, but the trend is upward". More people are taking out private insurance to hasten availability of treatment. "The incentive to do so obviously is the waiting lists."
There is strong public support for the social system, however, particularly from doctors and nurses. "The Danish Medical Association is committed to the ideal of free, open public treatment," says Marianne Rex Sorensen, the deputy managing director of the association, which represents the country's doctors.
"There could be injustices if all the wealthy citizens were able to get and use private medicine. This is not fair," she says. "You have to put the money into the public service."
Under the existing system, all citizens have free access to their GPs and to all subsequent treatments by consultants or surgeons. Hospital stays are free, as are drugs for life-threatening illnesses. A partial fee is levied for other prescriptions.
The services are paid for via punitive income taxes, which range from about 40 per cent up to 69 per cent of gross income. Given this approach, there is no question of someone with private insurance pushing past the queues in a public hospital to get treatment, says Pedersen. "That would not be politically acceptable in this country. Public hospitals are not allowed to charge patients who are entitled to health care for free."
Decentralisation has divided Denmark into counties and urban areas or municipalities. There are 15 counties, known as amt, and 275 municipalities.
The counties have their own "mayors" and political administrations and are responsible for organising and funding their own regional hospitals. The municipalities within a county are responsible for organising social services, such as care for the young and aged, social welfare and related community services.
All this is funded by taxes levied by the amt and municipalities. The ministry of health generally does not fund health care but does set strategy and agrees spending budgets with each county, says Pedersen. A recent exception was a government investment of 500 million Danish kroner (almost £53 million), agreed last June, to help reduce waiting lists for cancer treatments.
This decentralised structure means there can be great variation in the quality of services provided by one county hospital and the next. Waiting times for procedures also vary. Yet Danish law allows a patient to switch to any other hospital in the system, as they see fit.
Decentralisation unfortunately also causes a lot of duplication, which the government is trying to overcome. "There is a government policy to encourage counties to specialise. The counties have agreed to the policy and to do it, but implementation still has to be decided," says Pedersen.
An experiment is under way on the Baltic Sea island of Bornholm to see how co-ordinating resources might save money, according to Merete ThorsΘn, the chief executive of the Danish Nurses' Organisation. The seven municipalities on the island are pooling health-care resources as a way of reducing charges. She believes centralisation of some services must happen. "It will come."
There are other problems affecting the system, however, including severe staff shortages. The ministry has openings for 700 doctors, says ThorsΘn, and there is a constant shortage of nursing staff. "That is the biggest issue: a lack of doctors and lack of nurses."
Nor is the efficient use of resources helped by the country's egalitarian approach to work and careers. That doctors work 37 hours a week, just like everybody else, means hospital theatres run for only eight hours a day.
"If you ran them 20 hours a day, seven days a week, you would cut down on the waiting lists, but you would need special deals for doctors and nurses, and there is no money for that," says ThorsΘn.
Overall, Danes seem quite satisfied with their health system, despite any criticisms that might be made. "We mostly say care is good in Denmark," says Hans Thorbald Arildskopv of Patient Foreningernes Samvirke, the Danish Patients' Association. "There is always something you could do better. For this reason we are always running to the minister to say: 'Make it better.' "
Surveys have shown that generally people are happy with their doctors, according to Lis Truels Jensen, a founder of the National Danish Association Against Breast Cancer, an advocacy group. "Patient satisfaction is measured as being good."
In a country where education is free and many view doctoring as a job like any other, Truels Jensen believes doctors could be better appreciated.
"There are a lot of idealistic doctors, because if they went anywhere else they could earn more," she says. "They deserve much more gratitude, but people tend to say, this is what he does for me, and that is it."