Bringing in the bacon
Despite its small geographical size, Denmark has a big heart when it comes to asisstance and healthcare provision. Dorte Vesterholm Jensen tells us what to expect from the Danes
First published in ITIJ 91, August 2008
Despite its small geographical size, Denmark has a big heart when it comes to asisstance and healthcare provision. Dorte Vesterholm Jensen tells us what to expect from the Danes
Denmark is a small country with just five and a half million inhabitants, but the population is internationally oriented and very and keen on travelling. Danish citizens are also used to a relatively high standard of healthcare, and are well provided for by the country’s publicly financed health system. They likewise expect a good standard of medical treatment when travelling within or outside of the EU, and have come to rely on an excellent assistance industry to help them in such situations.
Travellers to Denmark enjoy the same high standards of medical care if they fall ill or are injured during their stay, which is paid for by the state up to the point when the patient is fit to fly. Here, we take a look at the structure of the healthcare market, and look at the developing assistance industry.
A public service
With more than 50 public hospitals in Denmark, the nearest medical facility is never far away, and the public health service is proud of its high standards and quality of care. It is based on the principle of equal and free access to treatment for everyone irrespective of social or financial situation, and is, to a large extent, financed by taxes. Acute help is always free, whereas medicines, dentistry, physiotherapy and psychological services are subject to partial self payment.
In the 1970s, the Danish health service was among the best in the world, but since then its position has been taken over by other Western countries. The main reason for this is the difficulty for the tax-financed system to keep abreast of the increasing consumption of health services and new, expensive methods of treatment. However, both public and private hospitals, as well as individual specialists, live up to the population’s demand for quality care, they adhere to international standards, and are among the most efficient in the Western hemisphere.
Denmark also has very good and reliable emergency services in case of accident or acute illness. There are waiting lists for certain non-acute treatments and surgery, but for a number of years work has been going on to reduce wait times, and a guarantee of treatment has been introduced which means that treatment or examinations are carried out at a private facility if the patient’s wait time exceeds a month.
In spite of the tax-financed health service, private insurance has gained a strong foothold in the country over the last five to 10 years, with approximately 15 per cent of the population now taking out insurance covering treatment in private hospitals; while even more people have taken out insurance to cover the excess on such items as dentistry, glasses and medicines.
There are only two private hospitals in Denmark, and several small private clinics
There are only two private hospitals in Denmark, and several small private clinics. None of the private hospitals or clinics have emergency rooms, but the standard of care is very good – as in the public sector – and you receive a better range of hotel services and your own room. The two private hospitals cover a broad range of treatments, and are based in Denmark’s capital city Copenhagen (Hamlet Hospital) and Vejle in Jutland (Mølholm Hospital).
Everyone who stays temporarily in Denmark is entitled to free treatment in case of sudden illness, sudden deterioration of a chronic illness, or accident. And most visitors – both European and others – are treated in state hospitals due to their accessibility, or in the university hospitals of Copenhagen, Odense, or Århus, which are considered the best of their kind. In an emergency, a ground ambulance will automatically take a patient to the nearest and best hospital for treatment.
The right to free treatment expires when the patient is fit to be repatriated to his country of residence. Regarding non-acute treatment, visitors from the EU and the Nordic countries are provided with medical care on equal terms to Danes, and expatriates residing in Denmark are similarly covered after their first six weeks’ stay.
The biggest challenge for assistance companies when working with Danish hospitals is that they have very strict rules on patient confidentiality. Thus, a doctor needs approval from the patient before any cooperation with assistance companies.
In need of assistance
Personal assistance is quite an old phenomenon in Denmark. At the end of the 1950s, SOS International, Denmark’s oldest assistance organisation was established to provide breakdown and recovery (technical) assistance to motorists, and later medical assistance to travellers. The decision to focus on technical assistance was a response to the popularity of the car as the preferred means of transport for Danes, both for domestic trips and for short international trips.
The Danes are well travelled and have been for many years. At the end of the 1950s, the first package trips to the sun of Southern Europe were sold in the country, and since then this industry has grown steadily. In recent years, however, as in many other developed countries, individual trips where holidaymakers plan their itinerary and travel details themselves have become more popular, and the travel insurance and assistance markets have developed in line with changing traveller needs.
In the EU, of which Denmark is a member, the European Health Insurance Card (EHIC) agreement applies, entitling any EU citizen the right to emergency medical treatment on the same financial terms as a resident of the country they are visiting. In addition, a special agreement exists between the Nordic countries and between Denmark and England, entitling residents of those countries who fall ill or are injured in one of the other countries in question to the same treatment as he or she would be in their own country.
Free emergency medical treatment for Danes travelling in Europe is no new thing, however. Since the 1970s, Denmark’s public health insurance scheme has covered the cost of such treatment for its citizens up to the point where they are fit to fly. This scheme is administered by an outsourced company, which since 1 January has been SOS International. The company won this contract through a public tender process in which four other companies were competing, taking over the role from Europæsiske Rejseforsikring.
with such a small population, there is a limit to how many assistance operators the market can bear
Until 31 December 2007, the public health insurance scheme also covered repatriation costs for those Danish citizens injured abroad but this cover has now been removed from the arrangement. Thus, Danes must now to take out their own private travel insurance if they want to be certain to have their repatriation expenses covered in case of illness or injury during a trip.
So, where do Danes tend to travel to when venturing abroad? Southern Europe, especially Spain, remain popular, as do France and Italy. After Southern Europe, the most commonly visited countries are neighbouring countries, while a quarter of all long-stay (four nights or more) trips abroad are to either Sweden, Norway, Germany or Great Britain. Even though destinations have become more exotic with increasing globalisation, European countries are still the preferred travel destination of the Danes. Therefore, medical assistance and treatment that is necessary abroad is, for Danes, to a very large extent covered by public compensation schemes.
Assistance growth
With such a small population, there are relatively few Danish speaking people in the world, making Denmark a fairly difficult place for foreign assistance organisations to operate in, as language capabilities are an essential requirement in this field. Also, with such a small population, there is a limit to how many assistance operators the market can bear. And it’s not like an assistance operator can simply set up a smaller base in a smaller country, as large costs are involved in the establishment of a 24-7 emergency operations centre no matter what its physical size.
Consequently, there are relatively few assistance organisations specialising in travel assistance in Denmark: a few insurance companies such as Tryg, Gouda and IHI have their own emergency centres that assist their policyholders if they find themselves in an emergency situation abroad. But most insurance companies, such as Topdanmark, Codan, Fair and Alka, choose to outsource their assistance services due to the high operating costs, special requirements and competencies needed for such work.
On the whole, SOS International is the only independent assistance organisation and emergency centre based in Denmark, even though other international assistance companies such as Europ Assistance have Nordic bases, and others such as Mondial work with commercial partners to provide services in the region. SOS is by far the largest player in this region – not only in Denmark but all the other Nordic countries as well – but it is still small compared to other international assistance companies. The reason it is, nevertheless, able to compete successfully in the international market is to a large extent due to the fact that the Nordic market is a niche market, and one it knows well. In addition, SOS is an independent player, placing its assistance requirements with a large global network of partners rather than insourcing service providers. This provides a flexible and cost-effective structure. At the same time, cooperation with far larger international organisations takes place when assistance is needed in countries where these organisations are based, while SOS and other Danish assistance organisations also undertake tasks for international organisations when assistance is needed in Denmark.
The country is a base for assistance organisations acting in the common Nordic market due to its advantageous geographical location being physically connected to the rest of Europe, and its large population size compared to the other Nordic countries. Generally, cooperation with Danish organisations is fairly simple: in many international surveys, for instance, Denmark is ranked as one of the least corrupt countries in the world, while Danes are perceived as extremely trusting people.
Regarding insurance, Danish companies tend to outsource travel claims handling more so than their Nordic neighbours. The reason being that travel claims are a relatively specialised area requiring specific competencies, and such skills have so far not been taught at the Insurance Institute – probably because travel insurance is such a small part of insurers’ business. As a result, travel claims in Denmark are handled by a number of companies who specialise in this field.
Take me home
As a nation of avid travellers, especially as so many of its population travel out of the region in the winter season to escape the harsh winter climate, Denmark has had plenty of experience repatriating injured citizens home from abroad. SOS International, for example, annually repatriates around 5,000 Scandinavians, predominantly from the Canary Islands, Spain and Thailand. The majority of its medical transports are carried out by scheduled or charter flights, however, as the largest scheduled and charter airlines in the Nordic countries fortunately still carry stretchers.
Approximately 180 stretcher repatriations are carried out from the Canary Islands during the winter season from October to April. Many elderly people travel to this area in the winter period, so at this time of year there are a higher than normal number of stretcher repatriations out of the island group. As this workload is pretty much guaranteed, SOS International pre-buys a number of stretcher spaces on this route each season.
Not only warm destinations are attractive, though: skiing holidays are also very popular. But contrary to their Nordic neighbours, Danes are not very good at skiing. This is probably due to the fact that Denmark doesn’t have any mountains – the highest ‘mountain’ is 170 metres above sea level. Nevertheless, during the 2008 ski season, SOS repatriated more than 2,000 tourists from the Alps with broken arms and legs. Again, in order to ensure seats and stretcher space for repatriating patients, SOS pre-bought a fixed number of reservations from various ski destinations.
As mentioned, most repatriations are carried out by scheduled or charter flights, but in order to ensure quality of service and price, SOS categorises airlines into A, B, C or D providers. Furthermore, with some of the airlines, SOS’s own physicians can approve a medical transport and give medical clearance, which means that the transport is authorised immediately if there is space on the flight. This quick turnaround could save a great deal of money if the patient waiting to be repatriated is in an expensive private hospital.
There is, naturally, always going to be some patients whose state of health is so critical that repatriation must be carried out by air ambulance, but air ambulances are also often used to repatriate clients from Copenhagen – a flight hub for the region – to other Nordic countries, as larger flights cannot access smaller airports in the region. Within the borders of Denmark, though, most transports from Copenhagen are carried out by ground ambulance, as the country is so small that it is often less stressful for the patient to be transferred in this way than to be transferred from one flight to another.
A happy ending
In summary, the Danish public health system is based on the principle of free medical treatment for everybody, and includes a high standard of accident and emergency treatment for foreigners who are temporarily staying in the country. Likewise, since the 1970s, emergency medical treatment required by Danes abroad has been covered by the public health insurance scheme.
As Denmark is a small geographic area, and as travel insurance is a niche market, many insurance companies outsource their assistance services relating to such insurance to assistance organizations operating in the entire Nordic market. The assistance market is highly developed, however, and offers a world-class standard of service to Danish and other Nordic citizens travelling abroad.