The context for supply and demand of public online services in Denmark

Politically and administratively, Denmark is organised in three levels: state central government, 13 Amter (Counties) and 271 Kommuner (municipalities). From 2007 onwards, a structural reform will collapse the 13 "counties" into five "regions", and reduce the number of municipalities from 271 to 98, of which a large number will have more than 30,000 inhabitants.

The purpose of the structural reform is strengthening and rationalising the work of the public sector. It leaves fewer responsibilities with the counties, and the power taken from the counties is then divided between the state level and the new, larger municipalities. This, however, does not alter the overall principle of government, namely that the public tasks which are close to the citizens' everyday life such as day-care, care for the elderly, schools and social support also are to be placed in the administrative level close to the citizen. Denmark has a strong tradition for leaving a number of important jobs to the municipalities at the local level.

Key figures about Denmark [1]

	Denmark	Ø EU15	Ø EU25
Old age dependency ratio	22.5	25.5	24.5
Population density	124.3	119.8	116.3
GDP per head	122.6	108.6	100.0
GDP growth - 5 year average	1.85%	1.85%	1.92%
Unemployment rate	5.4%	8.1%	9.0%
Inequality index	22	30	29

The Danish system relies on high taxes, which some argue need to be lowered; but most agree that compared to other countries, Denmark has few long-term, structural problems. Literacy levels are high, unemployment low and the economy of the country generally works well. Among the national challenges are keeping up with the fast-changing global economy, and figuring out how to finance the services of the welfare state in the years to come.

Denmark's modern market economy features high-tech agriculture, up-to-date small-scale and corporate industry, extensive government welfare measures, comfortable living standards, a stable currency, and high dependence on foreign trade. The GDP per head is much higher than the weighted average of EU25 (2002: 122.6), although the 5-years-average of the GDP growth is comparable to the rest of the European Union. Because of high GDP per capita, welfare benefits, a low Gini index, and political stability, the Danish people enjoy living standards topped by few other countries.

A major long-term issue is the projected sharp decline in the ratio of workers to retirees. Current demographic trends indicate that there will be 90,000 more elderly people over the age of 65 in the population by 2010, while the labour force - assuming unchanged rates of employment (2004: 5.4%) - will decrease by more than 50,000. Up to 150,000 public employees will retire by the year 2010. The demographic trends also imply a pressure on expenditure that will have to be dealt with within a restricted budget, while at the same time, it is also expected that the demands and expectations of citizens and companies towards public services will increase.

For businesses, in particular, the increasing level of internationalisation will require interaction with the public sector. In order to cope with these challenges, it is necessary to renew and enhance management, organisation, task performance and working procedures at all levels in the public sector.[2]

The latest Information Society Index (ISI) - a study carried out by IT market intelligence firm IDC on an annual basis - found that Denmark has displaced Sweden as the world's Information Society champion. Even though the prices for Internet use and ICT expenditure rates are close to the EU average in the European Union, exceptionally high Internet and broadband penetration rates indicate the advanced state of the Information Society in Denmark.

Information Society indicators[3]

	Denmark	Ø EU15	Ø EU25
Households with Internet access	69%	45%	42%
Broadband penetration	15.6%	7.6%	6.5%
Price for Internet use basket	49.3	49.57	48.35
ICT expenditure as percentage of GDP	3.1%	3.2%	2.6%
Digital Divide Index	61.4	53.0	50.1

Denmark's performance on the UN Telecom Index[4]

eHealth in Denmark

In Denmark a patient's entrance to the free of charge, public healthcare system is the general practitioner. He or she will refer the patients to specialists or hospitalisation or other treatments. There has been much public debate on the quality and standards of public healthcare, waiting lists, lack of appropriate treatments etc. in Denmark.

The possibility for patients to "navigate" through the healthcare system on their own, get second opinions, get information about available treatments in other regions (if the waiting lists are considered too long or not offered in ones own region) will put the patient in a stronger bargaining position vis-a-vis the general practitioner. This is a strong incentive when searching for information on the Internet on health related issues.

Key figures about the Danish Health System [5]

	Denmark	Ø EU15	Ø EU25
Percentage satisfied with own health	91.4%	82.5%	79.8%
Prevalence of long-term illness	27.5%	13.8%	20.0%
Doctors per 100,000 inhabitants	365	233	251
Health expenditure as percentage of GDP	5.8%	7.4%	7.3%

Denmark has a system of house doctors. All citizens are assigned a GP. You can either request a consultation with the doctor by calling his/her office or contact your doctor by telephone. Most house doctors make telephone consultation 1 hour a day. The telephone consultation is usually used for prescription renewal, advice and to estimate whether the doctor needs to see the patient in person.

When outside normal office hours the Lægevagten (Medical emergency call service) www.laegevagten.dk can be contacted by telephone.

Despite Denmark having only a little over 5 million inhabitants, the 14 Danish counties have invested in different computer systems some of them with interoperability issues. For now the Sundhedsstyrelsen (Danish National board of Health) have developed XML standards for data exchange within the healthcare sector, and plans are made to ensure interoperability and data exchange among the various actors. However the development of patients electronic record systems has been slow as ITC investment in healthcare has been very decentralised. Pressure for interoperability and the structural reform announced has either delayed or put many ITC projects in eHealth on hold.

There are 279 pharmacies in Denmark. Pharmacies are subject to in-depth state regulation and very strict competition. The Ministry of the interior and health and the Medicines Agency control and administer the sector through a licensing system. The state control stands in contrast to other parts of the health system, which is primarily operated by the counties. At the same time running a pharmacy is a liberal profession, and the proprietor pharmacist owns his/her pharmacy. This means that the proprietor pharmacist is economically responsible for the financing of the pharmacy and its operation. In order to become a proprietor pharmacist a licence must be obtained from the Minister of the interior and health who also appoints new proprietor pharmacists. In short, the Ministry of Health advertises a pharmacy licence when it becomes vacant. The authorities also determine how much the pharmacies may earn altogether. Every second year, the Danish Pharmaceutical Association and the Ministry of the Interior- and Health negotiate the gross profit, which corresponds to the contribution margin of the entire sector for all products and services.

Satisfaction with National Healthcare System[6]

The Danish Pharmaceutical Association has developed a website www.apotek.dk with information, guidance and relevant pharmaceutical information. From Apotek.dk it is also possible to buy medicine. Through law people with residence in Denmark are prohibited from buying prescription medicine from anywhere else than a licensed pharmacy. This prohibition also extends to the Internet, so that Danish citizens are not allowed to buy prescription drugs on the Internet from abroad.

In Denmark the first eHealth portal (NetDoktor) for the public was a private initiative in collaboration between physicians, healthcare professionals and information specialists. The portal is an information portal consisting of information and evidence based clinical practices, principles and information and advice. The service is maintained through a network of 80 attached doctors and other experts who writes, edits and answer questions from users in online communities. The portal has now migrated to other countries in the NetDoctor.com group now making up a group of portals in six countries.

General Practitioners with Websites[7]

Apart from the two mentioned portals a number of health related sites exist. Among the most important are www.medicinprofilen.dk (Medicine profile) and Lægemiddelkataloget (Danish Medicine Catalogue). Medicinprofilen is an electronic list of all Danish prescription medicine that can be bought in a pharmacy. As registration of prescription medicine is obligatory it is automatically registered in Medicinprofilen. The service can help patients, doctors and pharmacies prevent that patients get the wrong medicine, too much medicine or types of medicine that interacts with each other. Lægemiddelkataloget (www.lk-online.dk/) is an information service for health professionals with information on drugs, components, colouring agents, therapeutic groups, pharmaceutical companies, pharmacies. The purpose of the Medicine Catalogue is to give guidance to using human medicine.

Furthermore, a number of patient organisations exist (organisations for patients with specific deceases/diagnoses) and they all run websites that offer information on individual diagnoses and deceases.

In the spotlight: www.sundhed.dk

User orientation in eHealth services

In the Danish National IT Strategy for Healthcare 2003-2007 the public portal Sundhed.dk plays a main role. The intention is to create a common electronic main entrance to healthcare and to ensure increasing insight and dialogue between citizens and the health care system. The main objectives for the health portal are to:

• support future electronic communication between patients and the healthcare system;
• act as a communication tool between the various parts of the healthcare system;
• give citizens/patients an overview of the healthcare system and information related to the use of the healthcare system, as well as supporting the patients in taking charge of their own health and treatments;
• publish professional healthcare information relevant for professional healthcare practitioners.

Internet Use for Searching Health Information[8]

The portal Sundhed.dk will be implemented stepwise. In the first phase the main objective is on targeted information, overview and communication that supports the meting between patient and general practitioner. In the coming phases Sundhed.dk will develop towards a higher degree of integration, communication and process support for the whole healthcare system.

In the first phases all citizens will gain access through Sundhed.dk to their own personal homepage on health on the Internet. The homepage is seen as the citizens "virtual health folder" and a secure platform of communication with the health care system. It will be possible to electronically make reservations and renewal of prescriptions as well as conduct an e-mail consultation with patients own general practitioner.

The personal health homepage will also give targeted information about healthcare and give the patients a better overview on his or hers own options and treatment. The page will also give patients access to the data and information the health care system has collected about the patient, i.e. information on medication and in the longer term access to data from electronic patient health records.

For health professionals the health portal has the objective of providing and supporting the "clinical IT-work place" and the ITC tools used in the clinical work processes. The portal will ensure an easy and personalised access to targeted professional information, clinical guidelines and decision support systems, which should enhance quality, coordination and interdisciplinary cooperation in the health care system. It will increase access to up to date information on individual patients state of health in such a way that health professionals can access information on existing and past treatments through a secure access to patients medicine profile, historic data in the "Landspatientregistret" (a national register containing information about the Danish population's health status over the past 25 years), from laboratory systems, and electronic health records and systems etc.

eUser - the Project

The eUser study is funded by the European Commission's IST (Information Society Technology) programme. eUser is a major research and support project which has set out to provide solid evidence as to users' real needs regarding eGovernment, eHealth and eLearning offers, as well as providing data about their attitudes and the uptake levels of current public online services. The project supports the IST programme to achieve its key objectives of putting the user and his/her needs at the centre of IST developments. It provides empirical information on key public eServices domains -eGovernment, eHealth, eLearning - identified as priorities by the European Council, and assesses the demand/supply match in these fields.

The eUser Approach

To achieve its objectives, eUser addresses both generic user-related issues and domain-specific topics, and develops a globally accessible repository of evidence-based knowledge, methods and best practice examples. It pursues an extensive programme of active knowledge translation, transfer and dissemination supported by sophisticated online knowledge dissemination tools. The knowledge base will consolidate both existing knowledge and approaches, and novel data generated by the project through representative population surveys (demand side) in old and new Member States, and through comparative analyses of readiness to address user aspects of public eServices in each Member State (supply side).

The project is designed in two phases. Phase I - the preparatory phase - has developed a conceptual framework that systematically identifies and cross-references user issues and service characteristics in relation to online public services. An EU-wide population survey regarding the needs, experiences and requirements of both current and potential users of online public services has been carried out in early 2005. Concerning the supply side, information from national public sector environments has been collected, about the degree to which the European public sector pays sufficient attention to user-orientation of online services. Good practice examples regarding user-appropriate online public service provisions are being identified and described.

All these results build the basis and provide content for the eUser interactive online knowledge base and support service which is being set up as an online observatory on user issues. This constitutes the basis for active support services on user-centred topics which are being made available inside and outside the IST programme.

eUser Country Briefs

This document has been prepared by Lone Jensen of the Danish Technological Institute, as a partner in the eUser consortium, based on primary sources mainly within Denmark as well as secondary data sources such as Eurostat and other Commission Services.

25 eUser eHealth Country Briefs are available in a common format, one for each member of the enlarged European Union. You can access and download these documents in PDF format (for free) from our website.

More information

Check our results and achievements on: www.euser-eu.org. If you wish to be provided with more details, or to receive news and updates, please contact us at: eUser@empirica.com or get in touch with any of the project partners listed below.

empirica Gesellschaft für Kommunikations- und Technologieforschung mbH (Project Co-ordinator) Oxfordstr. 2, 53111 Bonn, Germany, Tel.: +49 228 985 30 0, www.empirica.com

Danish Technological Institute Center for Competence and IT Kongsvang Allé 29, Aarhus, Denmark, Tel.: +45 72201417, www.teknologisk.dk

Foundation for Research and Technology - Hellas Institute of Computer Science P.O. Box 1385, Heraklion, Crete, GR - 71110 Greece, Tel: +30-2810-391741, www.ics.forth.gr

Work Research Centre Ltd. 1 Greenlea Drive, Terenure, Dublin 6W, Ireland, Tel.: +353 1 492 7042, www.wrc-research.ie

University of British Columbia, Vancouver, BC, Canada #105 - 2194 Health Sciences Mall, Vancouver, B.C., Canada, Tel.: +1 6 04 6 39 46 68 www.cme.med.ubc.ca

National Research Council Canada, Saint John, New Brunswick 127 Carleton Street, Saint John, New Brunswick, Canada, E2L 2Z6, Tel: +1 5 06 6 35 06 33, www.iit-iti.nrc-cnrc.gc.ca

Notes About the Data Sources Used in This Document

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