My name is Henning Langberg. I'm a research professor at University of Copenhagen and I hold a professorship in rehabilitation and technology. I run a large research group on rehabilitation in close collaboration with the city of Copenhagen. And by the end of this lecture, you'll have a profound insight into how the Danish healthcare system is structured. The Danish welfare system is by many seen as the optimal way of providing healthcare to as many people as possible. And you will learn how the finance and resources are dispersed and how the public and private expenditures are organized. You will also be presented for the areas of tomorrow's rehabilitation. Due to an aging population in Denmark, with more than 20% being older than 65, and an increasing number of people with lifestyle-related chronic diseases like diabetes, cardiovascular failure, and obesity, the need for healthcare services will increase in the years to come. To deal with the increased demand, we need to design new ways of preventing loss of function in the elderly to allow them to stay in their homes as long as possible with no or reduced need for help. We are 5 and a half million people in Denmark, and in Denmark the healthcare system is tax funded and free for all Danish citizens. The responsibility of the Danish healthcare system is split between the regions and the municipalities. Denmark is divided into five regions that are in charge of hospitals and general practitioners, and the medical specialists. Since 1993, Danes have been able to choose among all public hospitals. In public hospitals, we have 3.7 beds per 1,000 citizens, whereas the number of private hospital beds are very limited. Denmark consists of 98 municipalities, and municipalities are responsible for public care in general and for school health services. Prevention, rehabilitation, and care of the elderly are also taken care of by the municipalities. To further understand the Danish healthcare system, I can inform you that patients must register to a general practitioner of their choice. And no citizen in Denmark should have more than 10 kilometers of transportation to his or her general practitioner. Each general practitioner is responsible once for 1,600 patients, and 45% of the consultations are done digitally. In Denmark, 90% of people use the Internet to search for health information. As presented earlier, the Danish healthcare system is financed by taxes. However, 5% of the population has supplementary health insurances to cover treatment in private clinics, allowing them to jump public waiting list. And nearly one-third of all Danes have complementary insurances to cover glasses, dental care, and pharmaceutical co-payment. When we look at the overall cost of the health, close to 10% of the GDP in Denmark is devoted to healthcare. This is in line with most other European countries, and it's such that it's not possible to increase it further in order to meet the growing demand from increasing number of elderly and people with chronic diseases. The healthcare costs per citizen increases with increasing age. Since the mean age in Denmark increases just as it do in the rest of the world, the overall cost per citizen is rising. Thus, there will be a need for prioritizing the healthcare tasks due to the increasing number of elderly, increasing number of people with chronic diseases, and the development of new and expensive medicine. We need to control and potentially reduce the cost per elderly. And one way to do this could be to preserve their physical function through better rehabilitation, and by investing in new technologies that can reduce the cost of primary care. So let's take a look at rehabilitation. One of the earliest definitions of rehabilitation is from 1941, and states that rehabilitation can be defined as the planned attempt under skilled directions by the use of all available measures to restore or improve health, usefulness, and happiness of those who have suffered an injury or are recovering from a disease. Its further objective is to return them to the services of the community in the shortest time. In Denmark, as in many other Western countries, the rehabilitation process is building on the international classification of functioning, disability, and health, also known as the ICF. ICF is a classification of health components of functioning and disability. According to the ICF model, rehabilitation is a goal-oriented cooperative process involving professionals and members of the public, and his or her relatives over a certain period of time. The aim is to ensure that the person who has or is at risk of having seriously diminished physical, mental, or social functioning can achieve independence and a meaningful life. Rehabilitation is a citizen-centered approach that takes into account the person's situation as a whole. A citizen-centered approach also means that rehabilitation is a tailored intervention based on the citizen's overall situation and needs, which is rarely the same for two persons. Rehabilitation thus becomes a tailored process based on choices and priorities, and there's never just one right option to a given situation. This is important that decisions and interventions are not performed for the citizen, but with the citizen. Rehabilitation is based on a multidisciplinary process. When deciding and planning the intervention, it is important that the professional has knowledge about the skills and competencies of other professional groups to include these in the rehabilitation process when needed. Professionals in the rehabilitation process should know of coherent rehabilitation processes, short or long-term, from the acute to the chronic, including legislation, culture, and structure. In international and Danish literature, rehabilitation refers to both the broader modern approach that are applied in this presentation, and a more narrow approach. Rehabilitation in the broader sense, using the ICF model, focuses on body function as well on activities and positive patient, rather than on just health and functional abilities. We have to be aware that function of the individual citizens must be seen in a wider perspective. That has to do with function in everyday life of the person as a whole. To deal with the prescribed challenges, the Danish welfare system is undergoing major changes under these years. A new way of providing multidisciplinary rehabilitation has been developed and implemented over the last years, the so-called everyday rehabilitation regime. The aim of the new concept is to give individuals who cannot manage everyday life on their own functional training to regain personal independence. Everyday rehabilitation has become the preferred way of rehabilitating elderly in their homes to ensure that they have enough physical function to stay in their home as long as possible and with no or reduced help. The key elements of everyday rehabilitations are active training before passive assistance. It takes place within a determined period of time with clear defined objectives, and it translates the specific goals of the elderly into practical action. Previously, when a drop in physical function occurred, we provided help for cleaning, and after some time personal care was added, then function dropped even further. And then more care and later standard retirement homes had to be given. The idea of everyday rehabilitation is to stop this process. As an effect of everyday rehabilitation, the physical function of the elderly Is restored through training. There is, however, also an economical benefit of the concept. The result of a slightly more expensive investment in the beginning is largely parallel shift of the curve, and as the function of the elderly is restored, the cost of the primary care is reduced. However, we cannot ensure that the possible dementia can be postponed, and therefore the curves will eventually meet. In order to provide rehabilitation within the present economical budget to the increased number of elderly and people with chronic and lifetime related diseases, we need to redesign the rehabilitation process. Based on our research, we suggest that we in the future design rehabilitation regimes that meet the four following key elements. It should be tailored, should be flexible, it should be scalable, and sustainable. Tailored solutions increases ownership and ensure that all citizens can be enrolled, and that the content is suited for the single person across culture, age, skills, and social economical background. Flexible solutions ensure that access to rehabilitation is not limited by the opening hours of the rehabilitation center, and that transportation does not become a barrier. It is important that the help to the citizen is given across disease causes and not at the specific time. Scalable solutions will ensure that we are able to manage the larger number of elderly with the same percentage of GDP. Today, most interventions are quite short, approximately 8 to 12 weeks. We need a more sustainable long-term view in order for us to guide the patients to make sustainable behavioral changes and develop new habits. To sum up, the cost of primary care to elderly represents a growing international challenge, since the number of elderly people is growing. We need new solutions in order to keep the future cost at a realistic level, and there are large business potentials. DigiRehab and Steno are examples of companies pursuing this growing market and dealing with the challenges. Maybe you could take part as well. Thank you for listening.
