Integrated medical care: lessons from Denmark and Sweden

During a week of intense visits, the French delegation was able to grasp the characteristics of these healthcare systems, which are renowned for their excellence.

In Denmark, the delegation was welcomed by the public agency Healthcare Denmark, which offered them a complete vision of the Danish healthcare system. The example of the pathways of diabetic patients made it possible to understand concretely the role of the various actors involved, between the hospital, which develops outpatient care for the most complex patients and the municipality, which carries out the prevention and accompanies the most autonomous patients.

The private sector also plays a role: the Novo Nordisk foundation finances the "City against Diabetes" initiative around the world. A round table gathering representatives of patients, rehabilitation professionals and doctors clarified the major interrogation of the participants: what is the path of complex patients when there are no hospital beds dedicated to rehabilitation? The visit of the Rehabilitation Center of Bispebjerg Hospital provided a response: patients are hospitalized until they are able to return home.

They then benefit from outpatient and home rehabilitation. Some citizens need an intermediate solution and they are then housed in non-medical municipal services. The Køge City Rehabilitation Center is a brand-new example of this intermediate care setting. It is designed as a platform for the well-being of the inhabitants and offers modern rehabilitation platforms as well as social spaces for patients suffering from chronic diseases. The use of new technologies to encourage the reduction of the average lengths of stay in hospitals and the return home has particularly interested the French delegates. The Life Science Robotics' robot ROBERT® helps to implement an early and eff ective rehabilitation for patients in addition to the care offered by physiotherapists.

In Sweden, the delegation was able to delve deeper into some of the themes inherent in the development of city-hospital care pathways. At the Karolinska University Hospital, the Directorate of Innovation presented a breakthrough in its work on telemedicine. Different solutions are used to improve the quality of care of patients at home. The head of the department of neurology has presented a solution that allows the titration of patients with Parkinson's disease at home. This procedure, which required nine days of hospitalization and 315 minutes spent by the doctor, is now performed in three days at home, for a total of 90 minutes spent by the doctor. Value-based payment is a major innovation that is emerging in Sweden as in France.

Thanks to Doctor Stalberg from Stockholm County, the Board of Directors of the FHP-SSR was able to find out in detail how the Orthochoice payment model was designed and implemented. This is a bund led payment for hip and knee prostheses for simple patients (ASA 1-2). The bundle covers the entire pathway, from initial appointments to possible complications. Doctor Wiren, head of the orthopedic department at Capio Group's St Göran Hospital, completed the presentation by explaining how he had to reorganize his ward to meet this new paradigm. Indeed, bundled payment requires a very reliable and qualitative organization to be profitable.

In summary, the program of visits to Denmark and Sweden allowed delegates to discover two examples of strategies to ensure the long-term sustainability of the healthcare system: by transferring the activity from the hospital to the city of one hand and by empowering health actors in their medico-economic efficiency on the other.