Analysis of the political process of Denmark’s hospital reform

Background

The German hospital landscape is characterized by a decentralization of the range of services provided, low levels of specialization and significant overcapacity. This leads to over-, under- and misuse of hospital care, which is not least evidenced by wide variation in quality in the system. In Denmark, since the early 2000s, a continuous restructuring of the hospital landscape has been undertaken. Among other things, hospitals have been rebuilt, many smaller hospitals have closed and the number of emergency rooms has been halved. The aim of the project K:IDD (Hospital: Impulses for Germany from Denmark) is to examine the conditions that have to be created to be able to incorporate parts of the Danish reform into German hospital care, and to leverage these for improved patient care. To learn from the case of Denmark, it is important to understand which circumstances facilitated the reform.

Methods

To analyse the political process behind Denmark's hospital reform using two different sources will be used: (1) A qualitative content analysis of 17 semi-structured expert interviews with political scientists, journalists, politicians, among others and (2) an analysis of the literature about the reform. Kingdon's (1994) multiple stream framework as well as Tsebelis' (1995) Veto-player theory will be used.

Results

The key success factors encouraging to the reform will be presented. In addition potential Veto-Players and institutional settings enabling or hindering the reform will be described. The final assessment of the policy process and comparison to the German context will lead to implementation guidance and recommendations for the German context. Further, alternative courses of action will be presented.

Conclusions

The findings from this analysis can provide important and practical recommendations for the necessary reform of the hospital landscape in Germany, thereby improving hospital care in the long term.

Key messages

The hospital reform in Denmark was possible due to the interaction of different social currents, which ultimately opened a window of opportunity. This could be used as role model for decision-makers, professionals and researchers strive for change in other countries.

DNA synthesis in HeLa cells and isolated nuclei after treatment with an inhibitor of spermidine synthesis, methyl glyoxal bis(guanylhydrazone)

Addition of methyl glyoxal bis(guanylhydrazone) to HeLa S3 suspension cultures resulted in increased putrescine levels and decreased spermidine and spermine levels preceding a drop in incorporation of [3H]thymidine, [3H]uridine and [14C]leucine into macromolecules. When putrescine, spermidine, spermine or cadaverine was added simultaneously with methyl glyoxal bis(guanylhydrazone), the drug had no detectable effect on the synthesis of macromolecules. In nuclei isolated from cells treated with methyl glyoxal bis(guanylhydrazone) the reduction in the rate of DNA synthesis was equal to the reduction of [3H]thymidine incorporation in the corresponding whole cells. The capability of the nuclei to synthesize DNA could not be restored by adding spermidine or spermine to the system in vitro. The rate of DNA chain elongation was only reduced slightly by methyl glyoxal bis(guanylhydrazone) indicating that decreased levels of spermidine and spermine lead to a decrease in the number of replication units active in DNA synthesis within each cell.