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The Danish health care system: evolution - not revolution - in a decentralized system

The Danish health care system has undergone gradual changes, but not radical reforms, from 1970 until 2004. Theoretically, the development can be viewed from the perspective of fiscal federalism, decentralization, and incentives embodied in reimbursement systems. Furthermore, path dependence and incrementalism have characterized the system. The Danish health care system is decentralized politically, financially, and operationally. The counties are responsible for health care, and finance it out of county income and property taxes along with block grants from the state. Hospitals are publicly owned while general practitioners are private entrepreneurs working on contract with the counties. Hospital services and GP and specialist services are free, while there are co-payments for drugs, adult dental care, physiotherapy and the like. Co-payments make up close to 19% of total health expenditures. The system has been characterized by expenditure control, reasonable positive development in productivity, and a high degree of patient and citizen satisfaction despite waiting lists. Free choice of hospital was introduced more than 10 years ago. It has recently been expanded so that after waiting 2 months for treatments like elective surgery at public hospitals, citizens can choose either private hospitals or go abroad with full payment from public funds. The thinking behind decentralization gradually has been eroded for a number of reasons. This has led to a reform that will be effective as of January 2007. The number of counties will be reduced, but the new regions retain responsibility for health care. A national earmarked health tax will be introduced so that the regions will receive revenues from state block grants and municipal co-payment, for instance an amount per hospitalization. Copyright © 2005 John Wiley & Sons, Ltd.

Optimal rotation with differently-discounted benefit streams

The case is often now made that discount rates should decline with time. Underlying reasons include that some kinds benefit (or cost) might be discounted at a lower rate than that used for others : in particular, that rates for carbon values and environmental amenities might be less than that for timber. A lengthening sequence of rotations then arises, whether the benefits are consumptive ones realised at the rotation end, or non-consumptive ones whose annual value increases through the rotation. A timber discount rate lower than that for non-consumptive benefits leads to a shortening sequence of rotations. The results differ importantly from those of discounting at a reducing rate through time