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Something is amiss in Denmark: A comparison of preventable hospitalisations and readmissions for chronic medical conditions in the Danish Healthcare system and Kaiser Permanente

Michaela Schiøtz12*, Mary Price3, Anne Frølich5, Jes Søgaard6, Jette K Kristensen7, Allan Krasnik2, Murray N Ross8, Finn Diderichsen2 and John Hsu34

Author Affiliations

1 Steno Health Promotion Center, Steno Diabetes Center, Niels Steensensvej 8, DK-2820 Gentofte, Denmark

2 Section for Health Services Research, Department of Public Health, Faculty of Health Science, University of Copenhagen, Øster Farimagsgade 5, Building 10, DK-1014 Copenhagen K, Denmark

3 Division of Research, Kaiser Permanente Medical Care Program, 2000 Broadway, Oakland, CA 94612, USA

4 Mongan Institute for Health Policy, Massachusetts General Hospital and Partners Health Care System, 50 Staniford Street, 9thFloor, Boston, MA, 02114; Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA, 02115, USA

5 Copenhagen Hospital Cooperation, Bispebjerg Bakke 23, Bispebjerg Hospital; DK-2400 Copenhagen NV, Denmark

6 Danish Institute for Health Services Research, Dampfærgevej 27-29, DK-2100 Copenhagen Ø, Denmark

7 Department of General Practice, University of Aarhus, Bartholins Allé 2, DK-8000 Aarhus, Denmark

8 Kaiser Permanente Institute for Health Policy, One Kaiser Plaza, 22nd Floor, Oakland CA 94612 USA

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BMC Health Services Research 2011, 11:347  doi:10.1186/1472-6963-11-347

Published: 22 December 2011



As many other European healthcare systems the Danish healthcare system (DHS) has targeted chronic condition care in its reform efforts. Benchmarking is a valuable tool to identify areas for improvement. Prior work indicates that chronic care coordination is poor in the DHS, especially in comparison with care in Kaiser Permanente (KP), an integrated delivery system based in the United States. We investigated population rates of hospitalisation and readmission rates for ambulatory care sensitive, chronic medical conditions in the two systems.


Using a historical cohort study design, age and gender adjusted population rates of hospitalisations for angina, heart failure, chronic obstructive pulmonary disease, and hypertension, plus rates of 30-day readmission and mortality were investigated for all individuals aged 65+ in the DHS and KP.


DHS had substantially higher rates of hospitalisations, readmissions, and mean lengths of stay per hospitalisation, than KP had. For example, the adjusted angina hospitalisation rates in 2007 for the DHS and KP respectively were 1.01/100 persons (95%CI: 0.98-1.03) vs. 0.11/100 persons (95%CI: 0.10-0.13/100 persons); 21.6% vs. 9.9% readmission within 30 days (OR = 2.53; 95% CI: 1.84-3.47); and mean length of stay was 2.52 vs. 1.80 hospital days. Mortality up through 30 days post-discharge was not consistently different in the two systems.


There are substantial differences between the DHS and KP in the rates of preventable hospitalisations and subsequent readmissions associated with chronic conditions, which suggest much opportunity for improvement within the Danish healthcare system. Reductions in hospitalisations also could improve patient welfare and free considerable resources for use towards preventing disease exacerbations. These conclusions may also apply for similar public systems such as the US Medicare system, the NHS and other systems striving to improve the integration of care for persons with chronic conditions.