OECD reviews of health care quality. Denmark 2013 : raising standards

Hailed as a means to transform cultural norms and change lives, violence prevention programs signal a slow-rolling policy revolution that has reached nearly two-thirds of young people in the United States today. Max A. Greenberg takes us inside the booming market forprogramming and onto the asphalt campuses of Los Angeles where these programs areimplemented, many just one hour a week for 12 weeks. He spotlights how these ephemeral programs, built on troves of risk data, are disconnected from the lived experiences of the young people they were created to support. Going beyond the narrow stories told about at-risk youth through data and in policy, Greenberg sketches a vivid portrait of young men and women coming of age and forming relationships in a world of abidingharm and fleeting, fragmented support.At the same time, Greenberg maps the minefield of historical and structural inequalities that program facilitators must navigate to build meaningful connections with the youth they serve. Taken together, these programs shape the stories and politics of a generation and reveal how social policy can go wrong when it ignores the lives of young people. This review of health care quality in Denmark examines policies related to quality and includes chapters covering primary and integrated care, hospital specialisation and equity. It finds that with a dense array of disease- and service-focused quality initiatives, and with information on the quality of care stored in separate data repositories, Denmark needs to create effective links and synergies between them to drive up quality in the healthcare system as a whole, rather than in disconnected elements. Primary care will be central in meeting Denmark's future healthcare challenges of an ageing population with multiple chronic conditions. Therefore, an urgent need is to create a national vision of how a modernised primary care sector will fulfill this new coordination role. National standards, clinical guidelines, accreditation of clinical pathways and targeted financial incentive programmes could support this role, along with more transparent and formalised continual professional development. To facilitate quality improvement from the ambitious hospital rationalisation, Denmark should collect and disseminate data on the quality of individual physicians as well as the hospitals. Undergraduate training and medical research should be reviewed in light of the new service arrangements. Close surveillance will be needed to monitor whether certain patient groups forego healthcare because travel times to providers are too long. Limited data availability complicate Denmark's ability to monitor its commitment to equitable healthcare. There is an urgent need for renewed action to tackle risk factors of chronic ill-health that disproportionately affect low-income groups. Better information on the impact of user-charges on unmet need in low-income groups is needed