The Danish Minister for the Interior and Health, Bertel Haarder, has never had health insurance.

“It’s simply not necessary,” he told a full Joukowsky Forum this week. “Health care in Denmark is free and all citizens are covered.”

During the talk titled “Health Care: Perspectives on Priorities in Denmark and the European Union,” Haarder compared various systems in terms of coverage, quality, and cost.

In Denmark, health is privileged – the government subsidizes two-thirds of annual spending on drugs, for instance – as part of the national ethos of equality, Haarder said. The system is financed through taxes and costs a little more than half the cost per capita than in the United States.

The Scandinavian country, he also pointed out, was rated the world’s happiest country by a Gallup World Poll in 2010.

But Haarder, who is ideologically positioned as center-right, also outlined some of the challenges in the health system. Because of the Danish focus on equality, the development of leading hospitals and medical innovations is difficult, he said. “There is a huge pressure on the health care system, the expectations are rising all the time,” the minister added. “You could call it the tyranny of equality. The worst thing you could do in Danish politics is diverge from that principle of equality.”

A growing elderly population, excessive drinking and smoking, and a dwindling number of general practitioners are the chief concerns in the Nordic country. But its health sector is growing in productivity by two percent annually and is the only sector with increased expenditure, he added.

Like Denmark, all European countries have universal health coverage, though the models vary. Haarder separated the Scandinavian tax-based model from the German model that combines compulsory private insurance with state-financed options for the elderly and the poor. “All systems have their advantages and shortcomings,” the minister said.

European Union member states remain responsible for their national health plans, he said. But the bloc approves pharmaceuticals sold within the internal market as a whole, for instance. And as of next year, patients will be able to use prescriptions in drug stores across the EU.

Health care provision is also progressing in the ex-Soviet states that have recently joined the EU, said Romano Prodi, the former prime minister of Italy and Brown professor at large, who attended the talk.

“Health care is the right of every European citizen,” Prodi said during the question and answer session. “It’s a very peculiar difference between the United States and Europe.”

While Haarder agreed that transatlantic views on health care diverge significantly, he said the major predicaments – the aging of the baby boomers and a growth in medical possibilities – are shared.

But skyrocketing costs and overtreatment are the principal ills in the American model, he added. And once expenditures have swelled, he added, shrinking them back is tricky. “There is no necessary link between cost and quality,” the minister said. “That of course should make it possible to reduce costs without reducing quality, but I have to see it before I believe it.”

While lamenting the money spent on insurance, lawsuits, and treatment in the United States, Haarder said the model’s competitiveness has benefits. European nations envy the prime American hospitals that often attract the best doctors, he added.
As a European, Haarder said he found it puzzling that the American health care reform did not overhaul the system more fundamentally.

“Health is at the top of the political agenda in the United States and that is also the case in Denmark. But we certainly have different points of departure,” Haarder said. “Is it possible to combine the two systems? Yes, it should be possible.”

His talk was co-sponsored by the Danish Institute for Study Abroad, Brown University’s Global Health Initiative, the Office of International Programs, the Program in Liberal Medical Education and the Watson Institute for International Studies.

By Watson Institute Student Rapporteur Alexandra Ulmer ’11

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