{"id":38899,"date":"2018-12-01T12:04:38","date_gmt":"2018-12-01T11:04:38","guid":{"rendered":"https:\/\/gestions-hospitalieres.fr\/?p=38899"},"modified":"2019-01-10T16:14:13","modified_gmt":"2019-01-10T15:14:13","slug":"le-systeme-de-sante-danois","status":"publish","type":"post","link":"https:\/\/www.ricom-web8.com\/gestions\/le-systeme-de-sante-danois\/","title":{"rendered":"Le syst\u00e8me de sant\u00e9 danois"},"content":{"rendered":"<span class=\"span-reading-time rt-reading-time\" style=\"display: block;\"><span class=\"rt-label rt-prefix\">Temps de lecture\u00a0: <\/span> <span class=\"rt-time\"> 3<\/span> <span class=\"rt-label rt-postfix\">minutes<\/span><\/span><h1>Un syst\u00e8me financ\u00e9 par l\u2019imp\u00f4t, avec un r\u00f4le r\u00e9gional tr\u00e8s marqu\u00e9<\/h1>\n<p>Fruit de l\u2019histoire, la diff\u00e9rence fondamentale entre nos deux syst\u00e8mes de sant\u00e9 r\u00e9side dans le mode de financement. Assis sur l\u2019imp\u00f4t dans le syst\u00e8me danois, il diff\u00e8re du syst\u00e8me fran\u00e7ais inspir\u00e9 de l\u2019histoire bismarckienne et fond\u00e9 sur les cotisations sociales<sup class=\"appel\" data-toggle=\"modal\" data-target=\"#notes\">(2)<\/sup>. Le syst\u00e8me de sant\u00e9 danois, lui, est bas\u00e9 sur une couverture universelle gratuite et l\u2019\u00e9galit\u00e9 d\u2019acc\u00e8s au syst\u00e8me de sant\u00e9.<\/p>\n<p>Le minist\u00e8re de la Sant\u00e9 danois \u00e9tablit les grandes lignes de la politique de sant\u00e9 (<i>figure 1<\/i>). Le syst\u00e8me de sant\u00e9 danois est fortement d\u00e9l\u00e9gu\u00e9 aux r\u00e9gions.<\/p>\n<button data-toggle=\"collapse\" data-target=\"#enc_2018_616_01\">FIGURE 1<\/button><div id=\"enc_2018_616_01\" class=\"encadre collapse\"><p><span class=\"surtitre_enc\">figure 1<\/span><\/p>\n<h2>Le syst\u00e8me de sant\u00e9 danois<span class=\"Apple-converted-space\">\u00a0<\/span><\/h2>\n<h3>Une organisation d\u00e9centralis\u00e9e et trois niveaux de responsabilit\u00e9<\/h3>\n<p><img decoding=\"async\" class=\"alignnone size-full wp-image-38853\" src=\"https:\/\/gestions-hospitalieres.fr\/wp-content\/uploads\/2018\/12\/Capture-d\u2019\u00e9cran-2018-12-27-\u00e0-14.15.12.png\" alt=\"\" width=\"600\" height=\"309\" srcset=\"https:\/\/www.ricom-web8.com\/gestions\/wp-content\/uploads\/2018\/12\/Capture-d\u2019\u00e9cran-2018-12-27-\u00e0-14.15.12.png 600w, https:\/\/www.ricom-web8.com\/gestions\/wp-content\/uploads\/2018\/12\/Capture-d\u2019\u00e9cran-2018-12-27-\u00e0-14.15.12-300x155.png 300w\" sizes=\"(max-width: 600px) 100vw, 600px\" \/><\/p>\n<\/div>\n<p>Jusqu\u2019en 2007, le Danemark comptait 14 d\u00e9partements, rassemblant entre 250\u2009000 \u202fet 500\u2009000 habitants. Ces d\u00e9partements pouvaient pr\u00e9lever l\u2019imp\u00f4t et \u00e9taient en charge de la sant\u00e9. Un comit\u00e9 a estim\u00e9 que ce niveau n\u2019\u00e9tait pas pertinent. Cinq r\u00e9gions, dont la comp\u00e9tence principale est la sant\u00e9 (96\u2009% de leur budget), ont \u00e9t\u00e9 cr\u00e9\u00e9es. Contrairement au mod\u00e8le su\u00e9dois, elles ne peuvent pas pr\u00e9lever l\u2019imp\u00f4t Elles disposent d\u2019une dotation g\u00e9n\u00e9rale de fonctionnement octroy\u00e9e par le gouvernement chaque ann\u00e9e et bas\u00e9e sur des facteurs sociod\u00e9mographiques.<\/p>\n<p>L\u2019\u00c9tat affecte au financement de la sant\u00e9 une taxe nationale de 8\u2009% sur les revenus (imp\u00f4t proportionnel), une partie des ressources de la TVA et des taxes \u00e0 vocation comportementale.<\/p>\n<p>L\u2019entr\u00e9e dans le soin passe pour 87\u2009% des Danois par le m\u00e9decin g\u00e9n\u00e9raliste, avec en moyenne 1\u2009600 patients par g\u00e9n\u00e9raliste.<\/p>\n<p>Les municipalit\u00e9s, en charge de la pr\u00e9vention, re\u00e7oivent des dotations et peuvent elles aussi pr\u00e9lever des imp\u00f4ts locaux.<\/p>\n<button data-toggle=\"collapse\" data-target=\"#enc_2018_616_04\">TABLEAU 2<\/button><div id=\"enc_2018_616_04\" class=\"encadre collapse\"><p><span class=\"surtitre_enc\">tableau 2<\/span><\/p>\n<h2>Comparaison France-Danemark<\/h2>\n<p><img decoding=\"async\" class=\"alignnone size-full wp-image-38856\" src=\"https:\/\/gestions-hospitalieres.fr\/wp-content\/uploads\/2018\/12\/Capture-d\u2019\u00e9cran-2018-12-27-\u00e0-14.18.02.png\" alt=\"\" width=\"600\" height=\"226\" srcset=\"https:\/\/www.ricom-web8.com\/gestions\/wp-content\/uploads\/2018\/12\/Capture-d\u2019\u00e9cran-2018-12-27-\u00e0-14.18.02.png 600w, https:\/\/www.ricom-web8.com\/gestions\/wp-content\/uploads\/2018\/12\/Capture-d\u2019\u00e9cran-2018-12-27-\u00e0-14.18.02-300x113.png 300w\" sizes=\"(max-width: 600px) 100vw, 600px\" \/><\/p>\n<\/div>\n<h1>Le programme \u00ab\u2009Super H\u00f4pital\u2009\u00bb<\/h1>\n<p>En 2007, le Danemark a lanc\u00e9 un programme \u00ab\u2009Super H\u00f4pital\u2009\u00bb de 21 projets hospitaliers (extensions ou constructions neuves) pour un investissement total de 6,4 \u202fmilliards d\u2019euros d\u2019ici \u00e0 2025, alors qu\u2019il en comptait 121 en 1880 et 78 en 2000 (<i>figure\u202f 2<\/i>). Le programme s\u2019est bas\u00e9 sur une double pr\u00e9vision de diminution de 20\u2009% des journ\u00e9es d\u2019hospitalisation et d\u2019augmentation de 50\u2009% de l\u2019activit\u00e9 ambulatoire <i>(tableau \u202f1<\/i>). De nombreux services d\u2019urgence ont \u00e9t\u00e9 fusionn\u00e9s et\/ou sp\u00e9cialis\u00e9s.<\/p>\n<p>Le programme \u00ab\u2009Super H\u00f4pital\u2009\u2009\u00bb est financ\u00e9 \u00e0 60\u2009% par l\u2019\u00c9tat et \u00e0 40\u2009% par les r\u00e9gions.<\/p>\n<p>Un panel d\u2019experts internationaux, avec une Norv\u00e9gienne et un Su\u00e9dois, est en charge du processus, afin de le d\u00e9politiser et le l\u00e9gitimer.<\/p>\n<button data-toggle=\"collapse\" data-target=\"#enc_2018_616_02\">FIGURE 2<\/button><div id=\"enc_2018_616_02\" class=\"encadre collapse\"><p><span class=\"surtitre_enc\">figure 2<\/span><\/p>\n<h2>L\u2019\u00e9volution du paysage hospitalier danois<\/h2>\n<h3>De 78 h\u00f4pitaux de soins de courte dur\u00e9e \u00e0 21 h\u00f4pitaux de soins de courte dur\u00e9e avec accueil 24h\/24<\/h3>\n<p><img decoding=\"async\" class=\"alignnone size-full wp-image-38854\" src=\"https:\/\/gestions-hospitalieres.fr\/wp-content\/uploads\/2018\/12\/Capture-d\u2019\u00e9cran-2018-12-27-\u00e0-14.17.28.png\" alt=\"\" width=\"600\" height=\"301\" srcset=\"https:\/\/www.ricom-web8.com\/gestions\/wp-content\/uploads\/2018\/12\/Capture-d\u2019\u00e9cran-2018-12-27-\u00e0-14.17.28.png 600w, https:\/\/www.ricom-web8.com\/gestions\/wp-content\/uploads\/2018\/12\/Capture-d\u2019\u00e9cran-2018-12-27-\u00e0-14.17.28-300x151.png 300w\" sizes=\"(max-width: 600px) 100vw, 600px\" \/><\/p>\n<p>&nbsp;<\/p>\n<\/div>\n<button data-toggle=\"collapse\" data-target=\"#enc_2018_616_03\">TABLEAU 1<\/button><div id=\"enc_2018_616_03\" class=\"encadre collapse\"><p><span class=\"surtitre_enc\">Tableau 1<\/span><\/p>\n<h2>L\u2019\u00e9volution de l\u2019offre danoise<\/h2>\n<p><img decoding=\"async\" class=\"alignnone size-full wp-image-38855\" src=\"https:\/\/gestions-hospitalieres.fr\/wp-content\/uploads\/2018\/12\/Capture-d\u2019\u00e9cran-2018-12-27-\u00e0-14.17.40.png\" alt=\"\" width=\"600\" height=\"237\" srcset=\"https:\/\/www.ricom-web8.com\/gestions\/wp-content\/uploads\/2018\/12\/Capture-d\u2019\u00e9cran-2018-12-27-\u00e0-14.17.40.png 600w, https:\/\/www.ricom-web8.com\/gestions\/wp-content\/uploads\/2018\/12\/Capture-d\u2019\u00e9cran-2018-12-27-\u00e0-14.17.40-300x119.png 300w\" sizes=\"(max-width: 600px) 100vw, 600px\" \/><\/p>\n<\/div>\n<h1>Des d\u00e9fis majeurs<\/h1>\n<h2>Des disparit\u00e9s entre les attentes des besoins et l\u2019offre propos\u00e9e<span class=\"Apple-converted-space\">\u00a0<\/span><\/h2>\n<p>En d\u00e9pit de ses adaptations, le syst\u00e8me danois souffre encore d\u2019un \u00e9cart entre la demande des patients et ce que le syst\u00e8me est en mesure de leur offrir\u2009:<\/p>\n<ul>\n<li>le traitement reste encore global l\u00e0 o\u00f9 la demande de sp\u00e9cialisation est forte\u2009;<\/li>\n<li>le syst\u00e8me est encore trop fragment\u00e9 l\u00e0 o\u00f9 une int\u00e9gration encore accrue des soins est requise. <i>Figure\u202f 3<\/i><\/li>\n<\/ul>\n<button data-toggle=\"collapse\" data-target=\"#enc_2018_616_05\">FIGURE 3<\/button><div id=\"enc_2018_616_05\" class=\"encadre collapse\"><p><span class=\"surtitre_enc\">figure 3<\/span><\/p>\n<h2>The gap and the Bermuda Triangle<\/h2>\n<p><img decoding=\"async\" class=\"alignnone size-full wp-image-38857\" src=\"https:\/\/gestions-hospitalieres.fr\/wp-content\/uploads\/2018\/12\/Capture-d\u2019\u00e9cran-2018-12-27-\u00e0-14.18.15.png\" alt=\"\" width=\"600\" height=\"287\" srcset=\"https:\/\/www.ricom-web8.com\/gestions\/wp-content\/uploads\/2018\/12\/Capture-d\u2019\u00e9cran-2018-12-27-\u00e0-14.18.15.png 600w, https:\/\/www.ricom-web8.com\/gestions\/wp-content\/uploads\/2018\/12\/Capture-d\u2019\u00e9cran-2018-12-27-\u00e0-14.18.15-300x144.png 300w\" sizes=\"(max-width: 600px) 100vw, 600px\" \/><\/p>\n<\/div>\n<h2>Le vieillissement de la population et le d\u00e9veloppement des pathologies chroniques<\/h2>\n<p>D\u2019ici \u00e0 2030, le nombre des plus de 75 \u202fans augmentera de 80\u2009% au Danemark. De 2013 \u00e0 2025, le nombre de patients atteints de malades chroniques s\u2019accro\u00eetra de 60\u2009% (<i>figure \u202f4)<\/i>.<\/p>\n<p>Jusqu\u2019en 2060, le Danemark devra injecter 60\u2009% de budget suppl\u00e9mentaire dans la sant\u00e9 rien que pour maintenir le niveau d\u2019aujourd\u2019hui\u2009: d\u2019o\u00f9 la n\u00e9cessit\u00e9 de r\u00e9organiser le syst\u00e8me.<\/p>\n<button data-toggle=\"collapse\" data-target=\"#enc_2018_616_06\">FIGURE 4<\/button><div id=\"enc_2018_616_06\" class=\"encadre collapse\"><p><span class=\"surtitre_enc\">figure 4<\/span><\/p>\n<h2>Why a Super Hospital Programme\u2009?<\/h2>\n<h3>Estimates for future challenges<\/h3>\n<p><img decoding=\"async\" class=\"alignnone size-full wp-image-38858\" src=\"https:\/\/gestions-hospitalieres.fr\/wp-content\/uploads\/2018\/12\/Capture-d\u2019\u00e9cran-2018-12-27-\u00e0-14.18.27.png\" alt=\"\" width=\"600\" height=\"304\" srcset=\"https:\/\/www.ricom-web8.com\/gestions\/wp-content\/uploads\/2018\/12\/Capture-d\u2019\u00e9cran-2018-12-27-\u00e0-14.18.27.png 600w, https:\/\/www.ricom-web8.com\/gestions\/wp-content\/uploads\/2018\/12\/Capture-d\u2019\u00e9cran-2018-12-27-\u00e0-14.18.27-300x152.png 300w\" sizes=\"(max-width: 600px) 100vw, 600px\" \/><\/p>\n<\/div>\n<h2>Un d\u00e9ficit en personnel m\u00e9dical et soignant<\/h2>\n<p>Le Danemark fait face \u00e0 des difficult\u00e9s de recrutement et de fid\u00e9lisation du personnel. Le <i>turn-over<\/i> peut ainsi atteindre un taux extr\u00eamement \u00e9lev\u00e9 dans un certain nombre de r\u00e9gions.<\/p>\n<h1>Des sp\u00e9cificit\u00e9s importables\u2009?<\/h1>\n<h2>Les urgences et le lien avec la m\u00e9decine de ville<\/h2>\n<p>Comme en France, les services d\u2019urgence sont engorg\u00e9s. Consid\u00e9rant, sans doute \u00e0 juste titre, que les difficult\u00e9s aux urgences sont moins li\u00e9es aux urgences elles-m\u00eames qu\u2019\u00e0 l\u2019organisation des soins primaires, le Danemark a instaur\u00e9 un double m\u00e9canisme\u2009:<\/p>\n<ul>\n<li>en heures ouvrables, le passage pr\u00e9alable par le m\u00e9decin traitant qui oriente le cas \u00e9ch\u00e9ant vers les urgences\u2009;<\/li>\n<li>hors heures ouvrables, l\u2019appel t\u00e9l\u00e9phonique pr\u00e9alable \u00e0 un groupe de m\u00e9decins traitants.<\/li>\n<\/ul>\n<p>Au sein m\u00eame des services d\u2019urgence, la seniorisation a \u00e9t\u00e9 renforc\u00e9e. L\u2019examen par un m\u00e9decin se fait dans les 30 minutes apr\u00e8s l\u2019arriv\u00e9e du patient, et les r\u00e9sultats des examens doivent \u00eatre rendus toutes les quatre heures. Une r\u00e9union coll\u00e9giale a lieu \u00e9galement toutes les quatre heures.<\/p>\n<p>Enfin, un <i>flow master<\/i> (responsable des flux) de l\u2019orientation intra-urgences et dans tout l\u2019h\u00f4pital est pr\u00e9sent dans chaque service d\u2019urgence.<\/p>\n<p>Le r\u00e9sultat de ces actions combin\u00e9es\u2009: trois quarts des patients rentrent chez eux quatre heures apr\u00e8s.<\/p>\n<h1>Le num\u00e9rique et l\u2019innovation parmi les grandes priorit\u00e9s<\/h1>\n<p>Cent pour cent des g\u00e9n\u00e9ralistes ont acc\u00e8s au dossier m\u00e9dical informatis\u00e9\u2009; 98\u2009% \u00e9changent par ce biais. Cent pour cent des analyses de laboratoires sont livr\u00e9es num\u00e9riquement aux m\u00e9decins g\u00e9n\u00e9ralistes et aux h\u00f4pitaux. Le dossier m\u00e9dical du patient comprend \u00e9galement toutes les informations relatives au traitement m\u00e9dicamenteux dispens\u00e9. Le renouvellement des ordonnances est informatis\u00e9.<\/p>\n<h1>Une culture du consensus et de la confiance<\/h1>\n<p>Le Danemark se caract\u00e9rise par sa culture du consensus et de la confiance. Cela se traduit dans l\u2019\u00e9change et le partage d\u2019informations, la transparence et la volont\u00e9 d\u2019associer tous les repr\u00e9sentants aux d\u00e9cisions, apr\u00e8s avoir identifi\u00e9 les besoins et d\u00e9fini des objectifs clairs. Le programme Super H\u00f4pital n\u2019aurait sans doute pu voir le jour dans d\u2019autres pays.<\/p>\n<p>Il s\u2019agissait l\u00e0 du dernier d\u00e9placement du Graph en Europe du Nord avant de franchir les Alpes pour la prochaine \u00e9dition\u2009: Turin, du 17 au 20 avril 2019.<\/p>\n<button data-toggle=\"collapse\" data-target=\"#enc_2018_616_07\">LE GRAPH<\/button><div id=\"enc_2018_616_07\" class=\"encadre collapse\"><p><span class=\"surtitre_enc\">Le Graph<\/span><\/p>\n<p>Fond\u00e9 en 1974 par six CHU (Clermont-Ferrand, Montpellier, Reims, Rennes, Rouen et Saint-Etienne), le Groupe de recherche et d\u2019applications hospitali\u00e8res (Graph) r\u00e9unit \u00e0 ce jour, dans le cadre de la loi de 1901 sur les associations, les \u00e9tablissements publics de sant\u00e9 adh\u00e9rents et les personnalit\u00e9s du monde de la sant\u00e9 associ\u00e9es \u00e0 ses activit\u00e9s \u00e0 titre personnel.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p>Le Graph est un groupe de directeurs d\u2019h\u00f4pital qui r\u00e9unit m\u00e9decins, philosophes, industriels, \u00e9conomistes\u2026 pour faire avancer la r\u00e9flexion sur les grands sujets de sant\u00e9 et de soci\u00e9t\u00e9.<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p>Ses objectifs<span class=\"Apple-converted-space\">\u00a0<\/span><\/p>\n<p>\u2022 Cr\u00e9er un nouvel espace de r\u00e9flexion et de recherche en dehors des sch\u00e9mas traditionnels et du protocole fig\u00e9<br \/>\n\u2022 Faire \u00e9voluer le management et apporter des solutions innovantes aux grandes probl\u00e9matiques de sant\u00e9<br \/>\n\u2022 Promouvoir la r\u00e9flexion et la recherche en mati\u00e8re de gestion hospitali\u00e8re<span class=\"Apple-converted-space\"><br \/>\n<\/span>\u2022 D\u00e9velopper la recherche et anticiper les \u00e9volutions continues des organisations hospitali\u00e8res<br \/>\n\u2022 Faire \u00e9merger de nouveaux talents<br \/>\n\u2022 Susciter les contacts et \u00e9changes d\u2019exp\u00e9riences, en France et \u00e0 l\u2019\u00e9tranger, dans une d\u00e9marche de benchmark.<\/p>\n<p>Le Graph organise trois s\u00e9minaires par an\u2009: Alpes, M\u00e9diterran\u00e9e et Europe (Berlin en 2014, Londres en 2015, Stockholm en 2017, Copenhague en 2018, Turin en 2019).<\/p>\n<p>Pr\u00e9sident\u2009: G\u00e9rard Vincent<\/p>\n<p>Site Internet : <a href=\"http:\/\/www.le-graph.com\" target=\"_blank\" rel=\"noopener noreferrer\">www.le-graph.com<\/a> - Twitter\u2009: <a href=\"https:\/\/twitter.com\/le_graph?lang=fr\" target=\"_blank\" rel=\"noopener noreferrer\">@le_Graph<\/a><\/p>\n<\/div>\n<script>function PlayerjsAsync(){} if(window[\"Playerjs\"]){PlayerjsAsync();}<\/script>","protected":false},"excerpt":{"rendered":"<p>Un syst\u00e8me financ\u00e9 par l\u2019imp\u00f4t, avec un r\u00f4le r\u00e9gional tr\u00e8s marqu\u00e9 Fruit de l\u2019histoire, la diff\u00e9rence fondamentale entre nos deux syst\u00e8mes de sant\u00e9 r\u00e9side dans le mode de financement. Assis sur l\u2019imp\u00f4t dans le syst\u00e8me danois, il diff\u00e8re du syst\u00e8me fran\u00e7ais inspir\u00e9 de l\u2019histoire bismarckienne et fond\u00e9 sur les cotisations sociales(2). Le syst\u00e8me de sant\u00e9 danois, lui, est bas\u00e9 sur une couverture universelle gratuite et l\u2019\u00e9galit\u00e9 d\u2019acc\u00e8s au syst\u00e8me de&hellip; <\/p>\n","protected":false},"author":23133,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[2,456],"tags":[2174,7031,1856,7030,497,216],"class_list":["post-38899","post","type-post","status-publish","format-standard","hentry","category-gestions-hospitalieres","category-graph","tag-benchmark","tag-copenhague","tag-danemark","tag-europe-2018","tag-graph","tag-systeme-de-sante"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.8.1 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Le syst\u00e8me de sant\u00e9 danois - Gestions hospitali\u00e8res<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.ricom-web8.com\/gestions\/le-systeme-de-sante-danois\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Le syst\u00e8me de sant\u00e9 danois - Gestions hospitali\u00e8res\" \/>\n<meta property=\"og:description\" content=\"Un syst\u00e8me financ\u00e9 par l\u2019imp\u00f4t, avec un r\u00f4le r\u00e9gional tr\u00e8s marqu\u00e9 Fruit de l\u2019histoire, la diff\u00e9rence fondamentale entre nos deux syst\u00e8mes de sant\u00e9 r\u00e9side dans le mode de financement. Assis sur l\u2019imp\u00f4t dans le syst\u00e8me danois, il diff\u00e8re du syst\u00e8me fran\u00e7ais inspir\u00e9 de l\u2019histoire bismarckienne et fond\u00e9 sur les cotisations sociales(2). 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