natgillin/translations-raw huggingface dataset:
Endvidere er der gennemført bevidsthedsskabende kampagner for at informere læger, når deres receptration pr. patient overskrider gennemsnittet.
In addition, it is planned that there should be greater competition between sick ness funds in tenns of both benefits and services they provide and the contributions they charge.
Navnlig blev der indført konkurrence mellem behandlere især inden for hospitalssektoren, hvor befolkningen i 1993 fik frit sygehusvalg og ret til at kræve og få behandling efter eget ønske.
depends on their characteristics (age, sex, income and so on).
Som følge heraf fik de praktiserende læger en større rolle med hensyn til at rådgive patienten om dette valg.
This part will amount to 10% of the health insurance budget in the period 1995 to 1997,20% between 1998 and 2001 and 30% thereafter.
Skattefinansierede, nationale syge sikringssystemer som Danmarks ser også ud til at have et indbygget problem med ventelister.
If the expenditure of a mutuality exceeds its revenue, then it will have to use its reserves to cover part of the deficit and if necessary increase its members' contributions.
Der er yderligere planer om at indføre et kontraktsystem mellem amterne og de enkelte hospitaler.
This new system is intended to give an incentive to the mutualities to moderate their expenditure.
Et anden forslag går ud på at give sygekasser ne mere fleksible muligheder for at indgå kontrakter med behandlere.
The latter will become effective from the beginning of 1996 while the other proposals are still being discussed.
Samtidig er der planer om at give alment praktiserende læger større indflydelse, således at de tilskyndes til at fungere som koordinatorer med henblik på at undgå, at adskillige specialister skal stille dyre diagnoser. Endvidere er planen, at der skal være større konkurrence mellem sygekasserne med hensyn til både de fordele og tjenesteydelser, de tilbyder, og de bidrag, de opkræver.
The latest proposal of the Federal Ministry of Health is generally to give the self-governing institutions in the sector more autonomy, though, according to a number of experts, the incentives and disincentives incorporated in the system are not power ful enough for such a move.
Et gammelt problem ved et forsik ringsbaseret system af den belgiske slags er at pålægge de gensidige fonde, der forvalter systemet, det faktiske ansvar for de udgifter, de påtager sig.
The health care system in Denmark as in other Scandinavian countries is financed by taxes and has a decentralised organisation.
Dette nye system har til formål at tilskynde de gensidige selskaber til at begrænse deres udgifter.
Though the system seems to operate with fewer problems than elsewhere in the Union, a number of reforms have been introduced in the last few years.
I Tyskland trådte en større reform af sygesikringssystemet i kraft i begyndelsen af 1993.
In Germany, a major reform of the health insurance system became effective at the beginning of 1993.
Som følge af de reformer, der blev indført i 1988, steg udgifterne stærkt i 1991, og der måtte omgående gennemføres nye foranstaltninger for at dæmme op for udgifterne.
Following the reforms introduced in 1988, expenditure increased sharply in 1991 and new measures of cost containment had to be implemented immediately.
Metoden bestod i at ind føre et budgetkontrolsystem, under hvilket udgiftsstigninger mellem 1993 og 1995 skal ligge på linie med stigningen i sygekassernes indtægter fra forsikringstagernes bidrag.
The approach was to introduce a system of budget control under which increases in expenditure between 1993 and 1995 have to be in line with the increase in income of the sickness funds from the contributions of the people insured.
I hospitalssektoren blev der indført differentierede takster afhængig af behandlingens art og intensitet.
In the hospital sector, differentiated charges were introduced which vary according to the kind and intensity of care.
Systemet med forbundsfinansiering er også ved at blive ændret med hen blik på at reducere antallet af sengepladser.
In particular, to introduce some competition between health care pro viders especially in the hospital sector, in 1993, people were given free choice of which hospital to go to and the right to demand and receive health care where they wished.
Budgetkontrol er også
As a result, the role of the general practitioner in advising the patient where to go was increased.
Sidstnævnte forslag vil blive en realitet fra begyndelsen af 1996, mens de øvrige stadig er til debat.
In Greece, there is a commonly perceived need to modernise the National Health system.
Det se neste forslag fra forbundsregeringens sundhedsministerium er generelt at give selvstyrende institutioner inden for sektoren mere selvstyre, selv om de i systemet ind byggede incitamenter og hindringer ifølge en række eksperter ikke er tilstrækkeligt stærke til at en sådan foranstaltning kan fungere.
In 1992 and 1994, amendments were introduced to modify administrative and organisational aspects and to improve primary health care, emergency prehospital services and the manage ment of hospitals.
Sygesikringssystemet i Danmark bliver som i andre skandinaviske lande finansieret af skatter og er organiseret decentralt.
Tax-financed, national health systems like that in Denmark also tend to have an inherent problem of wait ing lists.
Skønt systemet synes at fungere med færre problemer end i resten af Unionen, er der gennem ført en række reformer i løbet af de seneste få år.
There is a general consensus that the measures taken in 1993 were only a first emergency step in a more general reform of the health care system, the aim being to maintain the high standard of health care, to avoid imposing additional costs on con sumers and to contain costs.
Kapitel 5 - Sygesikringsreformer
Chapter 5 - Reforms in health care avoid this, there is a trend towards agreements being drawn up between the insurance funds providing budgets and the public hospitals.
Under det franske system er sundhedsbudgettet centraliseret, og be handlerne arbejder generelt på kontraktbasis; offentlige hospitalsbudgetter finansieres af forsikringsfonde, men skal godkendes af sundhedsministeriet.
Partly because of its high rate of economic growth, public expenditure on health in Ireland remained broadly unchanged between 1988 and 1993 in relation to GDP at around 5%, which is low as compared with other countries in the Union.
I Grækenland er det en almindelig opfattelse, at det nationale sundheds system trænger til at blive moderniseret.
A further issue under discussion is the extent to which the system should be regionalised in line with the division of government in Spain.
I 1992 og 1994 blev der indført forbedringer af administrative og organisatoriske aspekter og af den primære sundhedspleje, nødtjenester forud for hospitalsindlæggelse samt af forvaltningen af hospitalerne.
In practice, there is some tendency towards the develop ment of 17 different and separate re gional health care systems.
I de seneste år har der været en ten dens til at øge de private behandleres rolle og indføre mere effektive styringsteknikker.
For many years, the main issue as regards the health care system in Spain was achieving full coverage.
Dette blev først klart med de ændringer, der blev indført i Katalonien i 1990 i henhold til sundhedsreformloven, hvilket satte gang i en national diskussion, der førte til rapporten fra Abril-udvalget, der stillede forslag om tilbundsgående, strukturelle reformer med henblik på at indføre styret konkurrence, et forslag der afspejledes i de forandringer, der fandt sted mellem 1992 og 1994.
At the same time, the system as established tended to exhibit the typical weaknesses of centralised budgeting, in that there were inadequate incentives for those providing care to take account of costs.
Der er tendens til i budgetterne at indføje incitamenter til effektiv styring og at undgå over forsyning.
There are, nevertheless, efforts to improve the organisation and integration of general practitioner services and to encourage health promotion.
Et af regeringen udpeget internationalt ekspertudvalg fremlagde i 1994 en rapport med forslag til en radikal reform af sygesikringssystemet, som nu bliver diskuteret.
Measures were introduced in Italy in 1992 aimed at containing costs and improving efficiency, which took effect from 1994.
En central anbefaling er, at man etablerer en national enhedssygesikring bestående af de eksisterende sygekasser, der nu er en del af socialforsikringsfondene, som skal forhandle behandlingsydelserpå vegne af forsikringstagerne.
This was first evident in the changes introduced in Catalonia in 1990 under the Health Reform Law, which in itiated a national discussion leading to the Abril Committee report which suggested deep-seated structural re forms to introduce managed competition, a proposal which was reflected in the changes made between 1992 and 1994.
I 1993 blev der for første gang udarbejdet en liste over lægemidler, der blev forbudt, fordi de var for dyre til, at det offentlige system kunne levere dem.
In 1993, a proscribed list of pharmaceuticals too expensive for the public system to supply was produced for the first time. In 1994, a compromise
Delvis på grund af den høje økonomiske vækstrate forblev de offentlige sundhedsudgifter i Irland stort set uforandrede på ca. 5% mellem 1988 og 1993 i forhold til BNP, hvilket er lavt sammenholdt med de øvrige lande i Unionen.
Under these measures, the USL (local health units which form the basic structure of the national health service) were transformed into public enterprises with significant autonomy and local responsibility.
I praksis er der en vis ten dens mod i udviklingen af 17 forskellige og separate, regionale sygesikringssystemer.
Instead of being administered by a political committee, these are now under the control of a professional manager
Kapitel 5 - Sygesikringsreformer
Chapter 5 - Reforms in health care effects of the reform were at best mixed and have prompted opposition from several sides.
Luxembourg og integrationen af praktiserende lægers ydelser og på at tilskynde til sundhedsfremmende foranstaltnin ger.
Larger hospitals, formerly acting as branches of the USL, are able to become independent public hospital agencies with autonomous organisation and administration, which have to operate with balanced budgets.
tilbyder sundhedspleje, mens den en kelte selv fik lov til at vælge, hvilken sygekasse han/hun ønsker at lade sig forsikre af.
were inadequate mechanisms for controlling expenses, more detailed rules for negotiating agreements were introduced together with a list of services to be provided and the relative value compared with other services.
Dette skulle ledsages af en integration af alle de forskellige forsikringsordninger i én enkelt ord ning for alle indbyggere.
In the hospital sector, a system of individual budgets negotiated between each hospital and the health insurance funds will replace the existing system after 1995.
I 1992 indførte Italien foranstaltninger med det formål at dæmme op for omkostningerne og forbedre effektiviteten. Disse trådte i kraft i 1994.
Following a change of government, the more far-reaching aspects of the refonn have been abandoned.
I Luxembourg blev der i 1992 gen nemført en større reform af sundhedssektoren, der som andre steder havde til formål at øge effektiviteten.
This reform also brought changes in financing regulations, with central government maintaining overall planning responsibility and effectively paying for a standard set of services that must be guaranteed to each citizen in each region.
Hovedelementerne var en omorganisering af administrationen af syge sikringssystemet, et nyt system til finansiering af sygesikringen, en ny procedure til forhandlinger mellem forsikringsfondene og behandlere og et nyt finansieringssystem for hospitaler.
Each region continues to receive a predetermined sum from the centre according to its population, but any expenditure in addition to this has to be covered from its own resources.
Af disse er de to sidstnævnte de vigtigste, når det gælder om at for bedre effektiviteten.
In this way, it is intended to encourage regions and USL managers to co operate in containing costs and achieving an efficient use of re sources.
Det viste sig nødvendigt at træffe nye omkostningsdæmpende foranstaltninger, hvilket krævede et statsindgreb i en situation, hvor accepten af regeringens dominerende rolle var blevet nedbrudt som følge af reformen.
As described in Social Protection in Europe 1993, the reforms introduced in the early 1990s in the Netherlands were a radical attempt to introduce market forces into the health care system.
Virkningerne af reformen var i bedste fald blandede og har frem kaldt modstand fra adskillige sider.
In essence, the aim was to bring about competition between both providers of care and insurers.
I henhold til disse foranstaltninger blev USL (lokale sundhedsenheder, der udgør den grundlæggende struktur i den nationale sundhedstjeneste) omdannet til offentlige virksomheder med betydelig selvstyre og lokalt ansvar.
An important aspect was that the sickness funds were no longer obliged to contract with all institutions offering health care services, while individuals became free to choose which sickness fund to belong to.
Frem for at blive administreret af et politisk udvalg styres disse nu af en professionel leder, der udpeges af regionen for en kontraktperiode på fem år med mulighed for forlængelse.
This was to be accompanied by the integration of all the different insurance schemes into a single scheme for all residents.
Eftersom der praktisk talt ikke fandtes regler for det tidligere for handlingssystem, og der var utilstrækkelige mekanismer til at kontrollere udgifterne, blev der ind ført mere detaljerede regler for for handling af aftaler sammen med en liste over de ydelser, der skulle sikres og den relative værdi sammenlignet med andre ydelser. Inden for hospitalssektoren vil et system med individuelle budgetter, der forhandles mellem hvert hospital og sygeforsikringsfondene, erstatte det eksisterende system efter 1995.
The reforms which are now under discussion attempt to address these problems in detail, by, for example, expanding forms of care between hospitalisation, on the one hand, and outpatient visits, on the other, or by replacing the present system of hospital funding based on a daily lump sum rate by a system that is related to the costs of each case of treatment.
Efter et regeringsskifte er reformens mere vidtrækkende aspekter blevet opgivet.
In Luxembourg a major refonn of the health care sector occurred in 1992, which as elsewhere was aimed at in creasing efficiency.
Der skal ikke længere være en grundlæggende sygesikringsordning, der dækker alle indbyggere, og de ændringer, der bliver foretaget i systemet, sigter mod at øge regeringens indflydelse og pålægge stram mere budgetkontrol, selv om de allerede indførte markedselementer stadig fastholdes.
The main as pects were a reorganisation of the administration of the health insurance system, a new system of financing health insurance, a new procedure for negotiations between insurance funds and providers of health care and a new financing system for hospitals. Of these, the latter two measures are the most important as regards improving efficiency.
I al væsentlighed var formålet at indføre konkurrence mellem både behandle re og forsikringsudbydere.
The market approach succeeded in bringing about market-type behaviour, but this did not always achieve what the initiators of the refonn had in mind.
Et vigtigt aspekt var, at sygekasserne ikke længere var forpligtet til at indgå kontrakter med alle institutioner, der
New cost containment measures turned out to be necessary, requiring intervention by the State, in a situation where, as a consequence of the refonn, the acceptance of the dominant role of government had been eroded. The
Hver region modtager fortsat en forud fastsat sum fra centralt hold, men udgifter herudover skal den selv dække af sine egne ressourcer.
Since the former negotiation system was virtually unregulated and there
Behandlingssystemet i Østrig har ikke tilstrækkelige mekanismer til at forhindre overforbrug på efterspørgselssiden og overdrevent tilbud om service på udbudssiden og har ten dens til at stimulere dyre behandlinger af patienter på hospitaler, hvilket
The problems experienced by the National Health Service in Portugal in the late 1980s included a maldistribution of resources between re gions, dissatisfaction with the quality
Kapitel 5 - Sygesikringsreformer
Chapter 5 - Reforms in health care since they became essentially the customers for their services.
Finland herefter har ført til en for voldsom udvidelse af hospitalssektoren.
of the public service, inefficient or ganisation and management of the system and so inadequate means of containing costs.
ling af læger gennem honorarer pr. patient. Ansvaret forde ældre (i 1992) og mentalt handicappede (i 1995) er blevet overført fra amtsforvaltningeme til lokale myndigheder.
parts of the legislation relating to general practitioners will cease to apply at the end of 1995, though the provisions for strengthening the position of the patient will remain
Reformen af systemet for alment praktiserende læger fra 1994 havde til formål at tillade alle frit lægevalg med henblik på at styrke patientens stilling stunt at forbedre de primære behandlinger.
The health care system in Sweden — hospitals as well as most outpatient clinics — is mainly run by the re gional county councils and primarily financed through local income taxes. During the 1980s, health care costs were contained and output was simultaneously raised.
Som følge af valget i 1994 vil dele af lovgivningen vedrørende praktiserende læger imidlertid blive ophævet mod slutningen af 1995, omend der dog ikke vil blive rørt ved bestemmelserne vedrørende en styrkelse af patientens stilling.
Nevertheless, there were significant differences be tween the county councils in performance on both fronts. In particular, in the large cities long waiting lists built up for certain treatments thereby causing unnecessary costs for sickness insurance funds.
I stedet for at øge centraliseringen øgede man med de reformer, der trådte i kraft i begyndelsen af 1993, kommunernes fri hed til at fastsætte takster og tilrettelægge behandlingsudbuddet, og generelt blev reglerne for kontrol af kommunernes aktiviteter lempet betydeligt.
Since 1993, the approach has been to increase the extent of regional decentralisation and within each of the five health regions, to group together health centres and hospitals as 'units of health'.
Endvidere fik kommunerne den faktiske kontrol over hospitalssektoren, eftersom de blev denne sektors væsentligste kunder.
In addition, the National Health Service is now allowed to pro vide services directly, while there is a move away from public to private in surance, the main aspect being that private insurers receive payment from the government for each member at a rate below the average cost per head of the National Health Service.
I Storbritannien har det nationale sundhedsvæsen med centraliseret beslutningskompetance eksisteret siden 1948.
In the UK, the national health service with centralised decision-making has existed since 1948.
Siden 1991 er der dog indført omfattende reformer med det fonnål at begrænse omkostningerne og øge effektiviteten.
Since 1991, how ever, fundamental reforms have been introduced aimed at containing costs and increasing efficiency.
Både fordi det britiske system er model for nationale behandlingssystemer andre steder, og på grund af den valgte markedsorienterede model har disse reformer tiltrukket sig stor opmærksomhed i andre medlemsstater (og er derfor beskrevet mere detaljeret her end udviklingen i de andre medlemsstater).
Partly be cause of the UK system being the model for national health services developed elsewhere and partly because of the market-oriented approach adopted, these reforms have attracted a good deal of attention in other Member Slates (and are, there fore, described in somewhat greater detail here than developments else where).
Behandlingssystemet i Sverige — både hospitaler og de fleste ambulante klinikker — drives af de regionale amtsråd og finansieres primært af lokale indkomst skatter.
As in the other Scandinavian countries, the health care system in Finland is based on municipalities having responsibility for providing services.
I løbet af 1980'eme blev behandlingsomkostningerne holdt i ave, og produktiviteten blev samtidig øget.
The main problems concern inadequate coordination of infrastructure and a lack of incentives to increase productivity.
Der var imidlertid betydelige forskelle mellem amtsrådenes præstationer på begge områder.
Re sponsibility for caring for the elderly (in 1992) and the mentally disturbed (in 1995) has been transferred from county councils to local authorities.
Især i de store byer blev der oparbejdet lange ventelister for bestemte behandlinger, hvilket således forårsagede unødvendige omkostninger for syge kasserne.
In addition, a number of experiments have been carried out on coordinating social insurance and health care.
Systemet inde holder således incitamenter for forsik ringsudbydere til at fastholde omkostningerne.
In addition, municipalities were given effective control over the hospital sector,
Den grundlæggende filosofi bag reformerne var at skelne mellem købere og udbydere af behandling og at opfordre behandlere til at konkurrere indbyrdes og levere deres ydelser på grundlag af kontrakter forhandlet med køberne.
The reform of the general practitioner system in 1994 was aimed at giving everyone the freedom to choose their family doctor in order to strengthen the position of the patient as well as to improve primary care.
Der findes to slags købere.
As a result of the general election in 1994, however.
Kapitel 5 - Sygesikringsreformer næppe motiveret for at ændre deres adfærd i væsentligt omfang.
Chapter 5 - Reforms in health care to make good use of their budgets in order to attract more patients and so raise their income.
På behandlersiden er der indført konkurrence mellem hospitalerne og mellem lokale tjenester — i det mindste i princippet.
On the provider's side, competition between hospitals and between community services has been established, at least in principle.
Til trods for at der i store træk er lighed mellem systemerne, de problemer, man står overfor, og de metoder der anvendes, er reformerne forskellige, når man ser på detaljerne og kan kun vurderes ud fra de specifikke træk ved ordningerne i hen hold til hvilke de enkelte medlemsstater sørger for og finansierer sygesikringen.
Despite the broad similarity of systems, of the problems faced and of the approaches followed, reforms differ in detail and can only be as sessed in terms of the specific features of the arrangements for providing and financing health care in the individual Member States.
Dette betyder imidlertid ikke, at det nødvendigvis er malplaceret at forsøge at indføre markedselementer og flere valg muligheder i systemet, at opnå bedre oplysninger om omkostningerne og at tage mere højde for disse, når udgiftsmønstret besluttes.
This does not mean, however, that the attempts to introduce market elements and more choice into the system, to obtain better information about costs and to take these more into account when deciding patterns of expenditure are necessarly misplaced. placed.
Sammenligning af udviklingstendenser
Comparative developments
I næsten alle lande er der en vis tendens hen imod det, man kunne kalde en "kontraktlig" indgangsvinkel, selv om der er store forskelle på, hvordan en sådan anvendes, mellem medlemsstaterne.
In nearly all countries, there is some tendency to adopt what might be termed a 'contractual' approach, though the way in which this has been used differs significantly be tween Member States.
Stort set er dette blot en måde at organisere behandlingsudbuddet på.
In broad tenns, this is simply a way of organising the provision of care.