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OPINION: How does Denmark have better healthcare than the US for less money?

Health care researcher Justin C. Matus, a visiting professor at the University of Southern Denmark, looks at the difference between the Danish and United States healthcare systems.

Published: 14 December 2017 16:36 CET
OPINION: How does Denmark have better healthcare than the US for less money?
Photo: Torben Åndahl/Polfoto/Ritzau

Originally published by ScienceNordic

As an American health care researcher visiting Denmark over the past two months I have spent the majority of my time trying to answer what seems like a simple question: How does Denmark spend less money than the USA, provide health insurance for everyone, and yet still have better health outcomes than the USA?

I already knew about the relatively high taxes in Denmark, but that can’t be the reason since we know Denmark spends less money on healthcare as a percentage of GDP on a per capita basis than the US. 

What I thought I would find is that Denmark perhaps has a unique set of policies and procedures for arranging doctors and specialists, or perhaps a certain distribution of hospitals and clinics, or that the patients would have a long wait, or a limited choice.

In other words, I thought the answer to my question (how do they do it?) would be found with a very technical, health policy oriented solution. Oh how I was wrong! 

The healthcare system is not that complex, nor that unique. Its financing is fairly straightforward. Doctors are not highly paid compared to other occupations requiring similar education.

In terms of problems and challenges, from everything I have seen and learned they are very similar to the ones we face in the USA. For example, patients missing an appointment or not taking their medication are problems that all health care systems face. Conversely, Denmark does not have faster computers or better medical equipment or better doctors. It is something else.

READ MORE from ScienceNordic: Study ranks Nordic health care among best in the world, except Denmark and Greenland

It’s the culture, stupid!

What I now realise is that it is the entire culture that makes this country able to provide such an effective and efficient health care system. Yes, it’s the culture stupid!

My problem was that connecting all the little dots was not easy at first. Imagine you are trying to put together a puzzle but you do not have a photograph of what you are trying to make. On the other hand, once you know what the finished puzzle should look like you can quickly find the edges of the puzzle and then begin to fill in the middle until voila! You have completed the puzzle!

The moment I realised that the health care system was something which fit into the bigger puzzle of Danish culture, finding the pieces and fitting them together became much easier.

READ MORE from ScienceNordic: World’s largest sex study under way in Denmark

Cycling keeps you healthy

One example of Danish culture and health is bicycles. Ok, so a lot people ride bikes in Denmark. But why? Denmark’s terrain is relatively flat which makes it a lot easier for many people of all ages to ride bikes than in say, the Swiss mountains. And crucially, the Danes build bicycle lanes, lots of bicycle lanes! They even have traffic information screens just for the bicycles.

Riding a bike everyday helps keep you at a healthy weight. If you ride the bike to work every day, you don’t need a car. Fewer cars means fewer highways, fewer traffic accidents, and of course, less pollution.  Fewer highways presumably means that more tax money available to build better public transportation. And better public transportation means it is easier for patients to get to the doctor.


Photo: Joachim Adrian/Polfoto/Ritzau

A more dramatic example is what I recently experienced touring a large Danish city hospital. The director of the emergency ward was showing me around the facility, pointing out the various start-of-the-art equipment, when I asked “when was the last time you treated a gunshot wound?”

There was an awkward laughter at first, but eventually it was determined that it had been a few months ago. Although Denmark is not without problems in this area, suffice to say that the same question asked of any other emergency room in virtually any mid-size city in the US and the answer would have been very different.

Gun laws in the US are very different than in Denmark and the US constitution guarantees the right for Americans to own guns with very few restrictions. The gun culture is pervasive in the US and this no doubt gives rise to more violence and homicides. The chart below illustrates the dramatic difference in death rates from assault between the two countries.

Politics and healthcare are intertwined

Finally, the US political two party system creates one winner and one loser. The Danish multi-party system creates coalitions and consensus.

In this system, controversial issues are generally resolved through compromise. Compromise creates many winners and fewer losers. Larger coalitions tend to be longer lasting and programs are more faithfully executed since many more people wish to see a given program succeed.

My impression of Danish people, is that they do not necessarily think of life as a zero sum game whereby one must lose in order for another to gain. In the US on the other hand, it is commonplace to see Democrats and Republicans repeatedly describing each other’s plans in terms of “winning” or “losing.” Unlike Denmark, compromise in American politics is almost unheard of.

READ MORE from ScienceNordic: Aalborg University scientists: world renowned for causing pain

US healthcare needs more than a new law

Culture is pervasive and it is not one dimensional. Unfortunately for those of us in the US who think that fixing the American health care system is simply a matter of passing a new law, which would grant everyone health insurance, such a law would not change the American culture.

My working hypothesis is that if we wish to have a Danish style health care system in the United Sates we have to first re-orientate our culture.

A classic model to study cultures developed by the Dutch researcher Geert Hofstede suggests there are six main dimensions to culture: indulgence versus restraint; long term versus short term; masculinity versus femininity; tolerance of uncertainty; individuality; and power distance.

A simple side by side comparison of the US to Denmark clearly shows how strikingly different the countries are in these attributes.

For example, Denmark scores higher on the dimension of long term orientation compared to the United States (35 vs. 26).  This means people are more inclined to invest in the future, rather than live in the here and now.  As an example, Danes support initiatives such as wind turbines, which may be more expensive in the short term, but over the long term will be better for the environment and future generations. 

On the other hand, the United States scores much higher on the dimension of individualism compared to Denmark (91 vs. 74) meaning Americans tend to think about only taking care of themselves and their immediate family.  Danes, on the other hand, have a much higher collective mentality making them very accepting of the need to take care of the broader community, especially vulnerable populations such as the sick and elderly.

I think to suggest that these differences don’t play a role in either country’s health care system, regardless of how you describe each one, either good or bad, is simply naïve.

READ MORE from ScienceNordic: New EU law puts patient health at risk

Lessons to be learned on both sides of the Atlantic

The United States and Denmark can both learn and benefit from each other. The nature of one’s culture is complex and ever changing. The nature of a health care system is just as complex and ever changing.

The Danish example of a culture and a healthcare system offer a model for those of us in the US to carefully study and attempt to better understand its nature, meaning, and impact.

Only through careful study and objective analysis of ourselves and of others can we truly find meaningful and lasting solutions to help ourselves and our fellow man.

This article was originally published on ScienceNordic 

READ ALSO: Danish junior doctors start viral campaign to overturn key ruling against colleague

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OPINION AND ANALYSIS

OPINION: Down with Danish hygge – Sweden’s mys is more real, fun and inclusive

Hygge, the Danish art of getting cosy, has taken the world by storm. But the Swedish equivalent is refreshingly different, says David Crouch 

Published: 20 December 2022 08:41 CET
Updated: 6 August 2023 11:03 CEST
OPINION: Down with Danish hygge - Sweden’s mys is more real, fun and inclusive

It is around seven years since the Danish word hygge entered many of our languages. Hygge, pronounced hue-guh and generally translated as the art of cosiness, exploded almost overnight to become a global lifestyle phenomenon.

Hygge dovetailed with mindfulness and fed into other popular trends such as healthy eating, and even adult colouring books. “The Little Book of Hygge” became a publishing sensation and has been translated into 15 languages. It was swiftly followed by a second book from its author, “My Hygge Home”, one of dozens on the market. 

There is nothing wrong with new ways to relax, and certainly no harm in identifying them with Scandinavia. But as a guide to living your life, there are some problems with hygge. 

First, the original meaning of the word is too broad and subtle to enable a clear grasp of the concept among non-Danes. This probably helps to explain its appeal – hygge is an empty bottle into which you can pour whatever liquid you like.

Patrick Kingsley, who wrote a book about Denmark several years before the hygge hype, was “surprised to hear people describe all sorts of things” as hygge. Danes, he said, would use the word when talking about a bicycle, a table, or even an afternoon stroll. 

So it is hardly surprising that, outside Denmark, hygge is applied rather indiscriminately. Last week the New York Times devoted an entire article to achieving hygge while riding the city’s subway, of all places. “A train, after all, is basically a large sled that travels underground, in the dark,” it said, trying too hard to find a hint of Nordic-ness on the overcrowded railway.

READ ALSO: Danish word of the day – hyggeracisme

Hygge has become an exotic and mysterious word to describe more or less anything you want. It is as if someone decided that the English word “nice” had a magical meaning that contained the secret to true happiness, and then the whole non-English speaking world made great efforts to achieve the perfect feeling of “nice”. 

A second problem with hygge is that, in Denmark itself, it seems to operate like a badge of Danishness that can only be enjoyed by Danes themselves – a kind of cultural border that outsiders cannot cross. You can walk down a Danish street in the dark, one journalist was told, look through the windows and spot who is Danish and who is foreign just by whether their lighting is hygge or not.

When writer Helen Russell spent a year in Denmark, she was intrigued by hygge and asked a lifestyle coach about it. “It’s hard to explain, it’s just something that all Danes know about,” she was told. How could an immigrant to Denmark get properly hygge, Russell asked? “You can’t. It’s impossible,” was the unhelpful reply. It can’t be a coincidence that the far-right Danish Peoples Party has put a clear emphasis on hygge, as if immigration is a threat to hygge and therefore to Danish-ness itself. 

READ ALSO: It’s official – Hygge is now an English word

Outside Denmark, this exclusivity has taken on another aspect: where are all the children? Where amid the hygge hype are the bits of lego on the floor, the mess of discarded clothes, toys and half-eaten food, the bleeping iPads and noisy TVs? “Hygge is about a charmed existence in which children are sinisterly absent,” noted the design critic for the Financial Times. It’s as if the Pied Piper of hygge has spirited them away so you can get truly cosy. 

But there is a bigger problem with hygge. It is largely an invention, the work of some clever marketing executives. After spotting a feature about hygge on the BBC website, two of London’s biggest publishers realised this was “a perfect distillation of popular lifestyle obsessions”. They set out to find people who could write books for them on the subject, and so two bestsellers were born, spawning a host of imitations. 

Sweden has a different word that means roughly the same thing: mys (the noun) and mysig (the adjective). There have even been some half-hearted attempts to sell mys to a foreign audience in the same way as hygge. But the real meaning of mys in Swedish society is rather different, it seems to me. The reason for this, I think, is that mys has become so firmly identified with Friday nights, or fredagsmys – the “Friday cosy”. 

Fredagsmys is a collective sigh of relief that the working / school week is over, and now it is time for the whole family to come together in front of some trashy TV with a plate of easy finger-food. The word first appeared in the 1990s, entered the dictionary in 2006, and became a semi-official national anthem three years later with this joyous ad for potato crisps:

In this portrayal, mys is radically different to hygge. It is a celebration of the ordinary, witty and multi-cultural, featuring green-haired goths and a mixed-race family with small children. Food is central to fredagsmys, and what is the typical food of choice? Mexican, of course! Not a herring in sight.

Why Mexican? It seems nobody is really sure, but tacofredag now has roots in Swedish society. Tacos, tortillas, and all the accompanying spices and sauces take up a whole aisle of the typical Swedish supermarket. Swedes are accustomed to eating bread with various bits and pieces on top, according to a specialist in Swedish food culture, while the Swedish tradition of smörgåsbord (open sandwiches) makes a buffet meal seem natural. The fussiness of tacos is even reminiscent of a kräftskiva crayfish party.

There is no cultural exclusivity here. On the contrary, fredagsmys food could equally be Italian, North American, Middle-Eastern, British or French. And children are absolutely central to a good Friday cosy. 

With Swedish mys, everybody is welcome. Get cosy and relax, but do it by mixing and getting messy, rather than retreating into pure, perfect, rarified isolation. There is a time and a place for hygge. But the Swedish version is more real, more fun, and more inclusive.

David Crouch is the author of Almost Perfekt: How Sweden Works and What Can We Learn From It. He is a freelance journalist and a lecturer in journalism at Gothenburg University.

 
 
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