Geographical variation in key outcomes in new Danish health councils

Denmark's 2024 health reform established 17 health councils to strengthen cross-sectoral coordination from 2027. The Danish system is often described as homogeneous, but local variation in quality indicators across council areas has not been examined. We aimed to quantify inter- and intra-council variation in cross-sectoral quality indicators before councils become operational. We hypothesised that council averages would mask municipal outliers.

This was a national register-based cross-sectional study using aggregated data for all Danes. Indicators included chronic disease burden, general practice (GP) capacity, medication use (polypharmacy, antipsychotics in dementia), preventable admissions, readmissions, primary care contacts, municipal care contacts and primary care costs. Variation was quantified using coefficients of variation within (wCV) and between councils (bCV). Health Council Fyn served as illustrative case.

Among 5.98 million inhabitants, GP contacts and primary care costs showed limited variation (bCV 0.8% and 4.7%). Excessive polypharmacy (less-than 65 years) and municipal care contacts had wCVs above 20% and bCVs of a similar magnitude, whereas preventable admissions (≥ 65 years) varied more between than within councils (bCV 12.5% versus 8.2%). Antipsychotic prescribing in dementia had a bCV of 17.5%. In Health Council Fyn, Ærø had antipsychotic prescribing 62% and municipal care contacts 76% above the council mean.

Primary care access appears geographically uniform, but cross-sectoral indicators vary within and between councils, and council averages can mask municipal outliers.

None.

Not relevant.