Carlie: Hey there, it’s Carlie with the Expat Focus podcast. We’re diving into the Danish healthcare system today, with a returning guest, expat blogger and expert Melanie Haynes, of Dejlige Days.
She gave us some great insights into the Danish way of life in our first chat, so be sure to take a listen to our Life in Denmark episode.
This time, Melanie is going to go through everything you need to know about signing up with a doctor in Denmark, visiting the hospital, getting prescriptions, even having a baby in the country. So keep listening!
When it comes to the healthcare system and navigating how it works in Denmark, where would you suggest newly arrived expats start?
Melanie: Well the first place you start is any newly arrived person in this country, is you have to register, and you have to get what’s called a CPR card, which is a personal number that you’re given, and that is your access into many public services, but most predominantly, to get a GP. So when you register, the first thing that they will ask you is do you have a preference of a GP or a family doctor?
Now currently, we have something of a, not so much a crisis, but there aren’t that many doctors that are taking new patients. So on registering, you’re given a list of patient, of doctors in your area, where you can become a patient, and you choose one of those doctors. And then when you receive your, your yellow card, or your CPR card, it actually has your doctor’s details listed directly on that card with their phone number, so you have that with you at all times.
Carlie: Do you get to shop around and try a few doctors out before you settle on who is going to be your doctor?
Melanie: Well 11 years ago I would have said yes, you could do that. But right now, no you can’t. The, the number of doctors that are taking new patients has vastly diminished, so you would pick one doctor to start with. You might want to do a little bit of research beforehand, maybe ask on some of the expat forums about doctors that are going to be in your area. And it’s obviously recommended to pick a doctor that is within a short either bicycle or walking journey from your home, because of course when you’re sick, you don’t want to have to traipse across town to your doctor.
But once you have a doctor, it is possible if you’re not happy with that GP to change your GP. So you would just go back onto the system and find another GP in your area that was possibly taking new patients. Now there is an administrative cost of changing that doctor, and some people think that the cost is kind of like a punishment for changing your doctor. But it’s not, it’s just an administrative fee to get a new yellow card produced for you with a new doctor written on the front of it. But you can if you want to, but generally, most doctors here, you’ll get a similar kind of service from them.
Most of them will speak English to you. It’s something that if you’re looking at choosing a doctor you might want to check first of all whether they’re happy to do that. But one of the other things about the doctor system here is they all have different ways in which they offer you an appointment for urgent cases, for example. My doctor, I can ring at 8 o’clock in the morning, and if the nurse that I speak to at the end of the phone decides that yes I do need to see a doctor that day, they will normally find me something during the morning period. There are other doctors that will do an hour kind of drop-in service where you arrive, you take a number, and you wait for your number to come up, that’s if you, you need to see a doctor that day. And there are others that are simply very very busy, and you may not be able to get an appointment on the day that you would like it. So that’s something to really consider when you’re choosing a doctor.
Carlie: And, I know as an expat here in France it’s always really nerve-wracking when I need to make an appointment, and I love the doctors in the town where I’m living that allow you to book online. Is that very common in Denmark, that you can make your medical appointments online, or do you need to have those dreaded phone conversations?
Melanie: Some surgeries will have a website where you can book, perhaps appointments that aren’t time critical, so perhaps you need to go and have your smear test done, or maybe you need to have an immunisation or something along those lines. Sometimes you can book that online, but generally it is a phone call that’s required. But many many surgeries here, when you ring, they will say in Danish, press 1 for Danish, and then in English will say, press 2 for this message in English. So you obviously can change the language in which you speak to them.
Carlie: And how much does it cost to see a doctor?
Melanie: It’s free. Because we have universal healthcare. We have very high taxes here in Denmark, the top rate is 60%. But that money that you pay in your taxes, a big proportion of that goes towards healthcare. So you actually, for most of the medical services that you will require in Denmark, you won’t actually have to pay for them. There are a couple of types of medical support, such as physiotherapy and chiropractors, that you will have to pay something towards. But in general, going to see your GP, going to the emergency room, having surgery, having a baby, all of those everyday things, seeing any kind of consultant, will not cost you a penny, or a, or a crown! (laughs)
Carlie: When it comes to an employment package you might have in Denmark where you have private healthcare, how does that work with the public system which is so good?
Melanie: Well one of the problems that we have in this country, and I think many countries have, are waiting lists for certain types of either surgery or consultations. So, a lot of companies, if they do offer private healthcare, it will be because of that. It means that you can avoid waiting times, or you can choose to go to a specific private hospital.
So if you have something that you know that you would prefer to see a particular consultant at a private hospital, then you would use it for that. In general, people are very happy with the, the public service that they, they receive, and there’s also a rule that if you have to wait a certain amount of time for a consultation at a hospital through the public service, if it is too long, then they will pay for you to go and see a private consultant.
Carlie: That sounds like a very robust system then.
Melanie: It is, it is. I mean I’ve had a lot of experience of the healthcare here, and I would say that in the main, I’ve been very very happy with the services that I’ve received through the public hospitals. And probably slightly less happy the, with the ones I’ve had through the private sector. Now I’ve chosen to do, as, as, you know, I’ve just said about looking at waiting times.
Over the summer here, from the beginning of July probably to mid-August, there aren’t so many appointments available in the public system because people, doctors need to take their holidays, and nurses need to take their holidays. So I have taken out the, the opportunity that I have through my husband’s work package to use the private system. But I actually found that every time I’ve, I’ve been through the public sector, I’ve felt that I’ve received a much nicer experience, particularly in the, the time that they allow you to stay in after day surgery before they send you home.
Whereas in the private hospitals, they’re very much like, OK, you’re ready to go home, you go home now, even if, you know, you’re a little bit groggy and perhaps you’d like to rest a little longer. But whereas when I’ve had surgery in the, the public hospitals, generally if it’s day surgery, they let you stay until 5 o’clock, which is when the units close, and that’s when you go home. So I’ve often been able to sit there and really feel ready to return home.
Carlie: It’s so important, just those little extra things that happen when, when you’re talking about being in a hospital or a day surgery, that really impact on the quality of care you’re receiving.
Melanie: Oh absolutely! I really, I mean one time I woke up from surgery, and the nurse sitting next to me, the light was coming in the window behind her, and she looked like an angel! And I remember saying to her, wow, you look like an angel! I was obviously still very high at the time from the surgery! And, and she sort of laughed, and she said, I’m your angel until it’s my lunch hour! (laughs)
So, you know, it’s nice, and they’re often very chatty, and they take, both, from, I’ve found from both my GP all the way through to hospital consultations, I have never felt rushed. I’ve never felt that they’re, ooh, onto the next patient. And often, when I’ve been in sort of day surgeries at the hospital, I’ve waited and my appointment has been slightly delayed, but I know that’s because they’ve taken time with the patients before me. And likewise they’ll take time with me as well.
Carlie: So what else is important to know if you’re moving to Denmark and trying to decipher the healthcare system?
Melanie: OK, one of the things which people find a little bit odd and difficult to get their head around is how the emergency room or A&E works in this country. Now, you can’t just turn up at your local A&E, if you’ve hurt yourself or you need treatment. What they expect you to do is you have to ring a phone line which is called 1813, and in Danish it’s atten tretten.
If you require treatment that isn’t emergency treatment, of course, you know, if, if your arm’s fallen off or whathaveyou, you have to ring the emergency services. But if you’ve got something that’s slightly wrong with you and you need attention then from A&E, you’ve had a sports injury or something, you actually call in advance. Now, what happens when you call is they triage you, so you will actually speak to a medical professional at the other end of the phone.
Normally they’ll speak to you in English, if they don’t they’ll quickly put you back on the waiting, you know, they’ll say you’re fourth in line or whatever, and then they’ll get an English speaker to speak to you.
But they will actually triage you on the phone, and they will decide how urgent your treatment is, and also, which hospital has the shortest waiting time at that time for you to go to. So rather than sending you perhaps to the, the closest one to your home, which you may have to sit there for 4 hours to see someone, they may send you to one slightly further afield, maybe only you know an extra couple of kilometres further on, but you’ll be seen much faster.
They’ll also, I mean for example, my son had a very very high fever when he was younger, and it was out of the normal doctor’s surgery hours, so we called 1813, and they actually said yep, you can have an appointment at your local hospital in half an hour’s time, please make your way there now. So, although it seems like there’s this extra layer in between, it actually makes it much more streamlined, because you get to go to the right hospital, the hospital that has an X-Ray department if that’s what you require, and it makes it much easier for you as a patient. And who wouldn’t rather wait at home with an ice pack on their ankle for 3 hours, than sit in A&E for 3 hours waiting for an appointment?
So that system is something that’s different. It’s changing slightly, this used to be just a Copenhagen system, but they’re actually rolling it out next year across the whole of Denmark. So that’s definitely one thing that I think people need to be aware of, if they’re either travelling or moving here. Another thing that’s interesting to know about is, as well as private healthcare that you can take out where you pay an amount each year for it, there is also a health mutual insurance company here, and it’s simply called Danmark, which can get you reimbursement for glasses and dental treatment which aren’t covered under the free services. And also, if you regularly take any medication, you can get a discount on that medication that you take, like prescription medication.
So that’s definitely a scheme to look at and see if it’s worth you paying some amount of money through the year, if you are likely to need an, an amount of dental treatment or, you know, opticians’ fees, or even medicine. So that’s definitely something to consider.
Carlie: Is this separate from health insurance, and do you have to qualify for it though, like be a low income earner, or a parent?
Melanie: No, absolutely not. You just take out the, you just pay the money, and take it out. It obviously doesn’t cover you for the same level of things as a private one would, you know, you can’t go into a private hospital using that, it, it’s more a, just something that can help you out financially with some of the costs of healthcare.
Carlie: What do you find comes as a surprise to a lot of the expats that you work with when it comes to healthcare, and what might be different to what they’re used to in their home country?
Melanie: Well it depends, I mean if you’re coming from the US of course it’s a completely different system. You don’t pay for anything. But one of the things, particularly for people coming from the UK, is about prescriptions. In the UK you pay a flat fee for your prescription, no matter what the medication is that you are receiving, you pay, you know, £6-whatever it is nowadays. But here there’s no flat fee for prescriptions, so you pay for the cost of that medication. It is partially subsidised, so you’re not paying the full amount. And you can also ask for the cheapest version, or the generic version of the medication that you have been prescribed. So that can come as a little bit of a shock for people, because they might see a little bit more of the actual value of the medication that they have been prescribed.
But again, we live in a very fair society in Denmark, and we have a sliding scale about how much you actually have to pay for your prescriptions. So, the more you have to pay for prescriptions, the less you end up paying gradually through the year. So, if for example you just have the odd prescription from your, your GP through the year, you’ll pay the full amount. But as you’re paying more and more, it all accumulates under your CPR number, and you pay a lesser percentage each time.
Now I, I have a chronic health condition, so I take regular medication, and it’s not cheap medication. But after the first, I think the first two prescriptions within a 12 month period, after that I pay nothing for that prescription, because the value of it has added up through that time. Which means that there are people with chronic health problems in other countries, for example, my dad lives in France and he has a chronic, he has asthma, so his inhalers, he pays a full amount each time. Whereas if he lived here, after the first couple of inhalers in that 12 month period, he wouldn’t pay anything for them. So it doesn’t penalise you if you have a chronic health problem.
Carlie: On the topic of the CPR number, I’m guessing it’s similar to the carte vitale or the NI number in the UK. How difficult is it as an expat to actually obtain it? Is it a bit of a tricky one, a chicken and egg situation, when you first arrive in Denmark?
Melanie: Not at all. You have to get a CPR card to access anything in this country, not just your healthcare services. So, as an EU citizen, if you move to Denmark you get an EU registration, which is your first step towards becoming, you know, part of society here. Then once you have that you immediately need to apply for your CPR card. Without a CPR card you, you literally can’t do anything. You couldn’t take books out of the library, you couldn’t take a mobile phone contract. You wouldn’t be able to get your kids in school. So, the CPR card is basically your gateway to everything in Denmark, it’s not just healthcare.
The healthcare is a big part of it, but you need to have that, and you need to register for it when you, you are living here for anything longer than 3 months. So, it’s, it’s not a separate thing for healthcare, it’s, it’s all in one. You know, I mean the whole population of Denmark is about the same as Birmingham in England, so, you know, it, it does make it a little bit easier for these more integrated systems. And also we’re a very digitalised society here, you know, most things happen through an online, secure online portals, we have various different ways that you can sign into things, that you can sign documents online. So we’re very very much a digital society, and also an integrated society, for many of the services that are there.
We have a website, a health website that you can log into, and by using your CPR number, and also this unique identity number card that you’re given, you can sign into there and you can see all of your health records. Just you, sitting at home, on your laptop. So when I finished a consultation at the hospital, I give it a week or so for the, the details to have been put up there, because obviously the administrators are quite busy, but then I can see all the notes from my consultation with the doctor at the hospital.
I can see all the notes from going to see my GP, I can see my son’s notes on there as well, I can see how up to date he is with his immunisations, with anything on there, any test, tests that I have, all go onto that system, so I can see that I have very much kind of an open view of my own healthcare. And I think that that’s one of the really valuable things here, because often, I don’t know about you, but if you see a consultant at a hospital, they’re telling you so much at once, and sometimes you can take someone with you who’s a second pair of ears, but often, you’ll come home and you’ll think oh, now what was that thing that she said about such-and-such? It’s OK! You go on the system, you can see all the notes that that doctor has made, and you can refer back to them at any time.
Carlie: What’s another aspect of healthcare in Denmark that’s important for expats to know about?
Melanie: Dental care. Dental care is not covered under the public health. So you do have to pay to go and see a dentist. There are dentists, there are millions probably, it feels like, dentists in Copenhagen and in most towns, so you will be able to find a dentist. But you will have to pay something towards your dental treatment. Now again, holding a CPR card, you get some discount on the price of your dental care. And it is set, so no one dentist can go out there and suddenly like triple their prices. So there is kind of a, a ceiling as to how much can be charged.
But one very interesting thing is that there is a, obviously a university department where they train dentists, and if you have the time during the day to attend a dentist, you can go over to there, and you will have dentists who are right at the end of their training, obviously they’re supervised, to do very very simple dental treatment for you, and it costs you an awful lot less if you actually go and have somebody who’s still finishing up their, their training on being a dentist. But if you’re just going for a scale and polish, or a quick check-up or whathaveyou, then you feel quite confident that you can do that. And, and even bigger things done on your teeth. But, that’s definitely something to consider, that the dental care is not covered for free.
But as I already said about the, the health mutual insurance company, Danmark, part of that will help you towards dental treatment as well. So, if you’re getting, you know, slightly older, I think our teeth aren’t as good once we get into our 50s and onwards, so that’s definitely something to consider if you’re of an age where you think you’re likely to be having dental treatment, ‘cause it can, can start to add up a little bit.
Carlie: And what’s your best option if you’re wanting other treatments regularly, like a chiropractor, or a physiotherapist, or acupuncture? I’m guessing they would be elective and, and you’d have to have a private health insurance, or be paying upfront for that sort of thing as well?
Melanie: Yes. If you choose to go to a physiotherapist just yourself, you’ve decided you need to see a physiotherapist, and you go to one of the private physiotherapy clinics, you will pay the full amount of money for your appointment with the physio, if you don’t have private healthcare to help you cover that. If you have a referral from your doctor for a chiropractor, or a physiotherapist, or you mention acupuncturist, if you have a referral from them you will not pay the full amount of money.
So, I saw a physiotherapist, and my doctor had referred me. And I ended up paying around 150 krone per session, which I think is about €20. Now that was half the amount that it, it actually cost, because I’d had that referral. So it’s very important if you do want to see a chiropractor or a physiotherapist, or any kind of complementary, go to your doctor first, and get that referral from them, and that will help you out in, in a lot of cases, with some of the cost of that.
Carlie: What else is on the need to know list when it comes to healthcare in Denmark?
Melanie: Well travelling outside of Denmark, that’s something you need to consider. If you are travelling anywhere in the EU, you need to get, I think they’re called in the UK EHICs, but we call them very simply a blue European health insurance card here. It’s, it’s a card that you, you take when you travel to any other European country, and you will receive the same treatment that you would receive in Denmark with your yellow card, with that blue card in those other countries. You apply for that, it’s totally free. And you can apply online again, and you can apply for everybody in your household. So everybody would hold one of these blue health cards. They normally come through the post in a couple of weeks. So when you do travel, so if I travelled to see my, my parents in France, I’d carry that blue card, if any of us need any treatment while we’re there, we just show them that card and it’s, it’s universally recognised, and we’ll receive the same free treatment that we would receive in Denmark.
Carlie: When it comes to having a baby in Denmark, is that pretty straightforward? You mentioned earlier it is also covered through the universal healthcare scheme?
Melanie: It is fairly straightforward. Now, I will say that if you come from the US, you will be horrified at how few scans you have and how few appointments you have actually at a hospital. Now generally, when you suspect that you may be pregnant, the first step is you just do a home pregnancy test, which are very easy to get hold of. If that confirms that you are pregnant then you ring your family doctor, and you tell her you think you’re pregnant. She won’t want to see you for a few weeks, but she’ll set up an appointment. And then once you’ve seen her, you’re then passed on to a midwife team.
Now, when I had my son 9 years ago, or 10 years ago, I, I saw the same midwife every time, but you don’t always do that. But again, because of this integrated system of all the notes, and you have a specific journal which is given to you, where every appointment you have in relation to your pregnancy, wherever it is, whether it’s at the hospital having the nuchal scan, or it’s seeing your midwife team, or maybe you pop in to see your GP about something, all of that will be held in one specific area of your data. So everybody involved in your pregnancy, including you, can see all of that information.
Now, one of the big things that I’ve noticed here with healthcare professionals is they’re very laid back, they’re very relaxed. And their whole thing is, if there’s not a problem, we don’t fuss about it, but if there is, we’re going to deal with it. Towards the end of my pregnancy it became apparent that my son had not turned, so he was the wrong way, he was breech. And immediately they set the wheels in motion as to how are we gonna deal with this? We’re not just gonna let you go full-term, go into labour, and then go oh my goodness, he’s breech, what are we gonna do? So there was a big plan set up as to how we were going to approach this, and all the way along, they talked to me and they said, this is what we’re recommending, are you comfortable with this?
So when I went to visit the hospital where I was gonna give birth, they showed me the water birth room, and they said oh, well if there’s time you could use this, or, this is this other room, and this is the rooms that you’ll be in. And in the big hospitals they have what are called patient hotels. And you book a room. So you have a private room, it costs, you have to pay, but it’s a really small amount of money. And your partner can sleep in there, there is a bed for them in the room, and so once you’ve had the baby, particularly your first baby, you can go up into that patient hotel, and, and you’re in your kind of like little bubble there, but you’ve got all the health professionals around you. So it’s fairly straightforward, you get two scans, unless you’re in a high-risk group.
But they’re keeping an eye on you all the way through, and apart from that patient hotel, you don’t pay anything for it. And when you’re in hospital once you’ve had the baby, there are nappies for you to use, there’s, there’s everything you need to use when you’re in the hospital. So it takes a lot of that pressure away from actually going in and giving birth.
Carlie: So what sort of afterbirth support do you get?
Melanie: Well when you have your first baby you get quite a bit of support in the hospital. But when you come home, you have a health visitor who will come in. And she’ll come in fairly frequently in the first couple of weeks, and she will weigh the baby. So make sure that he’s doing OK. They might need to do some tests, like they do a heel test to test for some congenital diseases. And she’ll give you support if you’re breastfeeding and maybe you, you need some support with that. And, she does keep an eye on you, and, not in a kind of nasty way, but just make sure that you seem OK.
She doesn’t expect the house to be spotless when she turns up and that you’re, you know, fully dressed in, in a posh frock. But, you know, she’ll keep an eye on you and she will talk to you about your mental health as well after the birth. When I look back, I mean it was all in a paper book when I had my son, and it’s online now, but, I look back and she made, like, really small observations, but actually quite important ones, about how I appeared to her, you know, did I seem, you know, very upbeat, or was I just normal, or was I down, and how was he reacting, how was he sleeping? So she made so many notes about that, and I felt that that made me as a, as a new mum who was terrified of this thing that I’d brought home that I had no idea what to do with, that there was this person there, this safety net, who was looking out for us and helping us out.
Carlie: It sounds like that is really characteristic of the Danish healthcare system, in that it is such a great safety net.
Carlie: So if you’re moving to Denmark, and you want to get your head around the healthcare system, you’ve just given us a brilliant lowdown of how it works, and what to be careful of, and what to make sure you do. But what are some other really good resources for newly arrived expats?
Melanie: Well we have a place here called International House. It’s run by the, by the local council, and it’s also supported by the government, and they’re in most of the, these International Houses, or International Centres, are in most towns, most large towns in Copen-, in Denmark. And they have masses and masses of information on every aspect of bureaucracy, of how things work, so that would be a really good place to start, to get information both about the healthcare and about any other aspect of life.
And, in regard to having a baby, I actually, there is quite a lot of resources out there, but they’re dotted around, and I produced an ebook myself about having a baby in Denmark. And I regularly give presentations to new, newly-pregnant or planning to be pregnant expats about, you know, what to look out for, both within the health system, but also you know, how to just buy things and do things here. And I think sometimes when you’re in a new country, healthcare is something that is the biggest thing that you need to make sure that you know how it works. Because nobody wants to be panicking when they need to access any kind of healthcare, of not knowing the system.
Carlie: That’s it for this episode. If you have any questions for Melanie, or wanna share your own experiences with the Danish healthcare system, head over to expatfocus.com, follow the links to our Denmark forum or Facebook group. You’ll find more episodes on our website, also on iTunes, covering all aspects of expat life. If you like what we do in this podcast, please leave us a review. And I’ll catch you next time!