Strategic Healthcare Systems: A Comparative Analysis of Austria and Denmark

Abstract

Global healthcare systems are increasingly challenged by demographic changes, cost pressures, and medical innovations. This thesis does compare the decentralized healthcare infrastructure of Austria with Denmark’s strategically service-concentrated model. While both systems share a distributed governance, Denmark’s 2007 reforms consolidated the number of hospitals from 40 to 21. This had the goal of improving efficiency and quality through specialized “super hospitals”. In contrast to that, Austria has a network of 264 facilities. The study explores strategic advantages and challenges within each system regarding effectiveness, efficiency, patient access, and care quality. It does examine how differences in centralization and decentralization affect how resources are distributed and how sustainable the systems are in the long run. A mixed-methods approach combined extensive literature review with qualitative insights from seven expert interviews. Twenty strategic indicators, integrating quantitative data (e.g., OECD reports) and stakeholder perspectives, guided the analysis. The findings are indicating that Denmark’s centralized hospital strategy achieves better efficiency. This becomes visible with for example lower amenable mortality (60 vs. 83 per 100.000) and shorter hospital stays (4,3 vs. 6,2 days). Denmark has, just like Austria, a tax-funded system, which enables consistent financing. Around 90% of patient interactions are managed through primary care. Even though there are far fewer hospitals, the strong pre-hospital services and public acceptance contribute to high-quality specialized care. In contrast to that, Austria’s decentralized system does offer broad geographic access and high physician density. But the system faces coordination inefficiencies and uneven service standards. Resource limitations do arise from maintaining numerous facilities, which are often underutilized, with political resistance hindering structural reforms. In summary, the study identifies a key trade-off: Denmark does prioritize centralized quality and efficiency, while the focus in Austria does lay on access and regional autonomy. Denmark’s approach, which is focused on service concentration and primary care, is closer aligned with value-based healthcare principles. For Austria, adopting a more unified governance model could improve resource allocation and system performance.

Date of Award	2025
Original language	English
Supervisor	Christiane Rau (Supervisor)