Denmark is a small country of 5.7 million citizens of which 0.98 million are under the age of 15. The birth rate is 1.73 and the expected live expectancy is 80 years. Danish is the official language. 93 per cent of the population has a Western European background.
Almost all paediatric health care is tax funded. It is free to see a paediatric ophthalmologist and all surgeries are free. A growing number of adults have additional private insurances. The ophthalmologists are either in public funded private practices (50% of ophthalmologists) and the rest in public hospitals. Only a small portion work solely in private set ups. Denmark has a well-developed vision screening program by school nurses and general practitioners from 5 weeks to 8 years.
The biggest advantage of our system is free care for all. The majority of paediatric cases are managed in practice. The most common diagnosis here being refractive errors (mainly hypermetropia- myopia in children is not a big problem) and amblyopia. In Denmark children under the age of 10 have to have an ophthalmological examination in order to have glasses prescribed as only ophthalmologists are allowed to use cycloplegic drops. The rest of the children are seen in tertiary settings in ophthalmological departments, in close collaboration with paediatric departments. In hospitals there are less than 20 fulltime paediatric ophthalmologists with a mixture of medical paediatric ophthalmology and strabismus. Surgical treatment of paediatric cataract, glaucoma, retinoblastoma, ROP, etc. is centralized to 1-2 centres where 2 or 3 “adult” specialists in cataract, glaucoma, tumours, vitreoretinal surgery have subspecialized in paediatric surgery. Follow up is mainly by paediatric ophthalmologists. So in Denmark, a paediatric ophthalmologist might perform strabismus surgery but is otherwise not a surgeon. This system works well as the surgical case load is low and the centralization provides a sufficient number of cases in the hands of experienced full time surgeons. This system secures cheaper but also less specialized care for the easier cases (glasses and amblyopia not being centralized). Denmark has less than 15 orthoptists, all educated abroad.
The major challenge is the cost, growing expectations and possibilities and growing inequality in health. Even in this very homogenic population there are great differences in life expectancy depending on where you live. Also there is an increasing population of senior citizens with high life expectancy and thus gradually fewer tax-payers. But admittedly in a worldwide perspective our major problems are minor.