>> At the press conference preceding the event, Her Excellency, Susanne Hyldelund, the Danish ambassador in Berlin, emphasized that all participants should be “inspired by Denmark” because, after all, it is “about the future of care.” Both the German and Danish health systems are facing major challenges, because due to the effects of demographics, multimorbidity and the increase in chronic diseases, “we all have to align our health systems more closely with people’s needs,” because they need to respond more than ever can rely on the health systems. Her Excellency Susanne Hyldelund: "Let's see this as an opportunity."
The ambassador sees the close cooperation between public and private partners, as is the case with the Steno Diabetes Center, as an important Danish contribution to a robust healthcare system. And not since today or yesterday, but for 89 years, the Steno Diabetes Center has been a hospital specializing in the treatment of diabetes, research, prevention and the training of diabetes professionals. The aim is to offer all citizens with diabetes in the capital region the best treatment and prevention. Steno was owned by Novo Nordisk A/S during this period, but moved to the capital region on January 1st, 2017 to become part of a visionary company: the new Steno Diabetes Center Copenhagen (SDCC).  
Its vision is to improve the entire diabetes sector in the capital region so that people with diabetes in this region receive the best diabetes care and prevention to improve their quality of life. However, the SDCC also wants to provide suggestions and new insights on a national and international level, as did the longstanding but now retired Steno Managing Director Allan Flyvbjerg, who is also Chairman of the Board of the Danish Diabetes Academy, at the press conference. In his lecture, which bridged traditional to value-based structures, he explained that when comparing both health systems, one encounters the same problems and, first and foremost, the necessary access to data.

However, Denmark has long had this, as Jakob Skaarup Nielsen, the director of Healthcare Denmark, stated, and on a scale that Germany can only dream of. Nielsen: “We have been collecting health data for 50 years and the population has accepted it.” The magic word is: trust!
And the second: a consistent gatekeeper function, which has been established among the Danes for around 50 years. "In Denmark, the family doctor plays a very crucial role," says Nielsen, because they decide whether a patient needs to be referred to the specialist, but this only happens in 1 in 10 patients. A Danish family doctor has a similar number of patient contacts as a German colleague: around 60-70 contacts per day. “A Danish family doctor would therefore have no more time than their German colleagues,” calculates Nielsen. However, in Denmark, work in practices is organized differently, with many contacts being taken over by medical professionals. Currently, according to Nielsen, medical specialists play the main role in the treatment of diabetes. But there are signs of a kind of “new reality” in which well-trained patients are increasingly treating themselves – but with the medical specialists as assistants at their side. According to Nielsen, this change involves many actors and should be supported by all in order to enable diabetes patients to be independent and in control of their everyday life, which not only includes the diabetes patients themselves, but also family, friends and social environment. Nielsen: “It’s about the holistic understanding of a citizen and their life situation.”

Eberhard Mehl has a similar concept in mind, who reported on what had been developed in the “Diabetes 2030” expert group of patient pilots. Mehl, today Managing Director of doc of the world GmbH, until 2018 that of the German Association of General Practitioners, listed four things that annoyed him as a type 1 diabetic, but also his colleagues from patient associations and representatives: not enough integrated and coordinated care, lack of quality and knowledge standards, lack of humanity and transparency as well as accessibility and availability. His interjection, which the moderator Thomas Hegemann jokingly described as “personal coming to terms with the past”: “We are not on the way to achieving goals, but rather lose track of the paths because we are constantly trying to defend our sinecure.”
Overall, he gave the Danish approach of a family doctor-centered approach little chance in Germany. "The idea of putting the family doctor in a coordinating role will not work because we don't have enough young people in family doctor care." As good as the instrument of family doctor care is, if it is properly approached, it will not be able to be used . The delegation of medical activities to non-medical staff also falls under the dramatic effects of the shortage of skilled workers, because: "As a result, we lack the qualified people and thus also the skills to be able to take good care of diabetes."
Therefore, the only resource that is constantly growing must be activated: the patients. Similar to Denmark, it must be possible to bring "trained patients into the care in a structured manner". These, from the expert group of patient guides, so-called patient coaches, or PaCos for short, should be able to coach themselves and, above all, other patients after appropriate training. Mehls Petitum: “Let us integrate the PaCo into the care and ideally anchor it in the Diabetes DMP. That is the chance if the whole thing is controlled, evaluated and readjusted accordingly.”

Prof. Dr. got stuck exactly where the DMPs were. Diethelm Tschöpe from the Heart and Diabetes Center NRW in Bad Oeynhausen and one of the two conference presidents of the
event. “We have formed many structures in Germany that at first glance seem logical and consistent,” explained Tschöpe, referring to various levels of care and also the DMPs. His
Criticism: “We imagine that because we have these structures, everyone is doing exactly what was intended when the structures were formed. The truth is: nobody cares.” The individual stakeholders would largely act independently of each other; also act as if you would need a separate care system for each disease. Tschöpe: "We actually need a permeable, transparent and plastic system." Germany would have a problem, not because there is too little money in the system or too few structures have been created, but because the structures are not used enough. Tchöpe: "If we learn from the Danes, I would say pragmatically: let's start and put the things we have together sensibly and say: 'let it go, baby'."
The system that Tschöpe is talking about is of course centered on family doctors; However, one in which the family doctor must be able to decide whether she can manage on her own or wants to call in support from the specialist level, whether that is a diabetologist, a nephrologist or a neurologist. But there must always be the possibility of individualizing the treatment process and controlling it comprehensively. Tschöpe: "I predict: If this works, the percentage of satisfied patients will increase - there is nothing nicer."
In order to make such a system possible, Tschöpe believes that a public health vision is also needed. Because only with public health will one be able to “bring widespread diseases and epidemics under control”. However, a vision alone is not enough, consistent and permanent monitoring is also necessary. Tschöpe: "Here we are in Germany, not only in terms of diabetes, right at the beginning." This is also due to the fact that a "culture of mistrust" prevails in this country, especially when it comes to the use of data, what in contrast to the culture of trust in Denmark and other Scandinavian countries.
The most important thing - here he fully agrees with Healthcare Denmark boss Nielsen - is the word trust. "We have to get away from the world view of the professional association 'my fee your fee' and instead come to the point that all actors have an interest in organizing health system development in a way that benefits everyone." As soon as you have agreed on this starting position, the family doctor suddenly speaks with the specialist and the clinic
medical doctor and the representatives of the health insurance companies.

"We can't see the forest for the trees." In the opinion of Prof. Dr. Dirk Müller-Wieland from the University Hospital of RWTH Aachen, who spoke of "Diabetes 2030" for the DMP expert group, it was wrong to organize DMPs based on indications Question: "What do I do with a multimorbid patient? Do I enroll him in the diabetes DMP, or in the one for CHD, or in a completely different one? And: What should the patient do then?" It would be obvious to write a DMP for To create multimorbidity. This would make it possible to design care as a whole and to add certain indication-related modules. <<