Regions of Denmark

Like their geographical areas, the names of several regions are neologisms. The term Syddanmark (Southern Denmark) was known before the reform, but not in the present meaning. It was sometimes used to refer to Denmark proper as opposed to the North Atlantic parts of the Danish realm, the Faroe Islands and Greenland. The term Midtjylland was, and in common use still is, used to describe the interior centre of Jutland, but never the coastal areas of the peninsula (West Jutland and East Jutland).

The Regions of North Jutland and Central Jutland have chosen to market themselves internationally under the names of North Denmark Region and Midtjylland, respectively, although in Denmark these geographical terms have no traditional use and may be confusing.

The government most often uses the Danish names in English-language publications[6] or directly translated English names (e.g. Greater Copenhagen, Zealand, North Jutland, Southern Denmark, Central Jutland).[7]

Strictly speaking, there is no authority defining the correct English names since the official names are stipulated in a law existing only in a Danish version.

Note: Numbers for the year 2006 are pro forma to be a reference, an example, to compare (neighboring) regions and changes in population numbers when the economy was expanding, growing, as opposed to when it was contracting.[8]

The regions own all public hospitals in their areas and also control the primary care sector through contracts with general physicians (family doctors) and specialists. The name of the region is often used on hospitals' letterheads and on doctors' and nurses' white coats.

Four of the regions have a university hospital, corresponding with the four medical faculties of Denmark. The Region Zealand lacks a medical faculty but has in 2016 renamed its hospitals in Roskilde and Køge, close to Copenhagen, as university hospitals and will collaborate with the medical faculty of the University of Copenhagen.[9] The administrative reform of 1 January 2007 was in many respects also a centralisation of the healthcare system. While the former counties controlled hospitals relatively independently, healthcare policy is now decided by the government, while regions administer it. Some local hospitals have been closed or downgraded. New, large and highly specialised hospitals have been built including Aarhus University Hospital and Psychiatric Hospital Slagelse. Projects during or awaiting construction are the new Aalborg University Hospital, Odense University Hospital, North Zealand Hospital at Hillerød serving the northern Copenhagen area, the regional Gødstrup Hospital and Aabenraa Hospital, and large extensions of the Zealand University Hospital in Køge, Herlev Hospital, Bispebjerg Hospital and Rigshospitalet in Copenhagen and the regional South Jutland Hospital in Sønderborg.

The projects, in Denmark known as 'super hospitals' (da: Supersygehus), were intended to increase the quality of care and reduce costs, but have almost uniformally experienced large-scale planning problems including breach of budgets, delays, interior climate problems, unsatisfactory design and last-minute cost cuts such as removing kitchens, decreasing the bed capacity or removing amenities for patients. As a result of the centralisation, Denmark will decrease its hospitals with emergency care from 40 in 2007 to 21 in 2020. The changes have been criticised by residents in areas far from emergency hospitals. To compensate, some of the regions offer paramedic helicopter response in addition to ambulances. In addition, since 1999 the government has obliged Danish hospitals to increase their productivity by 2% per year for the same budget, in the expectation of possible benefits from technical progress, but often leading to cutbacks in services. A growth in bureaucracy has generally been observed by doctors and employees.[10] In the Capital Region and Zealand Region, a new electronic health record system developed by Epic Systems has been described as a major scandal, causing unresponsive IT systems, wrong prescriptions, more time-consumption and a lack of overview. Doctors and other employees have demanded the withdrawal of the system, but the regions insist that it will remain in place and errors be corrected.[11]

Regions are responsible for providing primary care to all citizens. This is carried out through contracts with general practitioners who for the most part own their clinics and provide treatment free-of-charge for the public, according to specifications laid down by the region. According to doctors, the burden of documentation and administration has increased, and the amount of young doctors wishing a career as general practitioners has diminished. Since many areas have been affected by physician shortage, the regions have been compelled to open region-owned clinics to fill the gaps.

After the 1970 reform, in 1974 Sengeløse Municipality was merged with Høje-Taastrup, and the parish municipalities Store Magleby and Dragør merged to form Dragør Municipality, reducing the number of municipalities from 277 to 275. Countrywide, many local mergers were proposed through the years, but none took place until 2003.

The five municipalities of Bornholm merged with Bornholm County on 1 Jan 2003 to form Bornholm Regional Municipality. This reduced the number of counties from 14 to 13, and the number of municipalities from 275 to 271. On 1 January 2007 it became part of the Capital Region, but retained its unique name of Regional Municipality since it has been allocated some regional powers due to its isolated location. These include being an employment region of its own, regional development, pollution control and public transport, but healthcare is in the hands of the Capital Region.

Ærø Municipality was allowed to be formed already 1 January 2006 from the island's former two municipalities of Ærøskøbing and Marstal, reducing the number of municipalities to 270.

The reform implied deep changes of the whole Danish public sector. It took effect from 1 January 2007, but was prepared from 2005. In the local elections of 15 November 2005, municipal councils for the upcoming 98 municipalities and five regions were elected. These councils were officially merger committees (sammenlægningsudvalg) from 1 January 2006 through 31 December 2006. During that year, their task was solely that of preparing the mergers. On 1 January 2007 these elected committees were renamed municipal councils and now ruling the new municipalities, without new elections taking place.

The councils of the older, smaller municipalities, as well as the old municipalities themselves, were in force until the end of 2006. They were elected in November 2001 and would normally have been in power for a four-year term of office, from 1 January 2002 until 31 December 2005, but their term of office was simply extended by one year.

The equivalent name for the upcoming regional councils were preparatory boards (forberedelsesudvalg) and these were likewise elected on 15 November 2005. The county councils of the old counties had their mandate prolonged by a year and existed parallel to the preparatory boards during 2006.

One municipality, Bornholm, which was formed January 2003 before the reform was initiated, and one formed January 2006, namely Ærø, as part of the reform, in addition to 30 municipalities, most notably Copenhagen, many of its surrounding municipalities and some island municipalities, were not affected by municipal mergers 1 January 2007. In these municipalities, the councillors served the full term of office from 1 January 2006 until 31 December 2009.

After the transitions, the next local elections took place on 17 Nov 2009. A few local political parties have emerged as a protest against closing of hospitals or cutbacks in healthcare, most notably Fælleslisten, which got over 40 percent of the votes in the Holstebro area in the 2009 election, and the Psychiatry List in the 2017 election, both in the Central Jutland Region.

The reform has been called the biggest reform in thirty years. It was an important policy issue for the former Liberal-Conservative cabinet, most importantly for Lars Løkke Rasmussen, then minister of the Interior and Health and formerly a county mayor.

The abolition of the counties had long been an important goal for both the Conservatives and the Danish People's Party. 24 June 2004 the Danish People's Party decided to back the government's proposal for a structural reform of the public sector, thus securing a majority in the Danish parliament (Folketing), although the party had preferred just abolishing the counties without replacing them with a new administrative level between the central government and the municipalities. The parties who wanted to limit the regional tier of government prevailed insofar as the regions have no authority to levy taxes, and are not municipalities unlike the former counties (1970–2006) (Danish amtskommune, literally 'county municipality'), and therefore cannot move budgets from one area of expenditure to another but must pay back any money not used, rather like departments or agencies of the central government.

The regions were distinct from the state administration offices (Danish: statsforvaltning(en)). The regions are responsible for devolved tasks within healthcare and regional planning and governed by an elected council. The State Administrations were not subordinate to the Regions, but regional governmental offices under the Ministry for Children and Social Affairs.

The state administration with its regional offices handled matters within family law, including child custody and child contact, divorce, paternity and child support cases, which often involve a high degree of conflict when parents disagree. It also handled matters such as name change, artificial fertilisation, citizenship, right of residence for EU citizens, guardianship for adults, and acted as a complaints authority for municipal decisions in building matters.

Initially after the reform, effective from 1 January 2007, there were five state administrations, covering the same areas as the five regions. They were subject to the Ministry of the Interior and Health. They also acted as a complaints board for a wider range of decisions taken by municipalities, including social law. The civil servants leading each of the five state administrations had the title of state administration director.

From 1 July 2013, the State Administration was organised with one central office in Aabenraa and eight regional representations. It was managed by one central State Administration director and several subordinate vice directors.

While not a court, the State Administration handled over 100,000 family law cases per year. In media reports, the entity was criticized for bureaucratic handling of cases and negligence of the best interest of children. Organizations of single fathers claimed that case officers were biased and would often side with the mother, for example when unproven accusations of incest or abuse were made.

A 2017 government plan proposed to abolish the State Administration and replace it with a new entity, the Family Law House (Familieretshuset).[13]

The State Administration was abolished from 1 April 2019, and the Agency of Family Law took over a large part of the tasks of the State Administration.

One of the tasks of the State Administration is the technical and economic supervision of the dioceses within the Church of Denmark, along with the bishops. In this function they bear the title of stiftamtmand (literally 'diocesan governor'). While each of the five regional state administration directors were simultaneously diocesan governors, the task is now carried out by several vice directors who carry the additional title of diocesan governors. Peculiarly, since the task is purely administrative and representing the government under the Ministry for Ecclesiastical Affairs, the person does not need to be a member of the Church of Denmark. In 2011, Niels Preisler, a Roman Catholic, was appointed director of the Copenhagen state administration and therefore diocesan governor of Copenhagen.[14]

Henrik Frederik von Söhlenthal, a Danish county prefect in the 18th century

Map of the 22 counties of Denmark existing until 1970 (without Greenland and the Faroe Islands)

The predecessor of the state administration(s), from 1970 until the 2007 reform, were the 14 county government divisions or prefectures (Danish: statsamt, plural: statsamter, i.e. 'state county'). They were each led by an amtmand (county prefect or governor) appointed by the government, while in ecclesiastical contexts the title stiftamtmand ('diocesan prefect') was used for the same position. These units were distinct from the 14 counties led by an elected council, but covered the same areas. Copenhagen, however, had the equivalent entity of Upper Presidium (Københavns overpræsidium) led by an upper president (overpræsident), a title originating from 1747. The municipality of Frederiksberg shared its county governor and county government division with Copenhagen County (not covering Copenhagen proper, but the surrounding area). Bornholm retained its county government office and governor even after losing its county status (2003–2006).

While prefect or governor is an English rendering of the title, county prefects were practically senior government officials, unknown to a larger public and less powerful than governors in many other countries. On the Faroe Islands and Greenland, after autonomy, the equivalent representative of the Danish government is the High Commissioner, (rigsombudsmand, formerly amtmand, which was often translated as governor).

The general public was mostly familiar with the former statsamt and then statsadministration as the entity dealing with divorce and child custody.

The position of county prefect dated back to the age of absolutism. After elected councils were introduced, the King-appointed county prefect still led the elected county council and had larger political influence. In 1970, his political role was then taken over by the county mayor (amtsborgmester) who was one of the elected county council members. The county prefect remained as the highest government representative in each county, and in his traditional civil servant uniform would be the person to receive the Queen on her visits throughout the country. In Copenhagen Municipality, the switch was made in 1938 when the title of Lord Mayor of Copenhagen (Københavns overborgmester, literally 'upper mayor of Copenhagen') was created for the elected leader of the city council. The equivalent of the Danish county prefect is the Swedish landshövding and the Norwegian fylkesmann.