Healthcare in Sweden

Last updated

Total health spending per capita, in U.S. dollars PPP-adjusted, of Sweden compared amongst various other first world nations. Total health expenditure per capita, US Dollars PPP (alt).png
Total health spending per capita, in U.S. dollars PPP-adjusted, of Sweden compared amongst various other first world nations.

The Swedish health care system is mainly government-funded, universal for all citizens and decentralized, [1] although private health care also exists. The health care system in Sweden is financed primarily through taxes levied by county councils and municipalities. A total of 21 councils are in charge with primary and hospital care within the country.

Contents

Private healthcare is a rarity in Sweden, and even those private institutions work under the mandated city councils. [2] The city councils regulate the rules and the establishment of potential private practices. Although in most countries care for the elderly or those who need psychiatric help is conducted privately, in Sweden local, publicly funded authorities are in charge of this type of care. [3]

Management

Sweden's health care system is organized and managed on three levels: national, regional and local. At the national level, the Ministry of Health and Social Affairs establishes principles and guidelines for care and sets the political agenda for health and medical care. The ministry, along with other government bodies, supervises activities at the lower levels, allocates grants, and periodically evaluates services to ensure correspondence to national goals.

Regional responsibility for financing and providing health care is decentralized to the 21 county councils. A county council is a political body whose representatives are elected by the public every four years on the same day as the national general election. The executive board or hospital board of a county council exercises authority over hospital structure and management and ensures efficient health care delivery. County councils also regulate prices and the level of service offered by private providers. Private providers are required to enter into a contract with the county councils. Patients are not reimbursed for services from private providers who do not have an agreement with the county councils. According to the Swedish health and medical care policy, every county council must provide residents with good-quality health services and medical care and work toward promoting good health in the entire population.

At the local level, municipalities are responsible for maintaining the immediate environment of citizens, such as water supply and social welfare services. Recently, post-discharge care for the disabled and elderly and long-term care for psychiatric patients was decentralized to the local municipalities.

County councils have considerable leeway in deciding how care should be planned and delivered. This explains the wide regional variations.

It is informally divided into 7 sections: "Close-to-home care" (primary care clinics, maternity care clinics, out-patient psychiatric clinics, etc.), emergency care, elective care, in-patient care, out-patient care, specialist care, and dental care. [4]

All citizens are to be given on line access to their own electronic health records by 2020. Many different record systems are used which has caused problems for interoperability. A national patient portal, ‘1177.se’ is used by all systems, with both telephone and online access. At June 2017 about 41% of the population had set up their own account to use personal e-services using this system. A national Health Information Exchange platform provides a single point of connectivity to the many different systems. There is not yet a national regulatory framework for patients’ direct access to their health information. [5]

Provision

Private companies in 2015 provide about 20% of public hospital care and about 30% of public primary care, although in 2014 a survey by the SOM Institute found that 69% of Swedes were opposed to private companies profiting from providing public education, health, and social care, with only about 15% actively in favour.

In April 2015 Västernorrland County ordered its officials to find ways to limit the profits private companies can reap from running publicly funded health services. [6]

Financing

Healthcare spending vs life expectancy for some countries in 2007 Life expectancy vs spending OECD.png
Healthcare spending vs life expectancy for some countries in 2007
Life expectancy development in Sweden by gender Life expectancy by WBG -Sweden -diff.png
Life expectancy development in Sweden by gender

Costs for health and medical care amounted to approximately 9 percent of Sweden's gross domestic product in 2005, a figure that remained fairly stable since the early 1980s. By 2015 the cost had risen to 11.9% of GDP -the highest in Europe. [7] Seventy-one percent of health care is funded through local taxation, and county councils have the right to collect income tax. The state finances the bulk of health care costs, with the patient paying a small nominal fee for examination. The state pays for approximately 97% of medical costs. [8]

When a physician declares a patient to be ill for whatever reason (by signing a certificate of illness/unfitness), the patient is paid a percentage of their normal daily wage from the second day. For the first 14 days, the employer is required to pay this wage, and after that the state pays the wage until the patient is declared fit.

The funding and cost of keeps healthcare affordable and accessible to all Swedish citizens. [9] Local taxes equate for about 70% of the budgets for councils and municipalities, while overall 85% of the total health budget come from public funding. [10]

Details and patient costs

Prescription drugs are not free but fees to the user are capped at 2350 SEK per annum. Once a patient's prescriptions reach this amount, the government covers any further expenses for the rest of the year. The funding system is automated. The country's pharmacies are connected over the Internet. Each prescription is sent to the pharmacy network, which stores information on a patient's medical history and on the prescriptions fulfilled previously for that patient. If the patient's pharmaceutical expenses have exceeded the annual limit, the patient receives the medication free of charge at the point of sale, upon producing identification.

In a sample of 13 developed countries Sweden was eleventh in its population weighted usage of medication in 14 classes in 2009 and twelfth in 2013. The drugs studied were selected on the basis that the conditions treated had high incidence, prevalence and/or mortality, caused significant long-term morbidity and incurred high levels of expenditure and significant developments in prevention or treatment had been made in the last 10 years. The study noted considerable difficulties in cross border comparison of medication use. [11]

A limit on health-care fees per year exists; 150-400 SEK for each visit to a doctor, regardless if they are a private doctor or work at a local health-care center or a hospital. When visiting a hospital, the entrance fee covers all specialist visits the doctor deems necessary, like x-ray, rheumatism specialist, heart surgery operations and so on. The same fee is levied for ambulance services. After 1150 SEK have been paid, health-care for the rest of the year will be provided free of charge.

Dental care is not included in the general health care system, but is partly subsidized by the government. Dental care is free for citizens up to 23 years of age.

Mental health care is an integrated part of the health care system and is subject to the same legislation and user fees as other health care services. If an individual has minor mental health issues, they are attended to by a GP in a primary health setting; if the patient has major mental health issues they are referred to specialized psychiatric care in hospitals. [12]

Performance

The reduction in infant mortality between 1960 and 2008 for Sweden in comparison with Ireland, France, Switzerland, the United Kingdom, and the United States. First-World-Infant-Mortality-Trends.jpg
The reduction in infant mortality between 1960 and 2008 for Sweden in comparison with Ireland, France, Switzerland, the United Kingdom, and the United States.

The system of investigating incidents in maternity care has been very successful. It starts with a no-blame investigation, which is completed quickly. There is then a consideration of whether the problem was avoidable, and if they were how the learning from the incident can be used. Families get compensation if it was avoidable, usually without going to court. [13]

Waiting times

Urgent cases are always prioritized and emergency cases are treated immediately. The national guarantee of care, Vårdgaranti, lays down standards for waiting times for scheduled care, aiming to keep waiting time below 7 days for a visit to a primary care physician, and no more than 90 days for a visit to a specialist. [14]

According to the Euro health consumer index the Swedish score for technically excellent healthcare services, which they rated 10th in Europe in 2015, is dragged down by access and waiting time problems, in spite of national efforts such as Vårdgaranti. It is claimed that there is a long tradition of steering patients away from their doctor unless they are really sick. [15]

A shortage of medical personnel is a major problem. [16]

Private healthcare

According to Nima Sanandaji, at the end of 2017, 643,000 individuals in Sweden were fully covered by private health insurance, which is 6.5% of the population of Sweden. This is an increase of over half a million fully covered by private health insurance compared to 2000. [17]

Criticisms

The Swedish health system is mainly effective but there are some problems within the system. [18] The decentralized healthcare system in Sweden leads to this inefficiency, because of decentralization the counties are granted an extreme amount of flexibility. The coordination between regions and municipalities is affected because of this constant shifting and flexibility. [19] Variation between outcomes and access to care in different regions has been highlighted as a weakness of the system by Socialstyrelesen. [20]

In recent years the health care system of Sweden has been heavily criticized for not providing the same quality of health care to all Swedish citizens. The disparity of health care quality in Sweden is growing. Swedish citizens of other ethnicities than Swedish, and citizens who are of a lower socio-economic class, receive a significantly lower quality of health care than the rest of the population. [21] [22] [23] [24] This was especially brought to light during the COVID-19 pandemic, as Swedish media and public health researchers pointed out that Swedish citizens of other ethnicities than Swedish, and people living in working class areas, were dying from COVID-19 at a significantly higher rate than the rest of the population, due to the fact that they were not provided with the same quality of health care. [25] [26] [27]

The Health and Social Care Inspectorate (Ivo) report

In January 2023 the IVO announced the results of its inspection of 27 hospitals around the country. This report concluded that the current system could not adequately guarantee patient safety in any of the hospitals inspected. Peder Carlsson, the unit chief at IVO who led the inspection said: “Patients do not get an acceptable amount of food, fluids or basic treatment, and according to our information, patients can be required to lie for several hours in their own faeces and urine.” Swedish news agency TT quoted Carlsson as saying: “This is a terrible situation, totally unacceptable and it is particularly striking that this is happening in the hospitals we have in our country". [28] [29] [30]

See also

Related Research Articles

<span class="mw-page-title-main">Medicare (Canada)</span> Canadas publicly funded, single-payer health care system

Medicare is an unofficial designation used to refer to the publicly funded single-payer healthcare system of Canada. Canada's health care system consists of 13 provincial and territorial health insurance plans, which provide universal healthcare coverage to Canadian citizens, permanent residents, and depending on the province or territory, certain temporary residents. The systems are individually administered on a provincial or territorial basis, within guidelines set by the federal government. The formal terminology for the insurance system is provided by the Canada Health Act and the health insurance legislation of the individual provinces and territories.

A health system, health care system or healthcare system is an organization of people, institutions, and resources that delivers health care services to meet the health needs of target populations.

Health insurance or medical insurance is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses. As with other types of insurance, risk is shared among many individuals. By estimating the overall risk of health risk and health system expenses over the risk pool, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to provide the money to pay for the health care benefits specified in the insurance agreement. The benefit is administered by a central organization, such as a government agency, private business, or not-for-profit entity.

<span class="mw-page-title-main">Healthcare in Canada</span>

Healthcare in Canada is delivered through the provincial and territorial systems of publicly funded health care, informally called Medicare. It is guided by the provisions of the Canada Health Act of 1984, and is universal. The 2002 Royal Commission, known as the Romanow Report, revealed that Canadians consider universal access to publicly funded health services as a "fundamental value that ensures national health care insurance for everyone wherever they live in the country."

<span class="mw-page-title-main">Two-tier healthcare</span> Unequal access to higher quality healthcare

Two-tier healthcare is a situation in which a basic government-provided healthcare system provides basic care, and a secondary tier of care exists for those who can pay for additional, better quality or faster access. Most countries have both publicly and privately funded healthcare, but the degree to which it creates a quality differential depends on the way the two systems are managed, funded, and regulated.

Health care in Ireland is delivered through public and private healthcare. The public health care system is governed by the Health Act 2004, which established a new body to be responsible for providing health and personal social services to everyone living in Ireland – the Health Service Executive. The new national health service came into being officially on 1 January 2005; however the new structures are currently in the process of being established as the reform programme continues. In addition to the public-sector, there is also a large private healthcare market.

<span class="mw-page-title-main">Health care system in Japan</span>

The health care system in Japan provides different types of services, including screening examinations, prenatal care and infectious disease control, with the patient accepting responsibility for 30% of these costs while the government pays the remaining 70%. Payment for personal medical services is offered by a universal health care insurance system that provides relative equality of access, with fees set by a government committee. All residents of Japan are required by the law to have health insurance coverage. People without insurance from employers can participate in a national health insurance program, administered by local governments. Patients are free to select physicians or facilities of their choice and cannot be denied coverage. Hospitals, by law, must be run as non-profits and be managed by physicians.

<span class="mw-page-title-main">Healthcare in the United Kingdom</span>

Healthcare in the United Kingdom is a devolved matter, with England, Northern Ireland, Scotland and Wales each having their own systems of publicly funded healthcare, funded by and accountable to separate governments and parliaments, together with smaller private sector and voluntary provision. As a result of each country having different policies and priorities, a variety of differences have developed between these systems since devolution.

<span class="mw-page-title-main">Healthcare in South Korea</span>

Healthcare in South Korea is universal, although a significant portion of healthcare is privately funded. South Korea's healthcare system is based on the National Health Insurance Service, a public health insurance program run by the Ministry of Health and Welfare to which South Koreans of sufficient income must pay contributions in order to insure themselves and their dependants, and the Medical Aid Program, a social welfare program run by the central government and local governments to insure those unable to pay National Health Insurance contributions. In 2015, South Korea ranked first in the OECD for healthcare access. Satisfaction of healthcare has been consistently among the highest in the world – South Korea was rated as the second most efficient healthcare system by Bloomberg. Health insurance in South Korea is single-payer system. The introduction of health insurance resulted in a significant surge in the utilization of healthcare services. Healthcare providers are overburdened by government taking advantage of them.

Healthcare in Finland consists of a highly decentralized three-level publicly funded healthcare system and a much smaller private sector. Although the Ministry of Social Affairs and Health has the highest decision-making authority, specific healthcare precincts are responsible for providing healthcare to their residents as of 2023.

The French health care system is one of universal health care largely financed by government national health insurance. In its 2000 assessment of world health care systems, the World Health Organization found that France provided the "best overall health care" in the world. In 2017, France spent 11.3% of GDP on health care, or US$5,370 per capita, a figure higher than the average spent by rich countries, though similar to Germany (10.6%) and Canada (10%), but much less than in the US. Approximately 77% of health expenditures are covered by government funded agencies.

<span class="mw-page-title-main">Health care in Spain</span>

Spain operates a universal health care system. According to the Organisation for Economic Co-operation and Development, total health spending accounted for 9.4% of GDP in Spain in 2011, slightly above the OECD average of 9.3%. Spain's healthcare system ranks 19th in Europe according to the 2018 Euro health consumer index. As of 2016, Spain is ranked 1st in the world in organ transplants.

<span class="mw-page-title-main">Healthcare in Italy</span>

Italy's healthcare system is consistently ranked among the best in the world. The Italian healthcare system employs a Beveridge model, and operates on the assumption that health care is a human right that should be provided to everyone regardless of their ability to pay. Life expectancy is the 4th highest among OECD countries and the world's 8th highest according to the WHO. Healthcare spending accounted for 9.7% of GDP in 2020.

<span class="mw-page-title-main">Health care in Poland</span>

Health care in Poland is insurance based, delivered through a publicly funded health care system called the Narodowy Fundusz Zdrowia, which is free for all the citizens of Poland provided they fall into the "insured" category. According to Article 68 of the Polish Constitution everyone has a right to have access to health care. Citizens are granted equal access to the publicly funded healthcare system. In particular, the government is obliged to provide free health care to young children, pregnant women, disabled people, and the elderly. However, private health care use is very extensive in Poland. Patients who are uninsured have to pay the full cost of medical services. According to a study conducted by CBOS in 2016, out of 84% patients taking part in the survey, 40% declared use of both private and public health services, 37% use only public health care, and 7% use only private health services. 77% of all responders declared using private health care is caused by long waiting for public health care services.

<span class="mw-page-title-main">Healthcare in Denmark</span>

Healthcare in Denmark is largely provided by the local governments of the five regions, with coordination and regulation by central government, while nursing homes, home care, and school health services are the responsibility of the 98 municipalities. Some specialised hospital services are managed centrally.

<span class="mw-page-title-main">Healthcare in Slovenia</span>

Healthcare in Slovenia is organised primarily through the Health Insurance Institute of Slovenia. In 2015, healthcare expenditures accounted for 8.10% of GDP. The Slovenian healthcare system was ranked 15th in the Euro health consumer index 2015. The country ranked second in the 2012 Euro Hepatitis Index.

<span class="mw-page-title-main">Healthcare in the United States</span>

Healthcare in the United States is largely provided by private sector healthcare facilities, and paid for by a combination of public programs, private insurance, and out-of-pocket payments. The U.S. is the only developed country without a system of universal healthcare, and a significant proportion of its population lacks health insurance. The United States spends more on healthcare than any other country, both in absolute terms and as a percentage of GDP; however, this expenditure does not necessarily translate into better overall health outcomes compared to other developed nations. Coverage varies widely across the population, with certain groups, such as the elderly and low-income individuals, receiving more comprehensive care through government programs such as Medicaid and Medicare.

<span class="mw-page-title-main">Healthcare in Belgium</span>

Healthcare in Belgium is composed of three parts. Firstly there is a primarily publicly funded healthcare and social security service run by the federal government, which organises and regulates healthcare; independent private/public practitioners, university/semi-private hospitals and care institutions. There are a few private hospitals. Secondly is the insurance coverage provided for patients. Finally, industry coverage; which covers the production and distribution of healthcare products for research and development. The primary aspect of this research is done in universities and hospitals.

Examples of health care systems of the world, sorted by continent, are as follows.

References

  1. ↑ "Getting Better Value for Money from Sweden's Healthcare System | OECD READ edition". OECD iLibrary. Retrieved 2017-12-07.
  2. ↑ "Improving Quality and Value for Money in Healthcare | OECD READ edition". OECD iLibrary. Retrieved 2017-12-07.
  3. ↑ Orange, Richard (2015-04-28). "Swedish council becomes first to limit private profits in healthcare". The Guardian. ISSN   0261-3077 . Retrieved 2017-12-07.
  4. ↑ Mittag, Ann-Marie (2008-11-25). "Hälso- och sjukvård" (in Swedish). Archived from the original on 2011-05-24. Retrieved 2009-03-15.
  5. ↑ Hägglund, Maria (30 October 2017). "How Sweden is giving all citizens access to their electronic health records". Future Health Index. Retrieved 1 November 2017.
  6. ↑ "Swedish council becomes first to limit private profits in healthcare". Guardian. 28 April 2015. Retrieved 29 April 2015.
  7. ↑ Ballas, Dimitris; Dorling, Danny; Hennig, Benjamin (2017). The Human Atlas of Europe. Bristol: Policy Press. p. 79. ISBN   9781447313540.
  8. ↑ Glenngard, A., Hjalte, F., Svennson, M., Anell, A., & Bankauskaite, V. (2005). Health Systems in Transition: Sweden. WHO Regional Office for Europe, 2005
  9. ↑ Anell, Anders (February 2008). "The Swedish Healthcare System" (PDF). The Commonwealth Fund.
  10. ↑ Rodriguez, Linda (2009). "Swedish Socialism" (PDF). Spinning the Globe: Sweden. Retrieved 2017-12-07.
  11. ↑ Office of health Economics. "International Comparison of Medicines Usage: Quantitative Analysis" (PDF). Association of the British Pharmaceutical Industry. Archived from the original (PDF) on 11 October 2017. Retrieved 2 July 2015.
  12. ↑ "The Swedish Health Care System" . Retrieved 2018-10-17.
  13. ↑ Hunt, Jeremy (2022). Zero. London: Swift Press. p. 126. ISBN   9781800751224.
  14. ↑ "Vårdgaranti".
  15. ↑ "Outcomes in EHCI 2015" (PDF). Health Consumer Powerhouse. 26 January 2016. Archived from the original (PDF) on 6 June 2017. Retrieved 27 January 2016.
  16. ↑ "Sweden's healthcare system bogged down by shortage of doctors, nurses" . Retrieved 2020-02-14.
  17. ↑ So Long, Swedish Welfare State?
  18. ↑ "OECD Economic Surveys: Sweden 2005 | OECD READ edition". OECD iLibrary. Retrieved 2017-12-07.
  19. ↑ Svanborg-Sjövall, Karin (2014-01-03). "Swedish healthcare is the best in the world, but there are still lessons to learn". The Guardian. ISSN   0261-3077 . Retrieved 2017-12-07.
  20. ↑ "Goda medicinska resultat men fortsatta problem med tillgång till vård". Socialstyrelsen (in Swedish). 2020-02-20. Retrieved 2023-11-16.
  21. ↑ "Svenskarna lever länge men hälsan är ojämlik i landet". Folkhälsomyndigheten . January 22, 2020. Archived from the original on October 12, 2020. Retrieved October 12, 2020.
  22. ↑ "Sjukvårdens struktur bidrar till ojämlik vård". Läkartidningen . June 15, 2018. Retrieved October 12, 2020.
  23. ↑ "Arbete för jämlik hälsa i Sverige nationellt, regionalt och lokalt". Idunn . January 1, 2016. Retrieved October 12, 2020.
  24. ↑ "Ojämlik vård – dags för verkstad". Life-time. March 26, 2015. Retrieved October 12, 2020.
  25. ↑ "Risk of dying from COVID-19 in Sweden is greater for men and the unmarried". Stockholm University . October 9, 2020. Retrieved October 12, 2020.
  26. ↑ "Covid-19 vanligare i utsatta områden - är sårbarhet för sjukdomar en klassfråga?". Stockholm University . April 24, 2020. Retrieved October 12, 2020.
  27. ↑ "Corona härjar bland fattiga – rika klarar sig". Expressen . April 24, 2020. Retrieved June 28, 2020.
  28. ↑ "Situation in Sweden's hospitals 'terrible and completely unacceptable': watchdog". Local Sweden.
  29. ↑ IVO.se. "IVO:s nationella sjukhustillsyn: Patientsäkerheten kan inte garanteras". IVO.se (in Swedish). Retrieved 2023-11-16.
  30. ↑ "Bara 4 av 15 sjukhus får godkänt av Ivo – fortsatt allvarliga brister". www.vardfokus.se (in Swedish). Retrieved 2023-11-16.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.