Healthcare in Sweden

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 and decentralized, although private health care also exists. The health care system in Sweden is financed primarily through taxes levied by county councils and municipalities.

Management

Södersjukhuset is one of the largest hospitals in Sweden. The hospital is owned, funded and operated by Stockholm County Council.

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.

At the regional level, responsibility for financing and providing health care is decentralized to the 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 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.

Sweden is, slightly simplified, divided into 21 county councils. Around 90 percent of the Swedish county councils’ work involves health care but they are also involved in other areas, such as culture and infrastructure. The population in these 21 areas ranges from 60,000 to 1,900,000. The 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.^[1]

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.^[2]

Financing

Costs for health and medical care amount to approximately 9 percent of Sweden’s gross domestic product (GDP), a figure that has remained fairly stable since the early 1980s. 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.^[3]

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.

Details and patient costs

Prescription drugs are not free but fees to the user are capped at 2,200 kr 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.^[4]

A limit on health-care fees per year exists; 150-300 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 1100 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 youths up to 19 years of age, while a general dental care insurance (introduced in 1974) covers all inhabitants from the age of 20 onwards.^[5]

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.

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.^[6]

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. ^[7] It does not however, always deliver. A child with psychiatric problems may often wait 18 months for an appointment.^[8]

See also

• Health care compared - tabular comparisons with the US, Canada, and other countries not shown above.

References

External links

Wikimedia Commons has media related to Health care in Sweden.

• Vårdguiden (The Care Guide) - EU-regulated health care website by the Stockholm health care system.

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