Photo: Fredrik Schlyter/Johnér
Equal access – the key to keeping Sweden healthy
People in Sweden are living increasingly longer. The average life span is now 83.5 years for women and 79.5 years for men. This can be attributed in part to falling mortality rates from heart attacks and strokes. In 2010, 18 per cent of the country’s population was 65 or older. That means Sweden has one of Europe’s largest elderly populations as a proportion of the national total. In principle, however, the number of children born in Sweden has been increasing each year since the late 1990s, a shift that will reduce the proportion of elderly Swedes.
Chronic diseases that require monitoring and treatment, and often life-long medication, place significant demands on the system.
The incidence of smoking, however, has been falling in Sweden since the mid-1980s. A study by the European Union has found that Sweden has the lowest proportion of smokers (18 per cent) among EU member states.
The responsibility for health and medical care in Sweden is shared by the central government, county councils and municipalities. The Health and Medical Service Act regulates the responsibilities of county councils and municipalities, and gives local governments more freedom in this area. The role of the central government is to establish principles and guidelines, and to set the political agenda for health and medical care. It does this through laws and ordinances or by reaching agreements with the Swedish Association of Local Authorities and Regions (SALAR), which represents the county councils and municipalities.
Decentralized health care
Responsibility for providing health care is devolved to the county councils and, in some cases, municipal governments. County councils are political bodies whose representatives are elected by county residents every four years on the same day as national general elections. Swedish policy states that every county council must provide residents with good-quality health and medical care, and work to promote good health for the entire population. County councils are also responsible for dental care for local residents up to the age of 20.
Shared medical care
Sweden is divided into 290 municipalities, 20 county councils and four regions – Gotland, Halland, Skåne and Western Götaland. Sweden’s regions are based on county councils or municipalities that have assumed responsibility for regional development from the state.
There is no hierarchical relation between municipalities, county councils and regions. Around 90 per cent of the work of Swedish county councils concerns health care, but they also deal with other areas such as culture and infrastructure.
Sweden’s municipalities are responsible for care for the elderly in the home or in special accommodation. Their duties also include care for people with physical disabilities or psychological disorders and providing support and services for people released from hospital care as well as for school health care.
Greater mobility among EU citizens has increased the need for co-operation on health and medical care. Sweden is actively involved in collaborating on specialised care, improving patient safety and enhancing patient influence.
There is also discussion of health and medical services outside the EU, particularly in organisations such as the WHO, the OECD, the Council of Europe and the Nordic Council of Ministers. Many of the challenges confronting Swedish health care can also be seen in other countries, and include issues of access, quality, efficiency and funding.
One priority area is patient safety. In early 2011, Sweden enacted a new patient safety law which provides everyone affected by health care – patients, consumers, family members – new opportunities to influence health care content. The aim is to make it easier to report cases of wrong treatment.
The state-owned Apoteket chain of pharmacies lost its monopoly in 2009. Some 200 pharmacies have opened since then.
Photo: Leif R Jansson/Scanpix
Care within 90 days
Waiting times for preplanned care, such as cataract or hip-replacement surgery, have long been a cause of dissatisfaction. As a result, Sweden introduced a health care guarantee in 2005.
This means no patient should have to wait more than seven days for an appointment at a community health care center, 90 days for an appointment with a specialist and 90 days for an operation or treatment, once it has been determined what care is needed. If the waiting time is exceeded, patients are offered care elsewhere; the cost, including any travel costs, is then paid by their county council.
Statistics from December 2010 indicate that about nine out of ten patients see a specialist within 90 days and receive treatment or are operated on within a further 90 days. Roughly 80 per cent today feel they receive the care they need. In 2006, the figure was 74 per cent.
For 2012, the Swedish government and SALAR will review the design of this health care guarantee. Their intention is to formulate a guarantee that will be even more patient-oriented and take a comprehensive view by regulating the maximum time a patient must wait from initial contact with a health care provider to the time treatment begins.
Focus on Swedish midwives
Sweden has long had trained professional midwives. Research shows this has resulted in a sharp reduction in mortality among women in childbirth. In the 18th century, the rate was about one in a hundred. By the beginning of the 20th century, mortalities had dropped to 250 women per 100,000 live births.
The Swedish Association of Midwives recently celebrated its 125th anniversary as a professional organisation and 300 years of midwife training. The first regulations governing midwifery in Sweden were established in 1711, and stipulated that midwives in Stockholm should be trained, assessed and take an oath.
Today, maternal mortality in Sweden is among the lowest in the world; fewer than six out of 1,000 babies and fewer than one woman out of 100,000 die in birth. Swedish maternal care is often highlighted as a success story in international contexts, given its long tradition of significant contributions.
Costs for care
Costs for health and medical care represent about 10 per cent of Sweden’s gross domestic product (GDP), which is on par with most other European countries. The bulk of health and medical costs in Sweden are paid for by county council and municipal taxes. Contributions from the national government are another source of funding, while patient fees cover only a small percentage of costs.
Primary care most expensive
County council costs for health and medical care, excluding dental, were SEK 196 billion (about USD 29 billion, EUR 21 billion) in 2010, an increase of SEK 4.6 billion or 2.4 per cent on 2009. Primary care accounts for the largest increase in costs. Costs for general medical care and emergency treatment, along with costs for nursing care, contributed most to this rise.
More private health care providers
It is now more common for county councils to buy services from private health care providers – 12 per cent of health care is financed by county councils but carried out by private care providers. An agreement guarantees that patients are covered by the same regulations and fees that apply to municipal care facilities.
The Swedish Association of Midwives
The Swedish Association of Local Authorities and Regions
The Swedish National Institute of Public Health
The Medical Products Agency
The Swedish Council on Health Technology Assessment
The Swedish Institute for Infectious Disease Control
The National Board of Health and Welfare
The Government Offices of Sweden
The Dental and Pharmaceutical Benefits Agency
Last updated: 11 November 2013