Photo: Helena Wahlman/imagebank.sweden.se
Health care in Sweden
Health care in Sweden is largely tax-funded, a system that ensures everyone equal access to health care services. Challenges include funding, quality and efficiency of its health care services.
Equal access – the key to keeping Sweden healthy
People in Sweden are living increasingly longer. The average life span is now 81.4 years for women and 80.3 years for men. This can be attributed in part to falling mortality rates from heart attacks and strokes. In 2016, one in five people was 65 or older. That means Sweden proportionally has one of Europe’s largest elderly populations. On the other hand, the number of children born in Sweden has been increasing each year since the late 1990s.
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.
Decentralised 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 21.
Shared medical care
Sweden is divided into 290 municipalities and 20 county councils. Three of the county councils: Halland, Skåne and Västra Götaland – as well as Gotland municipality – are called regional councils and 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. Chronic diseases that require monitoring and treatment, and often life-long medication, place significant demands on the system.
Greater mobility among EU citizens has increased the need for cooperation 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 and family members – new opportunities to influence health care content. The aim is to make it easier to report cases of wrong treatment.
Specialist care within 90 days
Waiting times for pre-planned 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 all patients should be in contact with a community health care centre the same day they seek help and have a doctor’s appointment within seven days. After an initial examination, no patient should have to wait more than 90 days to see a specialist, and no more than 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 2017 indicate that about 79.1 per cent of the patients see a specialist within 90 days and receive treatment or are operated on within a further 90 days.
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.
In 2011, the Swedish Association of Midwives 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 three out of 1,000 babies and fewer than four women 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 as a percentage of Sweden’s gross domestic product (GDP) is fairly stable and on par with most other European countries. In 2015, health and medical care represented 11 per cent of GDP. 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.
Public sector costs for health and medical care, excluding dental, were SEK 65 billion in 2015, one of the larger expenses for the government.
More private health care providers
It is now more common for county councils to buy services from private health care providers – in 2013, 12 per cent of health care was 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.
Last updated: 16 May 2016