At 450,295 square kilometres (173,860 sq mi), Sweden is the third largest country in the European Union by area

Sweden has a relatively low population density of 21 inhabitants per square kilometre (54/sq mi) with the population concentrated to the southern half of the country

Sweden is an export-oriented mixed economy featuring a modern distribution system, excellent internal and external communications, and a skilled labor force.

Timber, hydropower and iron ore constitute the resource base of an economy heavily oriented toward foreign trade.

CountryRegional Average

Global Average

Population 9,059,651

Life Expectancy

Male 79 71 66

Female 83 79 71

Both 81 75 68

Adult Mortality Rate (per 1000 adults 15 – 59 years) 61 146 176Under 5 Mortality Rate (per 1000 adults 15 – 59 years) 3 13 60Maternal Mortality Rate (per 100000 live births) 5 21 260Prevalence of HIV (per 1000 adults 15 – 59 years) 1 4 8Prevalence of Tuberculosis (per 100000 population) 8 63 201

WHO, 2009

CountryRegional Average

Global Average

Population Living in Urban

Area (%)85 70 50

Gross Nationa income per capita (PPP int. $)

38050 23530 10599

WHO, 2009

Country World Rank

Sex Ratio M/F 0.98 125

Population 0 – 14 15.7% 167

Population 15 – 64 65.5% 90

Population 65+ 18.8% 6Birth Rate (per 1000 population) 10.13 167Death Rate(per 1000 population) 10.21 58

Fertility Rate 1.67 151Infant Mortality Rate (per 1000 population) 2.75 190

WHO, 2009

Country World Rank

Sex ratio at birth 1.06 57

Sex ratio under 15 1.06 42

Sex ratio 15 - 64 1.03 46

Sex ratio 65+ 0.79 82

Net Migration 1.66 35Population Growth Rate 0.16 158

Life Expectancy/Birth 80.9 6

GDP per capita USD $38,500 17

WHO, 2009

Strong sense of societal solidarity The care of an elderly is not only a familial

but is also a societal concern Democratic polity Long period of economic affluence with

periods of crises Long tradition of publicly sponsored health

care

Collegium Medicum

district MDs- Local Government

1660 1752 1864

Crown hospitals; care parishes *

1874

Local Boards of Health, Public Health

System

1958

Regionalization

1960

Economic crisis

1970-1980

Prototype welfare state

Present

The Swedish health-care system is taxpayer-funded and largely decentralized.

Responsibility for health and medical care is shared by the central government, county councils and municipalities.

The Health and Medical Service Act (Hälso- och sjukvårdslagen, HSL) regulates the responsibilities of the county councils and municipalities.

The central government establishes principles and guidelines for care to set the political agenda for health and medical care by reaching agreements with the Swedish Association of Local Authorities and Regions (SALAR),  which represents the county councils and municipalities.

Structure Function

Primary Care, Public Health,

MNCHN, School/Industry

2k to 50k

Local District Health

Services

Inpatient Outpatient services Med, Sx, Rad, Anes

60k-90k

District County

Hospitals

Tertiary careMedschool, research

1M

Specialized wards (500-1,000 beds) and clinics 200k-300k

Regional Hospitals

Central County Hospita

ls

National Hospitals/Medi

cal Centres Regulation

Stewardship/ Planning

Policy EvaluationTrainingResearch

Ministry of Health and Social AffairsNational Board of

Health and Welfare Planning Rationalization

InstituteCounty Councils

Federation

Structure Function

National level

Parliament

Ministry of Healthand Social Affairs

Government

Approx. 1100health centres

Approx. 20 countyhospitals and

approx. 40 districtcounty hospitals

8 regional hospitalsin 6 medical care

regions

18 county councils,2 regions and1 municipality

(regional authority)

Regional level

Federation of SwedishCounty Councils

Swedish Association

of Local Authorities

290 municipalities(local authorities

Local level

Special housing and

home care for elderly

and disabled people

•Swedish Medical Association/ Professional Organizations•Social Democratic Party•Blue collar unions•White collar unions•Royal Commissions

“Whenever health systems are ranked, Sweden always seems to come top or at the very least a close runner-up”

--BBC News, 28 November 2005

Life Expectancy vs Health Care Spending in 2007 for OECD CountriesSource: http://www.oecd.org.

“The national guarantee of care states that a patient should be able to get an appointment with a primary care physician within 3 days of contacting the clinic. If referred to a dietician by the GP, they should get an appointment within 14 days, and if treatment is deemed necessary by the specialist, it should be given within 10 days.”

http://en.wikipedia.org/wiki/Healthcare_in_Sweden

Physicians- interns/residency training, specialist consultants, district physicians, and administrators

NursesPharmacistMidlevel- physiotherapist, nurse

midwives

1. Distribution to areas and fields of specialties

2. Supply of doctors3. Compensation and work stress4. Role of private sectors5. Education, training and research

opportunities6. Cost for the government7. Market-reform initiatives were

vulnerable to the whims of politicians

According to OECD data, total expenditure on health as a percentage of GDP in Sweden amounted to 8.4% in 1998, slightly less than the EU average of 8.6%.

Public health care expenditures amounted to 7.4% of GDP in 1998.

In 1999, approximately 85% (99 billion SEK or 10.9 billion Euros) of total county council net expenditure was spent on health care (excluding dental care and pharmaceuticals), while the remaining 15% was for expenditure on other services, including social welfare, culture and public transportation.

Of the total expenditures of 127 billion SEK spent on health care by the county councils, 99 billion was financed by taxes and not earmarked state grants (78%).

Acute secondary and tertiary health care consumed 62.3% of these revenues, psychiatric care 9.5% and geriatric care 5.8%, while the remainder (22.4%) was spent on primary health care.

Drug Benefit Scheme

Other earmarked subsidies

Patient Fees

Sales of services

Other

TOTAL

EXTERNAL REVENUES

14 710 2 933 2 519 7 979 3 92 28 533

LOCAL TAXES AND STATE GRANTS

99 139

TOTAL REVENUES

127 672

MAIN SOURCES OF HEALTH CARE FINANCES, million SEK

• The social insurance system, managed by the National Social Insurance Board, provides financial security in case of sickness and disability.

• Insurance is mandatory and covers part of individual income losses due to illness and health care services.

• The insurance also covers individual expenditure for prescribed drugs and outpatient care over a high cost-protection limit.

BENEFIT SERVICES

Medical expenses Outpatient servicesHospital treatmentParamedical treatmentPharmaceuticalsCounseling on Birth controlDental careMedical devices for rehabilitationTravel Expenses

Sickness Payments while illSubsidization of salary while caring for a close relative

Maternity Before and after birth

Parental benefit For care of a child under age 8

2008 2009

Total Expenditure on Health (% of GDP) 9.4 9.9

General Government Expenditure on Health (% of THE)

78.1 78.6

Private Expenditure on Health (% of THE)

16.8 16.6

GGHE as % of General Government Expenditure

13.8 13.8

Private Insurance as % of PHE 1.2 1.2

Out of Pocket Expenditure as % of PHE 92.8 92.8

PAYING THE PHYSICIANS

The counties employ most physicians on a salaried basis. Incomes are relatively less than in other industrialized nations at about 2x the average personal income.

Financed largely from country budgets, although the national government makes contribution for special facilities such as university training institutions

HOSPITALS 47%

PRIMARY CARE SERVICES 18%

DRUGS 8%

LONG-TERM CARE, SERVICES FOR THE ELDERLY

27%

1930’s – Legislations passed focusing on maternal and child health

low infant mortality rate

1947-1960 – Universal insurance and regionalization of services

primary care were provided thru government

sickness insurance agency, counties retain hospital services

1960-present – Decentralization health services shifted

from central to small counties

regional level take full responsibility

Government Type: Democratic Parliament

Ministry of Health and Social Services National Board of Health and Welfare

-- responsible for establishing legal and developmental framework for county implementation of health care-- county is required by central govt to develop 5 yr plans for health care

Health care, health, social issues/ insurance

Dental treatment eHealth Elderly care Health and medical care Public health Sickness insurance

The Ministry of Health and Social Affairs is responsible for the whole of the policy

The objective of public health policy is to create social conditions to ensure good health on equal terms for the entire population

The objective of health and medical care policy is that people must be offered good quality health care that is adapted to needs, accessible and effective

“Semashko”

Almost negative population growth rate

High burden of diseases of old age

High burden of mental illnesses

Although the health system is decentralized, there is system of coordination among the different levels of the system.

Referral systems local health districts and hospitals

Sweden has to cope with rising healthcare costs and shrinking productivity (taxable population)

Local taxes are the basis for funding health and medical care, which means opportunities for economic expansion are strictly limited

Cost effectiveness/Equity Rationing is severely limited in times of

crisis, a more efficient financing scheme is in order

1. almost nil chances of private practice2. Oversupply of doctors, nurses, allied medical professions3. Maldistribution to areas and fields of specialties4. Compensation and work stress5. Limited role of private sector6. Education, training and research opportunities7. Cost for the government

None really, fairly modern information network

A central quality assurance board and medical responsibility board

Tendency for institutions to be “arrogant” for they have a virtual monopoly of services

Insight: there is always some trade off, for the stellar health indices of Sweden, it entails considerable costs, tight regulation and governance.

References:

Genser, M. The Swedish Health Care System, The Fraser Institute http://oldfraser.lexi.net/publications/books/health_reform/sweden.html 2011

Blomqvst A International Health Care Models http://www.parl.gc.ca/Content/SEN/Committee/371/soci/rep/volume3ver5-e.pdfSaltman R. Renovating the Commons, http://jhppl.dukejournals.org/cgi/content/abstract/30/1-2/253

Jamlikhet (equality) And Tryghett (security)

Aging population, changing medical technology, integration into the European common market

Adaptation to a stronger primary care network, allow patients to choose doctors, health centers and hospitals within the public system

Reforms more focused on fiscal management, cost effectiveness and organizational changes

Government remains as the major provider and consumer of health care

Limited competition

physician distribution program- similar to DTTBP

opening of opportunities for foreign physicians. Assigning of slots per field of specialty

Encouraging private health centers and practitioners

Professional organizations serve as venue for lobbying for compensation and benefits

Setting of enrollment limitsProviding opportunities for post

graduate training, subspecialty, education and research.

Swedish Association of Local Authorities and Regions (SALAR); Swedish Health Care in an International Context - a comparison of care needs, costs, and outcomes; June 2005

http://www.oecd.org. David Hogberg, Ph.D. “Sweden's Single-

Payer Health System Provides a Warning to Other Nations”. National Policy Analysis.” May 2007.

http://en.wikipedia.org/wiki/Healthcare_in_Sweden