www.si.se 1

SWEDEN - GENERAL FACTS

• Area: 450,000 km2 (174,000 sq mi)

• 9.1 million inhabitants

• Average life expectancy: men 77.5 years, women 82.1 years

• Capital: Stockholm (1,643,000)

• Major cities: Göteborg 789,000, Malmö 518,000

www.si.se 2

Population

• 71% live in nuclear families (1990 census)

• 80% live in urban areas and along the coast

• Post-retirement age (65+) 18%

• Very elderly (80+) 4.9%

• Sami (Lapp) minority of 17,000 – 20,000

www.si.se 3

ORGANIZATION OF THE SWEDISH HEALTH SERVICES

STATECOUNTY

COUNCILS

LOCAL AUTHORITIES

Hospital and heath centers

Housing and care for elderly and disabled

Legislation

Supervision

Evaluation

Finance

Organisation

Follow-up

www.si.se 4

Local Government

Two types of local government body:

• 289 municipalities (kommun) with responsibility for schools, social services, elder care, care of people with physical or intellectual disabilities, physical planning and building, certain environmental tasks and rescue services

www.si.se 5

Local Government

• 18 county councils (landsting) + two health care regions and one municipality. Their main areas of responsibility are:

- health care services at hospitals, outpatient medical care at local health centers

- public dental services

- psychiatric care

www.si.se 6

The Financial Circumstances of Swedish Households

• Gainfully employed: 62% of adult population.

• Transfer payments to households (27% of GDP): pensions, child allowance, housing allowance, sickness benefit, parental leave etc.

• Universal state pension system

• Social assistance for those below the poverty line

www.si.se 7

Housing policy

• Allow families with low financial capacity to be able to acquire accommodation with good standard

• Programs for renewal and maintenance of flats and housing areas

• Housing allowances for those in need

www.si.se 8

Taxes

• 51% ceiling on mariginal income tax

• Local and state tax on income from employment, real estate, companies, pensions, capital and capital gain

• Taxes on alcohol, tobacco, petrol etc

• VAT on goods and services

www.si.se 9

SOCIAL ISSUES

• The Swedish welfare state – a social democratic project that has enjoyed broad support

• Universal welfare system covers everyone regardless of income or occupation. Some benefits are needs-based, however.

• The social insurance system, health care, schools etc are financed mainly via taxes and employer payroll fees

www.si.se 10

Social Insurance

• Uniform social insurance system providing:

- health care

- parental insurance

- cash benefits during illness

- occupational injury insurance

- unemployment benefits

- pensions

- other support for families with children

www.si.se 11

Care of the Elderly

• Care of the elderly outside the family is a public responsibility

• Costs for pensions, housing benefits, institutional care, home-help services etc account for some 16% of GNP

• Local variations in service levels

• An estimated 4 out of 10 elderly people do not receive any form of public assistance

www.si.se 12

Care of the Elderly

• 10% of care is provided by private organisations (public funding)

• 7,000 home-help providers for the elderly (often less than 20 hours/week)

• Around 7,000 close relatives receive cash grants for care of the elderly

• The family is the most important care provider

www.si.se 13

Health Care System

• County councils responsible for health care

• Primary care sector comprises health centres, district nurse clinics, child and maternity health care

• Hospitals, nursing homes and service apartments with 24 hours service a day

• 80 county and district hospitals and 9 regional hospitals

• 1 physician per 340 inhabitants

www.si.se 14

Health Care System

• Reductions in inpatient care. More outpatient care.

• Freedom to choose health centre, doctor or hospital

• About 8% of Sweden’s employees work in health services

www.si.se 15

Distribution of public health care costs, 2001

58%

10%

19%

3%

10%

Somatic short-term care

Psychiatric care

Primary care

Dental care

Other

www.si.se 16

Child Care

• Municipalities obliged to provide preschool care and school-age care. Grants provided to non-municipal childcare.

• Preschool care for children aged 1-5 is provided at preschools, family daycare homes and open preschools

• Childcare for children aged 6-12 is provided at leisure-time centres, in family daycare homes and at open leisure-time centres

www.si.se 17

Child Care

• Almost 75% of all children aged 1-5 are registered with preschools and 60% of children, aged 6-9, with leisure time centres or family daycare

• Children needing special support are entitled to a place irrespective of whether parents work or not

• Four staff categories: preschool teachers, leisure-time teachers, daycare attendants and childminders in family day-care

www.si.se 18

Disability Policies

• Disability policies aim at full participation and equality.

• Organizations for disabled people are run and dominated by people with physical disabilities

• Institutional living replaced by group accommodation, service housing and adapted homes

www.si.se 19

Disability Policies

• Local authorities have ultimate responsibility for personal assistance, preschool places, housing, home-help service etc. for the functionally disabled

• The majority of children with disabilities attend ordinary schools

• Rising unemployment has restricted functionally impaired people’s chances of obtaining work

www.si.se 20

Housing modification grant

• Was introduced in 1959• A complement to building regulations• People with disabilities should be able to live in

ordinary dwellings• Every local authority are by law obliged to provide the

grant• Is provided regardless of financial situation• Cover all costs for adaptation needed• For persons with all types of permanent disabling

conditions

www.si.se 21

Housing modification grant

• Permanent housing• Permanent structure of the building property• Not finance ordinary building maintenance• For building materials – a standard ordinary

type will be financed by the grant

www.si.se 22

A four part assessment

• The applicant’s self assessment of her/his problems and needs

• The occupational therapist's assessment of the applicant’s ability, disability, and handicap, and ways to solve the functional problems

• The engineer’s technical assessments of adaptive solutions to solve the problems of structural barriers

• Examination of legal guidelines about how the grant can be used and what can be financed by the grant

www.si.se 23

Home modification

• Automatic door opener • Stair case elevator

www.si.se 24

Approved grants 1998-2002

52500

55700

57800

57400

60200

50000

52000

54000

56000

58000

60000

62000

Ap

pro

ve

d g

ran

ts

1998 1999 2000 2001 2002

www.si.se 25

Home modification - total costs

710 710

780

830

650

700

750

800

850

Year1999 2000 2001 2002

www.si.se 26

Distribution of home modification grant 2003 (%)

0 10 20 30 40 50 60

< 1000

1 000 - 4 999

5 000 - 19 999

20 000 - 49 999

50 000 - 99 999

100 000 -

SE

K

%

www.si.se 27

Assistive devices

• Based on need• Regardless of the person's age, economic

status, or place of residence

• Free or almost free of charge• Every county council and/or local authority

have their own guidelines for how to provide these services

www.si.se 28

Assistive devices

• Assistive technology centres• Low vision centres• Hearing centres• Orthopaedic centres• Intrepretation services (non-hearing, non-speaking persons)

www.si.se 29

The Swedish Handicap Institute

• A national resource centre on assistive technology and accessibility

• Is run by:– the Ministry of Health and Social Affairs– the Federation of Swedish County

Councils– the Swedish Association of Local

Authorities

www.si.se 30

The Swedish Handicap Institute

• Improving the quality of assistive technology• Stimulating research• Stimulating development of new assistive

technology• Testing assistive technology products• Improving the provision • National and international co-operation• Information

www.si.se 31

Prescribed wheelchairs 2002 related to age

6%

17%

26%

51%

0-17

18-64

65-7980-

www.si.se 32

Assistive devices

• 70 % are prescribed for persons over 65 years of age