Health Care System in Sweden Jalal Safipour, PhD Senior lecturer Jalal.safipour@lnu.se Thanks to Judy Chow for sharing the materials for this presentation
Sweden The current population of Sweden is 10 093 734 The median age in Sweden is 40.9 years. Life expectancy in Sweden is among the highest in the world. Its principal cities, eastern capital Stockholm and southwestern Gothenburg and Malmö, are all coastal. Stockholm is built on 14 islands. To the west, Sweden is separated from Norway by mountains and is connected to the south by a road and rail bridge to Denmark. Sweden has one of the world s oldest populations, with more than 18% of the population being 65 years or older and more than 5% being 85 years or older.
Political system and health services 1. Liberal welfare states Minimum safety-net, basic health and social services for elderlies and some indigent groups (United State)-Obama care (affordable health insurance to all Americans)? 2. Wage earner welfare states Health and social services based on employment rather than citizenship (Australia). 3. Conservatives-corporatist welfare states Health and social services based on religious affiliation, union membership, or residence (Italy) 4. Social democratic welfare states Universal benefits to all residents (Nordic countries) Navarro, C; at el,. Politics and health outcomes, Lancet 2006; 368: 1033 37
Sweden: from poverty to a modern Welfare State 1800-1900 One of the poorest countries in Europe, (about 1.3 million Swedes left for USA) Pre Welfare stage - Establishment of old people s Homes 1913 National Pension Insurance 1918 Poor Law, Old people s 1940-50 Higher benefits within the pension system, Development of Home Help service 1947 New guidelines for old people s homes Welfare period 1959 Children no longer responsible for parents 1959 Income pension (ATP pension) 1960-1975 Public elderly care expands 1982 The social service Act 1983 The Health and medical Service Act Reassessment period 1992 More restrictive assessments within the elderly care 1992 Medical home care 2003 New old age pension system
Sweden Social democratic countries have also provided universal health care coverage, and social benefits to all citizens. Unemployment compensation for single mothers, Active labour market spending, Women s labour force participation, Low crime, Participation of women in government, Child care, Early child education, Paid maternity leave, Home care services. Navarro, C; at el,. Politics and health outcomes, Lancet 2006; 368: 1033 37
Swedish health system The Swedish health system is committed to ensuring the health of all citizens and abides by the principles of human dignity, need and solidarity, and cost effectiveness. There are three independent government levels the national government, the 21 county councils/regions, and the 290 municipalities. The state is responsible for overall health policy, while the funding and provision of services lies largely with the county councils and regions. The municipalities are responsible for the care of older and disabled people. The majority of primary care centers and almost all hospitals are owned by the county councils. The county councils/regions are responsible for the funding and provision of health care services to their populations. Anell A, Glenngård AH, Merkur S. Sweden: Health system review. Health Systems in Transition, 2012, 14(5):1 159.
High cost protection 1100 kr ( 122) for visits and treatment/year In 2011, the fee for consulting a physician in primary care varied between SEK 100 and SEK 200 ( 11 22) The fee for consulting a specialist at a hospital varied between SEK 230 and SEK 320 ( 25 35). Patients are charged about SEK 80 ( 9) per day of hospitalization. 2200 kr ( 244) for medicin/year Technical helping aids Free supply of certain helping aids
Service guarantee (waiting-time guarantee) Seeing a general practitioner (GP) within seven days Consulting a specialist within 90 days Waiting for no more than 90 days after being diagnosed to receive treatment
Health care expenditure Services for conditions requiring hospital treatment are provided at county and regional hospitals. Highly specialized care, requiring the most advanced technical equipment, is concentrated in regional hospitals. The responsibility for performing cross-sectoral follow up and evaluation of national public health policies lies with the National Institute of Public Health.
Principles Three basic principles are intended to apply to health care in Sweden: 1- Dignity: all human beings have an equal entitlement to dignity, and should have the same rights, regardless of their status in the community 2- Solidarity: those in greatest need take precedence in medical care 3- Cost effectiveness: when a choice has to be made between different health care options, there should be a reasonable relationship between the costs and the effects, measured in terms of improved health and improved quality of life. Anell A, Glenngård AH, Merkur S. Sweden: Health system review. Health Systems in Transition, 2012, 14(5):1 159.
Health care and other welfare services are considered a public responsibility in Sweden. According to the Health and Medical Services Act, the Swedish system provides Coverage for all residents of Sweden, regardless of nationality. In addition, emergency coverage is provided to all patients from the EU and European Economic Area countries, and nine other countries with which Sweden has bilateral agreements.
Health care expenditure Health care expenditure is mainly tax funded (80%) (2009). Only about 4% of the population has voluntary health insurance (VHI). Administratively, taxes are collected from employers by the national tax authority (Skatteverket). The highest total level of taxation (municipal and county council taxes) was 34.17% (in Ragunda municipality) compared to the lowest level which was 28.89% (in Vellinge municipality).
Paying health workers The majority of Swedish health care personnel are members of a professional union that represents them in salary negotiations. A full week s work is 40 hours. In 2010, the average monthly salary for staff employed by the county councils was SEK 56 600 ( 6300) for physicians, SEK 42 200 ( 4700) for dentists, and about SEK 29 000 ( 3200) for specialist nurses.
Training of health workers In Sweden, medical education is entirely financed by the state. The training of physicians, nurses, dentists and other medical staff is linked to the university hospitals and other relevant parts of the medical services. Nurses are educated at approximately 30 universities, university colleges and independent programme providers located throughout the country. Approximately 5000 students are admitted to the nursing programme every year To become a registered nurse, a student must complete a study programme of three years, including one or two periods of training. After having worked for a period of at least one year, nurses can continue with specialist training which lasts for 40 60 weeks.