at 450,295 square kilometres (173,860 sq mi), sweden is the third largest country in the european...
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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
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
“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
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
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
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