Healthcare system & Market
Sweden is a monarchy with a parliamentary form of government. The size of the population is about 9.4 million inhabitants and more than 80% of the population live in urban areas.
The GDP per capita, measured as purchasing power parity (PPP, current international US$), amounted to Swedish krona (SEK) 37 775 (€4200) in 2010. Life expectancy in Sweden is among the highest in the world. Diseases of the circulatory system are the leading cause of mortality, accounting for about 40% of all deaths in 2009. The second largest cause of death is cancer.
There are three independent government levels – the national government, the 21 county councils/regions and the 290 municipalities. The main responsibility for the provision of health care services lies with the county councils and regions. The municipalities are responsible for care of older and disabled people.
The Swedish health care system is a socially responsible system with an explicit public commitment to ensure the health of all citizens. Three basic principles are intended to apply to health care in Sweden:
- The principle of human dignity means that all human beings have an equal entitlement to dignity, and should have the same rights, regardless of their status in the community.
- The principle of need and solidarity means that those in greatest need take precedence in medical care.
- The principle of cost–effectiveness means that 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.
Organisation and governance
The Health and Medical Services Act of 1982 specifies that the responsibility for ensuring that everyone living in Sweden has access to good health care lies with the county councils/regions and municipalities.
The Act is designed to give county councils and municipalities considerable freedom with regard to the organization of their health services. Local self-government has a very long tradition in Sweden. The regional and local authorities are represented by the Swedish Association of Local Authorities and Regions (SALAR).
The state, through the Ministry of Health and Social Affairs, is responsible for overall health care policy. There are eight government agencies directly involved in the area of health and care and public health.
The county councils/regions are responsible for the funding and provision of health care services to their populations. The municipalities are legally obliged to meet the care and housing needs of older people and people with disabilities. There is a mix of publicly and privately owned health care facilities but they are generally publicly funded. Primary care forms the foundation of the health care system. 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. Counties are grouped into six medical care regions to facilitate cooperation regarding tertiary medical care. The responsibility for performing cross-sectoral follow- up and evaluation of national public health policies lies with the National Institute of Public Health.
Health care expenditure as a share of GDP was 9.9% in Sweden in 2009. Health care is largely financed by tax in Sweden. About 80% of all expenditures on health are public expenditures. Both the county councils and the municipalities levy proportional income taxes on the population to cover the services that they provide. The county councils and the municipalities also generate income through state grants and user charges. About 4% of the population have VHI, in most cases paid for by their employer. Funding from VHI constitutes about 0.2% of total funding.
About 17% of total funding of health expenditures is private expenditure, predominantly user charges. User charges for health care visits and per bed-day are determined by individual county councils and municipalities.
The mechanisms for paying providers vary among the county councils, but payments based on global budgets or a mix of global budgets, case-based and performance-based payment are commonly used in hospitals. Payment to primary care providers is generally based on capitation for registered patients, complemented with fee-for-service and performance-based payments. Most health workers across both public and private providers and independent of service sector (hospitals, primary care providers, nursing homes and home care services) are salaried employees. The county councils pay the full cost for all inpatient drugs. For reimbursed prescription drugs, the county councils receive a government grant that is negotiated at central level between the SALAR and the government.
WHO Sweden healthcare review
Download the CIVITAS Swedish market report
joined the group National markets insights: Sweden
Posted 20 July 2016