Living Healthy In Sweden -- White Paper | Medical News and Health Information

Reported April 15, 2011
Living Healthy In Sweden -- White Paper
By Fernanda Barros, Ivanhoe Health Correspondent

( Ivanhoe Newswire) -- Sweden is situated on the Scandinavian Peninsula in the Northern part of Europe. Living standards are among the highest in the world for its 9.1 million habitants. For many years, Sweden's health care system has ranked at or near the top of various international health systems reaching as high as 23rd in the world ahead of the United States. It has been understood that Swedes should not only have equal access to health services, but they should have equal access to high quality health services. On the other hand, like other nations with a single-payer system, Sweden has had to deal with the problem of ever-growing health care expenses causing a strain on government budgets. To understand why, we have to go back in history and analyze the progress of the health system in the country.


Back To The Future

In the seventeenth century, towns and cities employed physicians to provide public care, and the provision of health care has been predominantly public responsibility since then. In 1862, the county councils were established and health care was one of their principal duties. This was the beginning of today's Swedish health care system, but it wasn't until the Hospital Act in 1928 that the county council became legally responsible for providing hospital care to their residents. The National Health Insurance Act was the first important step towards universal coverage for doctor's appointments, prescription drugs, and sickness compensation, and by 1970, outpatient services in public hospitals were taken over by the county councils as well. In addition, doctors were no longer allowed to treat private patients seeking outpatient care in county council facilities. In 1985 the Health Care Act stated the overall objective of the public health services, "Good health care in equal terms for the entire population."

Main System

The Swedish health system is a regionally based, publicly operated health service. It is government funded and will provide care to anyone who needs it regardless of his or her ability to pay for it. It is organized on three levels: national, which covers approximately 20% of the total cost of the health system, regional and local, which accounts for over 70% of the healthcare costs. The aim of the primary care level is to improve the general health of the population. Each county council sets its own fees, but there is a uniform national, out-of-pocket, ceiling on the total amount that a patient pays during a 12-month period. For inpatient care usually a daily fee of 12 U.S. dollars is charged. The central Government's ceiling for out-of- pocket means that an individual's total charge for health care for a period of a year can be up to a maximum of about 141 U.S. dollars, not including inpatient care. Dental care requires out-of-pocket payment only for people over 20 years old. Patients also have freedom to choose among primary health care providers.

According to a government decision, all primary care physicians must be specialists in general practice. When additional resources are needed, usually the general practioner makes an appointment with a specialist, a diagnostic center or a hospital for the patient. Patients can choose the specialist and outpatient department but not the level of care. Regardless of the choice of the patient, he or she is guaranteed to be seen within three days. All treatment by a specialist is supposed to be completed within 10 days. All Swedish general doctors working in the public sector are employed by the county councils and receive a monthly salary in relation to their qualifications and work schedule.

In addition to local heath centers, private physicians also provide primary care. They are very common in major cities but they are private in the sense that they are privately run, but the majority of them have contracts with the county council and are reimbursed with public funds after seeing a patient. Every physician who intends to offer private health care must report to the National Board of Health.

For highly specialized care, Sweden has six large medical care regions, in which the county councils cooperate to provide the people with highly specialized care. The reason for this organization is so that the county councils are able to use available resources in the most efficient way. The county within which the regional hospitals are located takes care of the administration and the neighboring county councils reimburse the administering county for the care provided.

Benefiting From Your Benefits

When it comes to prescription drugs, they are reimbursed through the social insurance system. Reimbursements for drugs are made directly to the National Corporation of Swedish Pharmacies from the National Social Insurance Board and from the public and private health care providers. Deductions are made for the part that the patient has to pay. Pharmaceutical companies may set their own price. Each product has a single price and once a reimbursement price has been granted, the product is sold at that price to all patients and to hospitals. The benefit scheme limits the patient's total spending for prescription drugs during one year. As soon as the patient's share of co-payments goes over 1800 SEK (277.00 U.S. dollars), no further co-payments are needed on prescription drugs. The patient then receives a card that entitles the person to free pharmaceuticals during the rest of the one-year period.

Sweden is also one of the countries with the largest proportion of citizens over 65. The elderly represent an increasing part of the Swedish population. Many are in good health and lead active lives while living in their own homes. Sweden invests more of its gross domestic product in its elderly citizens than any other country in the world. In 2008, the total cost of elderly care in Sweden was over 14 million U.S dollars compared to 7.2 million spent in the U.S. Most of the care is financed by municipal taxes and government grants. Only four-percent of the financing comes from patients' charges. In certain areas, the elderly are allowed to choose whether they want their home help or special housing to be managed by public or private operators. The aim of municipal care provision is to ensure that older people and those with disabilities are able to live normal, independent lives. This includes living in their own homes for as long as possible.

Good vs. Bad

By now we understand that the uttermost importance to the sweetish healthcare is that its citizens have a quality life by having good health, but there are certain things that the country still struggles with and certain things where they exceed expectations.

· Sweden raked number 11 globally as the country with most heart disease deaths while the U.S. ranked 56th.
· Sweden also has a high rate of MS. A national prevalence of MS has been calculated for the first time. This has shown that there are approximately 17,500 people with MS in Sweden, which is considerably more than previously estimated.
· While it is correct that Sweden has no law specifically proscribing assisted suicide, the prosecutors might charge the assister with manslaughter.
· On the good side, Sweden ranked at the top with Iceland with 62 percent of cancer patients alive after 5 years of the diagnostic.
· It has also the lowest reported infant mortality rate among countries of the world with 2.3 deaths per 1,000 births.

The Double- Edged Sword

After looking at how the system works, the question remains, how does the government afford it? Tax revenues and patient fees determine Sweden's total health budget, made up of physician's visits as well as consumption, volume and drug mix. Generated income tax revenues, state grants, patient fees and reimbursements from other sources for treatment of patients from outside the county council determine the County Councils' total health care budget. Money goes from the central government to the county councils and part of the county councils' income also comes from income tax paid by the county's citizens.

For much of the 20th century, Sweden had a single-payer system of health care in which the government paid almost all health care costs. This is having serious consequences for Sweden's health care system, most notably expanding waiting lists. Waiting lists for surgery and other procedures had long been a problem in Sweden. The wait time for an angiogram at one point in the 90's was up to eleven months. Despite the government promise that no one should have to wait more than three months for surgery, 60 percent of hip replacement patients waited longer than three months in 2003. The wait time for bypass surgery could be an additional eight months. One study that examined over 1,400 Swedes on a waiting list for cataract surgery found that over 830 thousand U.S. dollars were spent on hospital stays and home health care for patients waiting for surgery, that was the equivalent of what it would have cost to give 800 patients cataract surgery. A study that examined over five thousand Swedish patients on a wait list for heart surgery found that the median wait time was found to be 55 days. While on the waiting list, 77 patients died. This waiting list problem comes from the primary concern over the freedom of choice of the patient to choose the provider they believe best fit.

Unemployment also has a major effect because of taxation for public expenditures. The state will only provide a minimal amount of money to healthcare during periods of high unemployment in the country. But on the bright side, if you are unable to work for any reason, your employer will still pay full wage for 14 days.

Closing The Book

The current Swedish health system is the result of many changes throughout the last century. Every individual has the right to good health and access to health services no matter their income, sex, and age. Equality and quality have been very important issues in the development of the Swedish model. The county councils are independent provisions that are publicly financed mainly through tax revenues and it concentrates in helping the citizens that live in that county as well as helping other counties to be successful. But like any other nation, the country also faces issues. Because everyone has equal access to healthcare, waiting lists have grown tremendously throughout the years making people wonder if the single payer system is the only way to go. As for the future, the population is growing bigger and older, and the challenge is to find what the public needs and what technology is bringing to the table. With new expectations comes a new cost that changes the way people think of what good health care should be and should provide.


SOURCES



1 The Swedish Institute,1 999, The Health Care System in Sweeden, Fact Sheets on Sweden, Stockholm SWEDEN.SE - The Official Gateway to Sweden — Features, Facts, Music, Film. Web. http://www.sweden.se/2 The Swedish Association of The Pharmaceutical Industry 2008-2010
3 "Sweden's Healthcare System - Best Health Care Countries." Best Health Care Countries. Web. http://www.healthgov.net/sweden.php.
4 Swedish Health Care - Your gateway to Swedish know-how
5 European Observatory On Health Systems - "Health Care Systems in Transition" writen by Catharina Hjortsberg and Ola Ghatnekar
6 The World Health Report 2000, Health Systems: Improving Performance
7 University of Gothenburg, Sweden
8 The National Center for Public Policy Research -Sweden's Single-Payer Health System Provides a Warning to Other Nations by David Hogberg, Ph.D.
9 "Assisted Suicide Laws Around the World - Assisted Suicide." Assisted Suicide - Information on Right-to-die and Euthanasia Laws and History. Web. 2005 http://www.assistedsuicide.org/suicide_laws.html.
10 Google - Public Data Explorer

Living Healthy In Sweden -- White Paper | Medical News and Health Information