It’s all about health care these days in the United States, so I thought I might offer a profile of the Swedish health care system.
In a turn of phrase that I expect we’ll never see in an official U.S. government document, I’m told that “Swedish health and medical care is based on the principles that care should be provided on equal terms and according to need, that is should be under democratic control and financed on the basis of solidarity.”
Specifically, health care is under the control of 18 County Councils that are responsible for organizing the provision of care within their area of jurisdiction. 71 percent of County Council operations are financed by County Council taxes,
with the rest coming from a mixture of patient fees and general revenue sharing form the central government. The County Councils are, in turn, grouped into 6 regions. Services are provided via a hierarchy of facilities—just over 1,000 “health centers,” 70 county hospitals, and eight regional hospitals. The regional hospitals are the ones where they can do difficult treatment of complicated diseases and are also the focal points for research and the training of medical personnel. Obviously there are more County Councils than regional hospitals, so those Councils that don’t contain a regional hospital make arrangements for their citizens to be treated, if necessary, in a neighboring county that has one. Note that the population of Sweden is about the same size as what we have in North Carolina or Los Angeles County.
People need to pay a token amount to receive medical care. The point of this isn’t really to raise revenue, it’s to create the correct incentives for people to seek care at the correct point on the hierarchy. Thus, it’s cheaper for a patient to go to primary care than to go to a hospital, so if you want to see a doctor you go to primary care and only bother with the hospital if the primary care personnel say they can’t help you. Out of pocket costs of this sort are capped at 900 SEK per year, which is about $125, so we’re really talking about a nominal fee.
In 2005, total health care spending (for everything up to and included glasses) was 9.1 percent of GDP. That’s also the year the government introduced a new reform aimed at curbing waiting times that may increase costs. They decreed that if qualified medical personnel reach a treatment decision, that your County Council must either provide the treatment within 90 days or else must pay for some other County Council to provide it for you. In part that should produce efficiency by making sure that you don’t have shortages in one county and unused capacity in another, but presumably it’s costing money to implement this.
The current right-wing government in Sweden has also introduced measures aimed at encouraging County Councils to pay private health providers for services rather than relying on direct public sector provision. There’s considerably county-to-country variance in the extent to which this actually happens. Since July of 2007, it’s possible for a health care provider to mix public and private sources of funding, which could undermine the egalitarian and solidaristic aspects of the system but will also open up more choice.
Sweden’s life expectancy is among the best in the world though as always this probably has more to do with other aspects of Swedish public health than with health care policy.