Under review: the healthcare framework in Sweden
All questions
Overview
As a general principle within Swedish healthcare, the population must be offered appropriate and efficient healthcare of good quality. Such care must be equal and accessible. In addition, there are also certain ethical principles that govern the priorities in health care.
The structure of the health care system in Sweden can be described as decentralized. The responsibility for providing such care in Sweden is divided between the state, regions (formerly county councils) and local municipalities. At government level, the Ministry of Social Affairs and Health is responsible for all policies relating to social care in Sweden, including policies for the provision of health care. The department is also responsible for legislation and the activities of authorities, for example the Public Health Agency and the Inspectorate for Care and Care (IVO). The main responsibility in terms of planning, financing and operation of the health care is placed on the regions and to some extent the municipalities. The municipalities are responsible for, among other things, elderly care and school health care. Since Sweden consists of 20 regions and 290 municipalities, the type of healthcare that is available can vary to some extent across the country.
The activities of the regions and municipalities are financed for the most part with taxes. In addition to the above, privately owned companies are to a large extent providers of health care, above all in open care (ie care that does not require the patient to be hospitalized). Through the social insurance system, in general, everyone who lives or works in Sweden has a certain financial protection in case of long-term illness. In addition to this insurance, there are supplementary private insurances.
When it comes to the structure of health care in Sweden, the basis is primary care (ie care that is not limited to certain diseases, age or patient groups). Such care is provided at, among other things, health centers and district nurse clinics. The second level of health care is regional care, normally conducted at Sweden’s university hospitals (rare and complicated diseases and injuries). Finally, there is national highly specialized healthcare that is conducted in only a few locations in Sweden. The purpose of concentrating the rare or most advanced care is to ensure the best possible care for the patient, regardless of where in Sweden the person lives.
The healthcare economy
in General
All Swedish citizens have access to healthcare in Sweden. According to the Health and Medical Care Act2 people living in Sweden have access to healthcare in the region where they live. Especially within open healthcare, healthcare is of both a private and public nature.
Persons temporarily staying in Sweden have the right to immediate health care. Normally, such care refers to emergency care. The related costs of such care depend on which country the person comes from.
Sweden’s citizens have extensive social protection which aims to give all citizens access to equal healthcare. Consequently, Swedish citizens are offered several health benefits that are mainly financed with public funds. There are both private and public healthcare providers and the same regulations apply to both.
In Sweden, there is a social insurance system to provide financial security. For example, people with a disability or illness can claim compensation for sick leave or child care. Through this insurance system, generally everyone who lives or works in Sweden has a certain financial protection in the event of, for example, long-term illness. The social security system is publicly financed through taxes and fees.
In addition, there is accident insurance for patient injuries according to the Patient Injury Act.3 This insurance gives patients the right to compensation for damages incurred in connection with health or dental examination, care or treatment in Sweden. All healthcare providers in Sweden must have patient insurance to cover liability for financial compensation. If a care provider is not insured, the patient can turn to the Patient Insurance Association, which handles the matter and pays out patient compensation.
In addition to the above-mentioned insurances, there are supplementary private insurances. A private health insurance supplements the compensation that can be obtained from the state-funded insurance. An employee can, for example, be offered private health insurance through their employer. In such a situation, the employer pays the insurance and the employee is taxed for the insurance benefit.
ii The role of health insurance
In Sweden, insurance related to healthcare is not mandatory for users of such services. In other words, it is not mandatory for Swedish citizens to take out any insurance in order to receive health care. However, see subsection above for a description of state-funded insurance.
iii Financing and payment for specific services
As described in subsections above, Swedish healthcare is mainly financed through state, regional and local sources, such as taxation. In the case of private healthcare providers in particular, they must have entered into agreements with the regions to be reimbursed for related costs. This means that when regions buy services from private healthcare providers, the healthcare is financed by the region but performed by the private healthcare provider.
Although healthcare in Sweden is mainly financed with state funds, patients must in most cases pay a fee for their care. However, some visits are generally free of charge, such as child and school health care and care for the elderly. The size of the fee normally depends on the care provided and is determined by the respective region. However, there is a limit to the size of such patient fees at national level (high-cost protection). The limit for cost protection varies, among other things, depending on the sector in which the provided health care belongs. Please note that this protection does not apply to fully private health care (which does not involve public funding), such as plastic surgery that is not medically justified.
Primary/family medicine, hospital and social care
The healthcare chain in Sweden consists of three different levels. The first level is primary care, which includes, among other things, health care provided by general practitioners, psychologists, physiotherapists and midwives and which is not limited to certain diseases, ages or certain patients. Such care, which is normally the patient’s first contact with healthcare, is provided by both public and private healthcare centers and district nurse clinics. According to the Health and Medical Care Act, the regions are obliged to introduce health care systems that allow citizens to choose between different primary care providers. All healthcare providers who meet the conditions determined by the regions have the right to establish primary healthcare with public compensation (procurement according to the Freedom of Choice System Act, see section VII). However, it should be noted that it is possible to provide corporate primary care without any reimbursement from the public. The care provider then sets his own prices for the care. The second level in the healthcare chain is regional healthcare, which includes both public and private specialist healthcare that treats rare and complicated diseases and injuries. Such healthcare is normally provided by regional and university hospitals, but also by private clinics. Finally, there is national specialized healthcare, which refers to publicly funded healthcare that can be carried out at a maximum of five healthcare units in the country. Such providers must meet certain criteria to provide the best possible care to patients. National specialized healthcare includes the most advanced care in the country.
All healthcare must be provided in accordance with basic principles. As a general principle, the population must be offered appropriate and efficient healthcare of good quality. Such care must be equal and accessible. The Health and Medical Care Act further states that health and medical care must be provided with respect for the equal value and dignity of all people.