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The Swedish health system is committed to ensuring the health of all citizens and abides by the principles of human dignity, need and solidarity, and cost–effectiveness. The state is responsible for overall health policy, while the funding and provision of services lies largely with the county councils and regions. The municipalities are responsible for the care of older and disabled people. The majority of primary care centres and almost all hospitals are owned by the county councils.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 (Sveriges Kommuner och Landsting (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 National Board of Health and Welfare, the Medical Responsibility Board (HSAN), the Swedish Council on Technology Assessment in Health Care, the Medical Products Agency (MPA), the Dental and Pharmaceutical Benefits Agency (TLV), the Swedish Agency for Health and Care Services Analysis, the
Swedish Social Insurance Agency and the National Institute for 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 followup 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. ( HiT )
Protokollbeilage 1 – EANA – Stockholm 23./24.5.2008
Öppningstal EANA Dr. Ewa Nilsson Bagenholm
Dear colleagues, ladies and gentlemen, very welcome to Stockholm and Sweden.
My name is ENB, I’m the president of the Swedish Medical Association and I’m very honoured to be able to invite you all to Sweden for this meeting.
The Swedish MA organises all doctors in Sweden, junior doctors, primary care doctors, hospital doctors, private doctors and also medical students and retired doctors. For many years more than 95% of the Swedish doctors have been members, but unfortunately during the past decade we have been loosing members.
The SMA is the union for doctors but also our professional organisation. It is not a self-regulatory body as in many other European countries, and that’s the way we want to have it. Sweden has a long tradition of strong unions for all professions, and the Swedish model for the labour market is built on collective agreements, which covers almost 90% of all workers in our country. All unions and professional
organisations are loosing members in our country and those of you that arrived yesterday and had the time to visit the city might have seen a huge mail boxe built up in a square not far from here. The reason was that one of our biggest unions asked the public for suggestions on how to strengthen the unions!
As you all probably know, Swedish people are well organised, and so is our social welfare system. Our health care system is financed by taxes and a small amount as a patient fee. In our law on health care, equal care to all inhabitants is of paramount importance. It doesn’t matter if you are poor or rich, we should all have the same care.
What are our main concerns and problems? We have been trying to build a primary health care system in Sweden with family physicians as the base for many years, but unfortunately we have so far not succeeded. Less than 20% of the Swedish doctors work in primary care. It’s not possible to define just one reason for that, and it’s difficult to change the way both patients, doctors and politicians have looked at it for several years. The SMA still believes that a well functioning primary care system can be built since the politicians now have changed their mind and they see the costeffectiveness and the benefits for the patients when they have their own doctor.
Many county councils are now building new primary care systems with a free patient choice. In a couple of years we will know if it worked out.
Doctors in private practice experience almost the same problem as the family physicians, struggling with a very hospital centered health care system.
We have as in many other western countries a shortage of doctors even though we
educate more doctors than we ever done before. We especially lack family physicians, psychiatrists and some other smaller specialities. In Sweden we have a
lot of doctors coming from other countries that are working here, about 25%, most of them coming from the other Nordic countries but also from EU-countries and thirdworld countries. What we have noticed during the last couple of years is that young doctors wanting to do their specialist training come to Sweden. They come from all European countries, I’ve met Greek, Italian, German and Polish junior doctors. They all say that the very well structured specialist training and education is of high quality and the rumour is now well spread among med students all over Europe. It is still to be seen if they will stay in our beautiful but quite cold country.
The SMA is very active in many international medical organisations, like the CPME,
standing committee of European doctors, WMA, World Medical Association and we
like to be part of the international community. I’m therefore pleased to see all of you here today and hope that you will have two very good days in Stockholm!