THE SWEDISH HEALTH CARE SYSTEM
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1 THE SWEDISH HEALTH CARE SYSTEM Mauricio Rojas Mullor Member of the Swedish Parliament ( ) Associate Prefessor of Economic History, Lund University IESE Business School Madrid June 19 th 2012
2 Basic comparative information
3 Total health expenditure/gdp, Belgium France Germany Portugal Denmark Austria Netherlands Greece Sweden Finland Ireland Spain Italy UK 9,9 9,7 11,8 Source: WHO Gráfico: Mauricio Rojas
4 Health expenditure per capita, 2009 (USD PPP) Netherlands Austria Belgium Germany Denmark Ireland France Sweden UK Finland Spain Greece Italy Portugal Source: WHO. Gráfico Mauricio Rojas
5 Public expenditure as percentage of total expediture on health, Denmark UK Sweden Netherlands France Ireland Italy Austria Germany Finland Belgium Spain Portugal Greece 72,8 81,1 85,1 Source: WHO.Gráfico: Mauricio Rojas
6 Euroindex 2012: Medical outcomes* Sweden Netherlands Finland Denmark Ireland France Spain Italy Belgium UK Germany Austria Greece Portugal *Indicators: Acute Heart Infarct (AMI) in-hospital case fatality; Infant deaths; Ratio of cancer deaths to incidence; Preventable Years of Life Lost; MRSA infections; % of births by Caesarean section; Undiagnosed diabetes; Depression Source: Health Consumer Powerhouse, Euro Health Consumer Index Gráfico: Mauricio Rojas
7 A system in transition
8 The change in the health care system is part of a general transformation of the Swedish Welfare State The crisis of the old Welfare State ( ) To reduce the size of the State (the level of expenditure and taxation) To change the structure of the Welfare State: From public management to public responsibility From public monopolies to a plurality of providers, competition and public-private partnership From administrative solutions to free choice
9 Main changes in the public health care system The old public system: 1. Universal coverage for legal residents 2. Tax funded plus patient fees (2-3% of total costs) 3. Administrated at county (21) level with own taxes and significant degrees of autonomy 4. Public monopolies (included the pharmacies) 5. Administrative assignation of patients by area of residence
10 Main changes in the public health care system (2007- ) The new public system: 1. Universal coverage for legal residents 2. Tax funded plus patient fees Patient fees The fee for a hospital stay is SEK 80 (USD 11, EUR 8) per day for the first ten days, and SEK 60 thereafter. Patient fees for primary care vary between SEK 100 and 200 depending on the county council. For specialist visits, there is an additional fee of a maximum SEK 350. High-cost ceiling After a patient has paid a total of between SEK 900 and 1,100 (depending on area of residence) in the course of a year, medical consultations within 12 months of the first consultation are free of charge. There is a similar ceiling for prescription medication, so nobody pays more than SEK 2,200 in a given 12-month period. One exception is Stockholm, where the maximum sum payable is SEK 1,800. Source:Sweden.se
11 Main changes in the public health care system 3. Administrated at county level with own taxes (cover 70% of the costs, the rest are state transferences, fees etc.) and high levels of autonomy 4. Public responsibility, broad public-private partnership and competition among providers 5. Free patient choice in primary care (in all counties from ) and hospital care (many counties)
12 Main changes in the public health care system Primary care: Free patient choice (and to change provider) Freedom to start new health care centers for any authorized provider, public or private, for profit or not for profit Equal patient fees (no extra payment is allowed) Equal general conditions (regulations and payment) Payment: capitation for enrolled patient (varies from 40 to more than 80%) and for service rendered
13 Main changes in the public health care system Hospital care: Public responsibility Public or contracted providers Equal regulations and payment (for service rendered) Broad outsourcing of complementary services Increased free patient choice
14 Other changes and evolution of in the public health care system Freedom to start pharmacies Free choice and competition in elderly care Increased controls and transparency No negative effects has been detected on costs, outcomes or patient satisfaction In some cases the evidence shows positive effects in terms of efficiency, patient satisfaction, accessibility and equality The most evident effect is the increase in the number and importance of private providers
15 Growth of private primary care centers: January 2010(=100)-October Source: Konsumentverket, Uppdragsforskningsrapport 2011:4
16 Percentage of public and private primary care centers, October 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% ,7 10,8 40,0 64,9 61,5 87,3 89,2 60,0 35,1 38,5 Stockholm Vätsmanland Sweden Örebro Dalarna Public management Private management Source: Konsumentverket,
17 Percentage of the public health care poducede by private providers ,4 9,6 10,4 11,7 12, Source: Ekonomifakta
18 THANK YOU FOR YOUR ATTENTION! Mauricio Rojas Mullor Member of the Swedish Parliament ( ) Associate Prefessor of Economic History, Lund University IESE Business School Madrid June 19 th 2012
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