Health Care in Sweden
Göran Hägglund, Minister for Health and Social Affairs
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.
42 Responses to “Health Care in Sweden”
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October 1st, 2009 at 10:54 am
When I tell Swedes about American health care, especially the part about for-proft medicine and people going bankrupt because they can’t pay, they look at me like I’m making stuff up.
There’s no way things turn out in an inegalitarian fashion vis-a-vis healthcare there. They wouldn’t tolerate it.
October 1st, 2009 at 11:12 am
Thank you for posting this nice summary, Matthew. It’s really helpful to read about how this is handled in different ways by different countries.
October 1st, 2009 at 11:15 am
Comparing what Sweden has with the Tauzincare proposals circulating among the whores in D.C. shows how corrupted our supposed “progressive” party has become.
October 1st, 2009 at 11:15 am
Why does he keep bringing up Sweden when he’s admitted that nobody is actually going to replicate the swedish system?
It seems misleading, especially given that he used to argue that Obamacare was identical to the Swedish system. Well, either that or he was dishonestly arguing that the Swedish system would work fine WHILE arguing for Baucaus/Obama care.
October 1st, 2009 at 11:18 am
Where do the death panels come in?
October 1st, 2009 at 11:20 am
Only the U.S. distinguishes between public health and health care delivery. Texas removed access to primary care as a key public health indicator ten years ago.
October 1st, 2009 at 11:20 am
When I was in London a couple of years ago, I met a Swedish doctor who was moonlighting on the weekends in London to supplement her income. I’d be interested to know whether this is common because if it is, it would seem that Sweden is enjoying free rider benefits.
October 1st, 2009 at 11:21 am
Why does he keep bringing up Sweden when he’s admitted that nobody is actually going to replicate the swedish system?
By that logic, it’s pointless to bring up any other system at all, because we’re not going to replicate any other system.
October 1st, 2009 at 11:28 am
It seems misleading, especially given that he used to argue that Obamacare was identical to the Swedish system. Well, either that or he was dishonestly arguing that the Swedish system would work fine WHILE arguing for Baucaus/Obama care.
When did I do that? I think I said that Obamacare was similar to the Swiss health care system, which is very different from the Swedish system.
October 1st, 2009 at 11:31 am
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.”
Aiiieee! Aiiiieeee! Fascism! Socialism! Fascistosocialism! This is one step from the Khmer Rouge killing fields! Also.
October 1st, 2009 at 11:39 am
When did I do that? I think I said that Obamacare was similar to the Swiss health care system, which is very different from the Swedish system.
This is just like that bit in Trading Places right before Sen. Franken watches someone get raped by a bear.
October 1st, 2009 at 11:41 am
When did I do that? I think I said that Obamacare was similar to the Swiss health care system, which is very different from the Swedish system.
Sweden/Switzerland – what’s the difference? They both start with Sw, and they’re both full of people who talk funny, drive little cars and kick serious a** at the Winter Olympics, right?
October 1st, 2009 at 12:14 pm
Sweden/Switzerland – what’s the difference? They both start with Sw, and they’re both full of people who talk funny, drive little cars and kick serious a** at the Winter Olympics, right?
I’m always surprised how many Americans mix these two countries up. Before a recent trip to Sweden, I had numerous people joke that I should find the Swiss Miss so I could bring them back hot chocolate. When I said I would but it would involve me jumping out of the plane on my way to Sweden, they just looked at me funny.
October 1st, 2009 at 12:16 pm
Hey Matt,
if you have time and are interested in old artifacts, check out the Vasa ship museum. I think I stared at that thing for an hour.
October 1st, 2009 at 12:16 pm
Don’t feel bad, soullite. President Bush also thought the Swedes and the Swiss were the same people. You’re in good company.
October 1st, 2009 at 12:20 pm
[...] original post here: Matthew Yglesias » Health Care in Sweden Comments [...]
October 1st, 2009 at 12:30 pm
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.
Why even mention it then?
October 1st, 2009 at 12:34 pm
The world really has gone mad.
Matthew writes a lengthy post with no embarrassing typos.
One of his commenters mixes up countries. (Wasn’t that Matthew’s job once upon a time? Denmark/Germany, anyone?)
Matthew actually responds to people in comments (after years of ignoring us, he’s suddenly been appearing in the comments a lot lately…)
What is wrong with the world? It’s like if the Republicans suddenly started accusing the Democrats of wanting to cut Medicare, or something. Or like if conservatives suddenly began attacking the President for making a speech about the importance of personal responsibility to schoolchildren.
We’re through the looking-glass here, folks.
October 1st, 2009 at 12:34 pm
Good summary Matt.
The population of Los Angeles County but an area slightly larger than California creates some logistical problems.
In general the right and the left really agrees on the Swedish welfare system. One example: When you have a baby, one of the parents can stay home for 18 months or so – with pay. For every baby. It’s very popular also on the right. As is subsidized day care. A modern Swedish man is expected to like this as a matter of enlightenment and equality.
October 1st, 2009 at 12:52 pm
@AB: Because “More-than” =/= “All-and nothing”.
October 1st, 2009 at 1:45 pm
@NihilCredo: Cross-national life expectancy is so far removed from health care policy as to make it absolutely worthless to even mention it, and to question either the intelligence or the good faith of someone who does. But if one insists on mentioning it, you also ought to acknowledge the data that shows the US ranks #1 if you adjust for homicides and accidental deaths.
Matt knows it is a meaningless statistic in this context.
October 1st, 2009 at 2:27 pm
But if one insists on mentioning it, you also ought to acknowledge the data that shows the US ranks #1 if you adjust for homicides and accidental deaths.
Not only is that meaningless, but is it even accurate? Are you adjusting the other nations’ life expentancy figures to exclude homicides and accidents, too?
October 1st, 2009 at 2:31 pm
There is a lot of interesting stuff about swedish health care, that i missed in this report, which mostly focuses in the financial part of it, instead of the structural, which I think it’s what finally makes a health care system affordable and effective.
Sweden happens to be the country in Europe with the highest rate of inhabitants per hospital bed (aka very few hospital beds proportionally). That was pretty shocking in my country, where we lack enough hospital beds and people has to sleep in hospital halls a lot of times (mostly in Madrid, led by a conservative and private-enterprise-crazed goverment).
Why is that? Because they give most of health care at home, so you can be more comfortable when you are sick and it’s also, if properly done, a good way to lower costs.
Hospitals are almost only used for surgery, difficult treatment(like radiotherapy and so), research and terminal patients. Then, they have an extremely good network of ambulant nurses and doctors, and a huge logistical system to bring everything needed for health care to your house.
And what I read of the number about they high number of primary care centers in relation to the number of hospitals it’s also a very good signal, since here in Spain, we have a good network of primary care centers8even american goberment showed some interest about it), but they are still to small and too few to be efficient and a lot of people has to go to emergency rooms to get treatment or at least a doctor to check them, which I think is one of the main problems in America.
This is the kind of state-wide planification that you cannot have in a pure private market, since private companies allocate their resources to the most expensive and profitable treatment and don’t care about a correct alocation of resources in basic health care, which is way more important than your way of life to sustain a high expectancy and quality of life.
October 1st, 2009 at 2:33 pm
Driving Volvos and having gun ownership prohibited also probably contributes to life expectancy.
October 1st, 2009 at 2:50 pm
@AaLD: Not only is that meaningless, but is it even accurate? Are you adjusting the other nations’ life expentancy figures to exclude homicides and accidents, too?
Yes, of course it adjusts the other countries life expectancies, I don’t know why you would suspect such a ridiculous omission. “I” am not adjusting anything, the researchers who have studied this are.
And why would you say this is meaningless? If someone is going to cite life expectancy as an indicator of relative quality of health care systems, don’t you think you ought to account for deaths that have nothing to do with the health care system?
October 1st, 2009 at 2:53 pm
I’m a swede and have been reading this blog for a long time now. I think it’s nice you’re in sweden, and write about swedish politics and it’s a quite good description of the swedish health care system you’re delivering. However, the degree of political consensus isn’t really what you make it out to be.
The right-wing parties presently in office are slowly transforming the system. They want to introduce more of private insurance – with hospitals only for the privately insured, they have recently introduced a system (in Stockholm county) where everyone gets an (equal value) voucher to take with them to the prefered health care clinic, and supplementary financing based more or less solely on the number of people physically getting to see a doctor, thus creating a weird incentive to get more people to visit a doctor even when there is really no need.
The model has resulted in a draining of resources in socio-economically challenged areas and a flow of funds to wealthier inner city neighbourhood-clinics. A leading right wing think tank recently actually argued that sweden need to get a system more like the american, specifically “individual health care savings-accounts”.
Quite worrying, i’d say.
October 1st, 2009 at 3:40 pm
Yes, of course it adjusts the other countries life expectancies, I don’t know why you would suspect such a ridiculous omission. “I” am not adjusting anything, the researchers who have studied this are.
And they would be….?
October 1st, 2009 at 4:07 pm
The notion of a nominal charge for care is a good one. Much like the dollar we charge for the company Christmas dinner, it introduces a mental buy-in on the part of the consumer.
AB (#21): the US ranks #1 if you adjust for homicides and accidental deaths.
In the US, homicide is 0.7% of all deaths, all accidental deaths are 4.4%. BFD. In any case, the spread between the top ten and #42 in life expectancy is only 2.3 years.
So, that gets us back to the fact that we’re blowing a vast sum for a slightly shittier health outcome.
October 1st, 2009 at 5:48 pm
And they would be….?
They would be Robert Ohsfeldt and John Schneider, economists at the University of Iowa.
http://www.aei.org/docLib/9780844742403.pdf
October 1st, 2009 at 6:26 pm
Re: 29 – that report doesn’t quite say what you claim. In order to put the U.S. on top, they had to pretend that all the OECD countries have the same accidental & homicide death rates to produce “standardized” life expentancies that are in many cases lower than the actual life expectancies. In other words, they are manipulating statistics to produce a desired result.
October 1st, 2009 at 6:30 pm
In the US, homicide is 0.7% of all deaths, all accidental deaths are 4.4%. BFD. In any case, the spread between the top ten and #42 in life expectancy is only 2.3 years.
Seriously? This is your “analysis”? You think just citing the raw percentage of deaths from those causes gives insight into the overall effect it has on life expectancy? This “0.7 and 4.4%” are enough to make the US life expectancy the highest among all OECD countries when you adjust accordingly.
So, that gets us back to the fact that we’re blowing a vast sum for a slightly shittier health outcome.
Well, no, since people here seem to think this is a relevant metric (I don’t), this means we’re blowing a vast sum for a slightly superior health outcome.
October 1st, 2009 at 6:41 pm
Re: 29 – that report doesn’t quite say what you claim. In order to put the U.S. on top, they had to pretend that all the OECD countries have the same accidental & homicide death rates to produce “standardized” life expentancies that are in many cases lower than the actual life expectancies. In other words, they are manipulating statistics to produce a desired result.
Oh geez. You might want to put your dunce cap on AaLD.
Why the scare quotes around “standardized”? You do know what that means right? It means that in order to compare life expectancy as it relates to health care between countries you have put them all on the same basis as far as other things that affect life expectancy. This is not “manipulation”, it is standard statistical practice.
If you wanted to compare relative road safety between countries, you would not compare deaths/1000 people, you’d have to adjust it for rates of automobile ownership and vehicle miles driven/capita. You know, you would “standardize” it.
It is beyond laughable that you would impugn the motives of these professors based simply on your own astounding ignorance of the most basic economic analysis.
October 1st, 2009 at 6:46 pm
Sorry to scare you with those quotation marks. I’ll try to avoid unnecessarily alarming punctuation in the future. Despite (or because of) your attempts to belittle me, I’m not at all persuaded by your defense of the report. Academics with agendas? Who would have thought! The bottom line is that they applied their analysis such in a way that produces a result which doesn’t appear in the real world, and which happily coincides with a result desired by a certain side in this debate. Call it what you want, but that’s manipulation.
October 1st, 2009 at 6:48 pm
they had to pretend that all the OECD countries have the same accidental & homicide death rates to produce “standardized” life expentancies that are in many cases lower than the actual life expectancies
Just to focus on this one bit: Yes, that is exactly what they are doing! In fact, that is exactly what one should do to perform this type of analysis! Can you honestly believe what you wrote is anything other than complete nonsense? How else do you think one should calculate life expectancy adjusted for homicide and accidental death?
October 1st, 2009 at 7:02 pm
The bottom line is that they applied their analysis such in a way that produces a result which doesn’t appear in the real world, and which happily coincides with a result desired by a certain side in this debate. Call it what you want, but that’s manipulation.
And rather than realize the gaping errors in your logic, you’ve decided to double down on the crazy. I’ll try to make it simple for you, because I truly cannot believe someone would be so brazen in displaying their ignorance.
The hypothesis is that life expectancy is largely driven by variations in health care systems. I disagree, but let’s accept that as a given for the sake of the analysis. But we also know that in each country there are a number of deaths that have nothing to do with the health care system, namely homicides and accidental deaths like auto accidents. So in order to compare life expectancy across country, the life expectancy that we can attribute to health care, one has to adjust the mortality data to account for different rates of those deaths. The way you do this is to assume a similar rate for all countries, so that variations in cross-national homicide/accident rates are not affecting the data. You could assume they all have the same rate as the US, that they all have rates of 0, or that they all have the same rates as Vatican City. It matters not which one you choose, only that they are all on the same basis.
What you will end up with is, as you’ve said, “a result that does not appear in the real world”. This is in fact a goal of the analysis, to produce a result that has not actually happened, a result in which you can make comparison between countries because you have removed the effect of the confounding variable. You are able to say “without the national variation in homicide/accident rates, here is a direct comparison of the life expectancy that is attributable to health care.”
This is very basic stuff, there is nothing manipulative or controversial about the methodology.
October 1st, 2009 at 7:32 pm
This is very basic stuff, there is nothing manipulative or controversial about the methodology.
I dunno about that. Apparently even the OECD itself takes issue with Orfehlt and Schneider’s methodology.
http://blogs.wsj.com/health/2009/08/25/violence-traffic-accidents-and-us-life-expectancy/
October 1st, 2009 at 7:41 pm
Look, I admit I’m no expert on economics or statistics, not even close. But your demeaning approach leads me to believe (rightly or wrongly) that your posts are at least 50% bluster. And your implication that the authors of that report were not motivated by an agenda when their book was published by AEI leads me to question your honesty. So if your goal was to persuade, you failed. If you just wanted to insult someone, go for it. My online pseudonym is not easily offended.
October 1st, 2009 at 8:14 pm
I’m not looking to insult anyone, and you really need to lighten up if you think what I said is demeaning. It comes down to one very simple fact, you claimed that adjusting all countries life expectancy using the same rate of homicides/accidents to produce “something which never happened” is manipulating statistics, when it in fact is the exact method one should employ for this type of analysis. You immediately questioned the integrity of the authors (as well as my own honesty for citing the study) while displaying a laughable ignorance of this type of analysis. If I was not the most cordial in doing so may the world’s tiniest violin play a symphony just for you.
your implication that the authors of that report were not motivated by an agenda
There was no such implication. What I said was “you would impugn the motives of these professors based simply on your own astounding ignorance of the most basic economic analysis.” Whether or not there was an agenda was irrelevant to that, and in fact you had not even mentioned the AEI connection, you were questioning their methods based solely on a complete lack of understanding of those methods. That was and is ridiculous.
There is no bluster here. If you don’t like a “demeaning” tone, then you should refrain from demeaning others when your qualifications to do so are nonexistent. Imagine that someone questioned your honesty/professional integrity while in the same breath showing a stunning lack of knowledge on the subject they were speaking of. I hope that you would refute them with the same tone I have used today.
October 1st, 2009 at 9:25 pm
One of the major ways in which Japan and many European countries have controlled costs is by implementing a uniform (and pretty low, by US standards) reimbursement schedule for medical evaluations and procedures. Has Sweden does this too?
October 1st, 2009 at 11:04 pm
[...] be provided on coequal cost and according to need, … Go here to wager the original: Matthew Yglesias » Health Care in Sweden Posted in Health, Uncategorized | Tags: capitol, capitol-hill-, covers-events, equal-terms, [...]
October 2nd, 2009 at 9:36 am
As a Swede, I’d like to make a couple of points:
1. (Re: 12) Unfortunately, we do not kick serious butt at the winter olympics, although we did take home the hockey gold last time (that’s quite impressive);
2. Yes, we have single payer (basically). However, we also have voucher systems much like the school voucher system republicans thinks would be so great for education, so the consumer gets to pick who gives the best care rather than a govt/insurance bureaucrat. Thus, I get to pick a primary care provider, and my mom could get hip replacement surgery at a private hospital.
3. We have also largely privatized social security (beyond a fairly stingy guaranteed pay out) and school vouchers. How come Bill O’Reilly doesn’t mention that?
4. (Re: 7) Swedish doctors, nurses etc often do go abroad where the pay is better. This is probably not due to flaws inherent in the swedish health care system, as the countries they most often go to (UK, Norway) are, in town hall parlance, much more “socialist” than Sweden in this respect. Conversely, the Polish doctors working in Sweden probably aren’t here because the Swedish system is such a wonder of free-market incentivization.
October 2nd, 2009 at 11:52 am
The OECD also provides stats on life expectancy at age 65, which screens out the generally youthful victims of violence, accidents, and stupidity. The US is still mediocre but not as bad as when life expectancy at birth is compared. It’s hard for me to believe the AEI figures if expectancy even at 65 isn’t superior.