JANUARY

What is being done to reduce disparities?
SWEDEN
The 1982 Health and Medical Services Act emphasizes equal access to services on the basis of need, and
a vision of equal health for all. International comparisons indicate that health disparities are relatively low in
Sweden. The National Board of Health and Welfare and the Public Health Agency compile and disseminate
comparative information about indicators on public health. Approaches to reducing disparities include programs
to support behavioral changes, and the targeting of outpatient services to vulnerable groups in order to prevent
diseases at an early stage. To prevent providers from avoiding patients with extensive needs, most county
councils allocate funds to primary care providers based on a formula that takes into account both overall illness
(based on diagnoses) and registered individuals’ socioeconomic conditions.
What is being done to promote delivery system integration and
care coordination?
The division of responsibilities between county councils (for medical treatment) and municipalities (for nursing
and rehabilitation) requires coordination. Efforts to improve collaboration and develop more integrated services
include the development of national action plans supported by targeted government grants. In 2005, Sweden
introduced a “guarantee” to improve access to care and to ensure the equality of that access across the
country. The guarantee is based on the “0–7–90–90 rule”: instant contact (zero delay) with the health system for
advice; seeing a general practitioner within seven days; seeing a specialist within 90 days; and waiting no more
than 90 days to receive treatment after being diagnosed. For county councils to be eligible for the grant
targeted at accessibility, 70 percent of all patients must receive care within the stipulated time frames. At the
county council level, providers are eligible for grants linked partly to the fulfillment of goals related to
coordination and collaboration in care provided to the elderly with multiple diagnoses.
What is the status of electronic health records?
Generally, both the quality of IT systems and their level of use are high in hospitals and in primary care; more
than 90 percent of primary care providers used electronic patient records for diagnostic data in 2009 (Health
Consumer Powerhouse, 2009). Nearly all Swedish prescriptions are e-prescriptions. Patients increasingly have
access to their electronic medical record for the purposes of scheduling appointments or viewing their
personal health data, but there is variation in this regard between county councils. The Swedish eHealth
Agency (eHälsomyndigheten) was formed in 2014 to strengthen the national e-health infrastructure. Its
activities focus on promoting public involvement and providing support for professionals and decision makers
(see governance section, above).
How are costs contained?
County councils and municipalities are required by law to set and balance annual budgets for their activities. For
prescription drugs, the central government and the county councils form agreements, lasting a period of years,
on the levels of subsidy paid by the government to the councils. The Dental and Pharmaceutical Benefits
Agency also employs value-based pricing for prescription drugs, determining reimbursement based on an
assessment of health needs and cost-effectiveness. In some county councils, there are also local models for
value-based pricing for specialized care such as knee replacements.
Because county councils and municipalities own or finance most health care providers, they are able to
undertake a variety of cost-control measures. For example, contracts between county councils and private
specialists are usually based on a tendering process in which costs constitute one variable used to evaluate
different providers. The financing of health services through global budgets, volume caps, capitation formulas,
and contracts, as well as salary-based pay for staff, also contributes to cost control, as providers retain
responsibility for meeting costs with funds received through those prospective payment mechanisms. In several
counties, providers are also financially responsible for prescription costs.
International Profiles of Health Care Systems, 2015 159