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SWEDEN What major innovations and reforms have been introduced? Important policy areas that have been under scrutiny at both the local and the national level during the last two years include the quality and equity of care, coordination of care, and patients’ rights. Studies following Sweden’s 2010 market reform in primary care show that objectives related to accessibility have been achieved. Its effects on quality, equity, and efficiency, however, are unclear. Accurate reporting and monitoring to measure these criteria remain important challenges in Swedish primary care and are a concern for policymakers. In the area of specialized care, there have been recent efforts to foster greater equity. The government has committed to providing SEK500 million (USD55.87 million) per year from 2015 to 2018 to reduce waiting times in cancer care and to reduce regional disparities. This effort is to be built on work previously undertaken within the framework of the National Cancer Strategy and the six Regional Cancer Centers (RCCs). In addition, a commission on equitable health, established in 2015, is to submit a report (due by the end of May 2017) containing proposals for reducing health inequalities in society. To improve continuity and coordination of care, in 2014 the government launched a four-year national initiative for people with chronic diseases. Its three areas of focus are patient-centered care, evidence-based care, and prevention and early detection of disease. In 2015, a new law addressing patients’ rights went into effect, with the purpose of strengthening the rights of patients and enhancing patient integrity, influence, and shared decision-making. The law clarifies and expands providers’ responsibility in conveying information to their patients, patients’ right to a second opinion, and patients’ choice of provider in outpatient specialist care throughout the country. The government has commissioned the Swedish Agency for Health and Care Services Analysis to monitor and follow up on implementation of the new law until 2017. References Anell, A., A. H. Glenngård, S. Merkur (2012). “Sweden: Health System Review.” Health Systems in Transition 14(5):1–161. Health Consumer Powerhouse (2009). Euro Health Consumer Index 2009 Report. Danderyd: Health Consumer Powerhouse. Organisation for Economic Co-operation and Development (OECD) (2015). OECD.Stat (database). DOI: 10.1787/data- 00285-en. Accessed July 2, 2015. Statistics Sweden (2015a). Systems of Health Accounts (SHA) 2001–2013. Statistics Sweden (2015b). Lönestrukturstatistik, landstingskommunal sector 2014. SALAR (2011). National Initiative for Improved Patient Safety. Stockholm: Swedish Association of Local Authorities and Regions. SALAR (2014). Statistik inom hälso- och sjukvård samt regional utveckling. Verksamhet och ekonomi i landsting och regioner 2013. Stockholm: Swedish Association of Local Authorities and Regions. SALAR (2015). Patientavgifter i hälso- och sjukvården 2015. Stockholm: Swedish Association of Local Authorities and Regions. Swedish Insurance Federation (2015). http://www.svenskforsakring.se. Accessed June 18, 2015. Swedish Medical Association (2013). Läkarförbundets undersökning av primärvårdens läkarbemanning. Stockholm: Sveriges läkarförbund. Swedish Medical Association (2014). Kostnader och produktion i primärvårdens vårdval. Stockholm: Sveriges läkarförbund. 160 The Commonwealth Fund
The Swiss Health Care System, 2015 Paul Camenzind Swiss Health Observatory What is the role of government? Duties and responsibilities in the Swiss health care system are divided among the federal, cantonal, and communal levels of government. The system can be considered highly decentralized, as the cantons are given a critical role. The 26 cantons (including six half-cantons) are responsible for licensing providers, coordinating hospital services, and subsidizing institutions and organizations. Cantons are like U.S. states in that they are sovereign in all matters, including health care, that are not specifically designated as the responsibility of the Swiss Confederation by the federal constitution. Each canton and half-canton has its own constitution articulating a comprehensive body of legislation. Who is covered and how is insurance financed? Publicly financed health insurance: There are three streams of public funding: 1. Direct financing for health care providers through tax-financed budgets for the Swiss Confederation, cantons, and municipalities. The largest portion of this spending is given as cantonal subsidies to hospitals providing inpatient acute care. 2. Mandatory statutory health insurance (SHI) premiums. 3. Social insurance contributions from health-related coverage of accident insurance, old-age insurance, disability insurance, and military insurance. All government expenditures are financed by general taxation. In 2013, direct spending by government accounted for 20.2 percent of total health expenditures (CHF69.2 billion, or USD50.5 billion), while income-based SHI subsidies accounted for an additional 5.8 percent. 1 Including SHI premiums (30.9% of total health expenditure, excluding statutory subsidies), other social insurance schemes (6.5%), and old age and disability benefits (4.4%), publicly financed health care accounted for 67.9 percent of all spending (SFOS, 2015a). Mandatory SHI coverage is universal. Residents are legally required to purchase SHI within three months of arrival in Switzerland, which then applies retroactively to the arrival date. Policies typically apply to the individual, are not sponsored by employers, and must be purchased separately for dependents. There are virtually no uninsured residents. Temporary nonresident visitors pay for care up front, and must claim expenses from any coverage they may hold in their home country. Missing SHI for undocumented immigrants remains an unsolved problem acknowledged by the Swiss Federal Council (SFC), the highest governing and executive authority. SHI is offered by competing nonprofit insurers supervised by the Federal Office of Public Health (FOPH), which sets floors for premiums offered to cover past, current, and estimated future costs for insured individuals in a given region. Cantonal average annual premiums in 2015 for adults range from CHF3,836 (USD2,800) to CHF6,398 (USD4,670) (Appenzell Innerrhoden; Basel-Stadt). Funds are redistributed among insurers by a central fund, in accordance with a risk equalization scheme adjusted for canton, age, gender, and hospital or nursing home stays of more than three days in the previous year. 1 Please note that, throughout this profile, all figures in USD were converted from CHF at a rate of about CHF1.37 per USD, the purchasing power parity conversion rate for GDP in 2014 reported by OECD (2015) for Switzerland. International Profiles of Health Care Systems, 2015 161
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JANUARY 2016 2015 International Pro
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2015 International Profiles of Heal
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Table 1. Health Care System Financi
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Table 3. Selected Health System Per
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The Australian Health Care System,
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AUSTRALIA low-income adults, childr
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AUSTRALIA In 2013, the federal gove
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What is being done to reduce dispar
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References AUSTRALIA Australian Bur
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CANADA What is covered? Services: T
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CANADA funding to 145 not-for-profi
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CANADA Organization of the Health S
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CANADA provides recommendations to
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CANADA Health Council of Canada (20
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CHINA Private health insurance: Com
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CHINA is not substantially more exp
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CHINA Organization of the Health Sy
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CHINA References Chen, X. (2014).
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DENMARK In addition, nearly 1.5 mil
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DENMARK Social psychiatry and care
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DENMARK Quality data for a number o
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DENMARK portion is small, it makes
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ENGLAND immunization, and vaccinati
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ENGLAND Hospitals: Publicly owned h
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ENGLAND Organization of the Health
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ENGLAND How are costs contained? Ra
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ENGLAND Organisation for Economic C
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FRANCE VHI finances 13.8 percent of
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FRANCE The average income of primar
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FRANCE What are the key entities fo
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FRANCE inequities in prevention rel
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FRANCE Nolte, E., C. Knai, and M. M
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GERMANY There were 42 substitutive
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GERMANY The 16 state governments de
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GERMANY management system, by the s
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GERMANY What major innovations and
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INDIA Private health insurance: The
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INDIA provide after-hour care, reim
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INDIA are provided by other ministr
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INDIA How are costs contained? Ther
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ISRAEL Together, these two types of
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ISRAEL Primary care physicians are
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ISRAEL Organization of the Health S
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ISRAEL • Using electronic health
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ITALY during hospitalization (Thoms
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ITALY Some regions are promoting ca
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ITALY Organization of the Health Sy
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ITALY although the degree of evolut
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ITALY The author would like to ackn
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JAPAN What is covered? Services: Al
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