Sweden

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Sweden adopted universal health coverage in 1955.  How did the universal health coverage develop?  A 2004 World Health Organization report provides the answer.

Health insurance in the 19th century mostly occurred through mutual aid organizations, which paid out sickness benefits if their members became ill.  By 1885, about 10% of workers had joined “Friendly Societies.”  In the latter half of the 19th century, employers and unions began to create sickness funds for their workers.  Employers wanted to attract more workers; unions hoped to increase their member’s independence by reducing their reliance on employer-based schemes.  In 1891, the government not only recognized these societies, but began to offer subsidies to help finance their operations.

“Over  the next 40 years, government legislation moved steadily toward realizing the goal of universal effective health insurance coverage.  Early regulations sought to reduce the number  of societies so that they could achieve economies of scale. The government also gradually increased the number and categories of individuals who were required to  have coverage. A gap emerged between professionals with individual contracts and  manual workers with collective contracts, with the former enjoying a higher level of insurance coverage, particularly with regard to sick pay. Sweden almost enacted a universal insurance system in 1935, but the economic crisis in that period forestalled adoption.  The legislation establishing a universal system was finally passed in 1946 and implemented in 1955.”

The CIA World Factbook provides some additional facts on the Swedish healthcare system:

  • Health Spending: 9.9% GDP
  • Taxes: 53% of GDP.
  • Health Revenue derived from county taxes: two-thirds
  • Share of local budget dedicated to health: 85%
  • Life Expectancy: 81.07 years
  • Total Fertility Rate: 1.67

Source: William Savedoff, Tax-Based Financing for Health Systems: Options and Experiences, WHO Discussion Paper, 2004.

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On my recent vacation, I visited Stockholm Sweden.  In addition to walking the beautiful streets of a city made up of 14 islands and eating lots of pastries, I also had my Healthcare Economist glasses on as well.  One thing I noted was the large number of fathers who were walking their babies in a stroller.  Why were so many men staying home with their children?  Is it the Swedish gender equality ethic?  Is it because so many female Swedes work (73% of women work – only 3 percentage points below male employment rates)

Partly.

Policy explains a lot, however. Sweden has the most generous parental paid leave benefits of any country in the world.  Parents are entitled to 480 days (16 months) of paid leave.   The next closest country is Norway with 13 months, and a number of countries (e.g., Albania, Bulgaria, Denmark, Slovenia) offer 12 months paid leave.

As reported in theLocal.se, State-sponsored parental leave (‘föräldraledighet’) can be split between both parents (unless the parent is a single parent in which case they can use all the days).  However, the mother cannot use more than 420 days of the paid leave, 60 days are reserved for the father.

According to Mats Mattsson, head of the parental insurance section at Försäkringskassan “The principle is that you split it in half, but that the father can donate part of his leave to the mother, or vice versa.”

Read the rest of this entry »

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The Healthcare Economist is taking a vacation to Sweden and Spain over the next week and a half.  Blog posting will resume by Monday, September 12.

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Here is my earlier review on Norway.  The information below on Sweden and Finland has not yet been presented before in my blog.

SWEDEN

Hospitals

  • There are 4 types of medical facilities: local health centers, county level hospitals, district level hospitals, and regional teaching hospitals.
  • Local health centers are staffed by GPs, nurses, midwives, occupational therapists, social workers and psychologists.
  • Citizens can pick their own local health center and their own physician.

HIT

  • 98% of Swedish GPs have computerized practices
  • 90% use electronic medical records.
  • Patients can provide physicians with necessary information before the visit using the patient’s Smart card.

Malpractice

  • The Scandinavian model is built on the premise of no-fault liability.
  • About 3 patients file a malpractice claim for every 1 in the U.S.
  • Awards payments come from a compensation fund supported by tax revenues.

FINLAND

Hospitals

  • Finland is divided into 20 hospital districts, each with 1 central hospital with more sophisticated technology and several satellite hospitals.
  • Of the central hospitals, 4 are university hospitals with the most specialized care.
  • Municipal health centers serve the majority of each community’s health needs. 

Funding

  • Funding is very decentralized.  The central government only paid for 18% of care in 2000.  The municipalities pay for the majority of care.

Malpractice

  • Similar to the Swedish system

NORWAY

Insurance

  • Has a centralized system, like Canada.
  • The National Insurance scheme covers all citizens.
  • No private insurance exists

Funding

  • The National Insurance Scheme is funded by general tax revenues. 

Physicians

  • Most physicians work are paid via capitation.  The capitation rate is based on the number of patients who have chosen a doctor to be their primary physician. 
  • Some specialists do work on a fee-for-service basis.

Malpractice

  • Similar to the Swedish system

Source: Roth, WF (2010) Comprehensive Healthcare for the U.S.: An Idealized Model. Productivity Press, 174 pages.

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