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The following OECD assessment and recommendations summarise Chapter 5 of the Economic Survey of Sweden 2005 published on 9 June 2005.
The healthcare system is in good shape
The Survey also includes an in depth look at Sweden’s healthcare system. By international standards, it is in good shape. Healthcare is of a high quality, the system is relatively well funded, and the various players have been innovative in the way they finance and deliver services. However, there are some problems around the edges. The main challenges are to improve access to primary care, lift quality in the lower performing regions, increase value for money in the hospital sector and put financing on a more stable and sustainable basis.
Most health indictors are better than the OECD average, and have been improving
1. The shaded area shows the middle two quartiles (i.e. half the countries fall in this range).
2. The Potential Years of Life Lost is a summary measure of avoidable or premature mortality, providing an explicit way of weighting deaths occurring at younger ages (before 70 years), that are in principle preventable. It is measured as years lost per 100 000 people.
Source: OECD Health Data 2004.
Access could be improved, especially to primary care
Too many people go to a hospital for their primary care because there is a shortage of GPs and because doctors work short hours. The number of family doctors might be boosted if it was easier for specialists in other fields to retrain as specialists in family care. Doctors could be encouraged to work more, deal with patients more efficiently and have more convenient consultation hours by introducing mixed payment systems that include a fee for service element. In the hospital sector, the Waiting Time Guarantee should be adjusted to make it consistent with the principle that those most in need should be treated first (for example, by making duration in the queue just one of several factors that determines when a person is treated).
Too much decentralisation harms quality and efficiency
Decentralised responsibility for healthcare has its advantages. It has allowed counties to experiment with different ways of running their systems, which is one reason why Sweden’s healthcare system is relatively innovative and flexible. However, excessive decentralisation in some areas affects quality and patient safety (for example, too many emergency units are below the minimum safe size, while insufficient co ordination between counties and municipalities leads to problems in the grey area between hospital care and social care). It also affects efficiency because of duplication. The government should consider reducing the number of counties to perhaps half a dozen or fewer, which would also help the counties re organise their hospitals so that fewer are below safe size. Co ordination between municipalities and counties needs to improve, especially for people with psychiatric, drug or alcohol problems.
The hospital sector could be run more efficiently
In the hospital sector, there are considerable regional differences in efficiency, quality and medical practice. In most counties, there is a need to: enhance the role of purchasers; improve hospital funding mechanisms, including some form of per case payment; improve management through better case costing systems, especially in psychiatry, outpatient and primary care; and make more use of multi year budgets. The government could also encourage a greater diversity of providers by removing the restrictions on for profit hospitals or allowing exemptions on a case by case basis – but only when an adequate regulatory framework is in place to minimise the risk of cream skimming.
Funding arrangements are unstable and unsustainable
The current funding arrangements have several problems. With balanced-budget rules, healthcare financing is too cyclical. Possible solutions include stabilisation funds, giving counties a less cyclical tax base (such as property taxes), calculating the tax base as a moving average and moving to multi year budgeting. Second, the income tax base may not grow fast enough with an ageing population. Counties may need a share of the national VAT, for example. Finally, the high cost protection ceilings on user charges should be re assessed because patient charges are not having the desired effect of channelling people to the right level of service. The government could raise the ceilings, which have fallen significantly in real terms, or make them a fixed percentage of household income instead of a flat amount.
Return to the OECD Economic Survey Sweden 2005 homepage
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A printer-friendly Policy Brief (pdf format) can also be downloaded. It contains the OECD assessment and recommendations, but not all of the charts included on the above pages.
To access the full version of the OECD Economic Survey of Sweden:
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Readers at subscribing institutions can go to SourceOECD, our online library.
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Non-subscribers can purchase the PDF e-book and/or printed book at our Online Bookshop.
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Government officials can go to OLISnet's Publication Locator ( subscribe).
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Accredited journalists can go to their password-protected website.
For further information please contact the Sweden Desk of the OECD Economics Department at webmaster@oecd.org. The OECD Secretariat's report was prepared by David Rae and Martin Jørgensen under the supervision of Peter Jarrett.
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