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Challenges that arise from Government Financed Healthcare

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Challenges that arise from Government Financed Healthcare

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-High taxation for low healthcare costs

To- sustain and ensure a low healthcare costs , the government is forced to increase the level of taxation on the country

-Despite the fact that most Swedes are more than willing to put up with the increase in income tax and value added tax (VAT) to sustain the government-financed system, sooner or later, the tax burden will fall on a smaller group of working citizens due to their ageing population

-Growing number of people needing healthcare

The costs need to be controlled further and more things need to be taken into  ccount

Mainly, global budgets (county councils and municipalities) are used to control total costs. Periodically, agreements have been established between the State and the county councils/municipalities to limit cost increases, taxes, etc.

The Swedish Council on Technology Assessment in Health Care, known internationally by its Swedish acronym, SBU, promotes efficient utilisation of resources through assessing new and establish health technologies.

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The government-financed approach in Sweden has strong intervention by the government. This is done to ensure access to healthcare for all socio-economic status groups in society especially the lower income group.  Patients above 20 years old are charged about $15.28 (SG dollars) per day just for hospitalisation

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In fact, 12 percent of Sweden's population is foreign-born, with large numbers of expats living and working in Stockholm.

What makes Sweden an attractive choice for expats is that they are entitled to receive the same healthcare, education, and welfare benefits as the native population.

Sweden prioritizes better healthcare

The healthcare system in Sweden is often used as a model by other countries. Although the country doesn't spending as much as some others, it still manages to deliver excellent services for everyone.

The country spends 9 percent of GDP on healthcare, which is almost half of the US healthcare budget, but it still achieves high life expectancy and low infant mortality rates.

Patients enjoy the shortest hospital stays, compared to wealthier nations such as the US, western Europe, Canada, Japan, China, and Australia.

In 2003, Sweden implemented a nationwide strategy to improve population well-being, which involved tackling the underlying determinants of health including housing, education, access to leisure activities and financial support for the poor and unemployed.

Highlights of the Swedish system

The most noteworthy feature of the healthcare system in Sweden is the availability of healthcare for all, including both native citizens and expats.

Admittedly, the country faces challenges in funding, efficiency, and quality of its healthcare services, but improvements are continually being made. This all contributes to the low mortality rate and higher-than-average life expectancy which is 79.5 years for men and 83.5 years for women.

In Sweden, most adult patients have to contribute a modest amount towards services such as a visit to the doctor. Health and dental care, as well as care for the elderly and disabled, is decentralized to local county councils and municipalities.

However, Sweden is leaning towards making its healthcare industry more competitive through privatizing some services. Today, you can find private hospitals with for-profit healthcare operations, which encourages the promotion of Sweden as a top destination for medical tourism.

Furthermore, there are certain rulings that make Swedish healthcare system one of the very best in the world. Waiting times for pre-planned care, such as hip-replacement surgery or cataracts, cannot exceed 90-days. This means that if you, as an expat or a Swedish citizen, see a specialist that confirms you require surgery, you will receive proper treatment within 90 days.

If the waiting period is likely to exceed this time limit, you can go elsewhere for treatment and the council will pay the bill, including the cost of travel for surgery.

Eligibility for expats in Sweden

Healthcare coverage in Sweden is universal, which means all residents, including expatriates, have access to publically financed healthcare services. This system covers inpatient and outpatient hospital care, prescription drugs, primary healthcare, dental care for children and young people, public health and preventive services, disability support and rehabilitation services.

In addition, homecare, nursing homecare, and patient transport support services are also covered under the publicly financed healthcare system.

Healthcare at what cost?

It is important to understand that, contrary to popular belief, healthcare in Sweden isn't always 100 percent free. Cost-sharing arrangements are available for most publicly financed services.

For example, patients may have to make a contribution of 200-300 Swedish crowns for a visit to a specialist, or pay 80 crowns per day for a hospital stay. The good thing is that health and dental care is subsidized by the government, and there are cost ceilings in place for healthcare services, which expatriates can take advantage of.

Reassuringly, there is a limit on individual contributions to healthcare of 900 crowns per year. Once you have reached this limit, all other healthcare services and medical consultations for the remainder of the 12-month period are free of charge.

Similarly, the limit on outpatient pharmaceuticals is 1,800 crowns a year, and children are exempt from cost sharing for all health services.

Expats in Sweden need to be aware of certain conditions. They must be residents for at least a year before they can receive dental care benefits under the Swedish healthcare system.

They must also have a Swedish personal identity number and all taxes must be paid. Dental care is available free of charge for children and adolescents up to the age of 20. Allowance is provided for regular visits, depending upon the age of a person - an allowance of 150 crowns/year is available for people aged 30-74.

However, emergency dental care services are available free of charge for EU/EEA citizens who are covered in their home country and can produce a European Health Insurance Card (EHIC).

Primary healthcare: private v public

Effective January 2010, a patient can choose between private and public healthcare for their primary care, which is one of the reasons why there has been a steady increase in the number of private healthcare providers in the recent years.

Still, county councils are tasked with providing everyone in Sweden with quality medical care. They are also responsible for collecting income tax, instigating projects in preventative medicine and promoting wellness.

Overall, the heavily subsidized healthcare system in Sweden makes healthcare widely available to its population. Although the services may not be free, payments are modest and generally affordable.

Surprisingly, the Swedish government is also deliberating offering the same direct access to state subsidized healthcare even to undocumented immigrants.

What is most encouraging is that children under 18 will enjoy the same rights as Swedish children, which means that not only will they have rights to emergency care, but they will also have access to dentistry and preventive care through the all-important years of development.

This certainly indicates how serious Sweden is about providing healthcare services to all, irrespective of nationality and status.

However, expats may choose to supplement the Swedish healthcare system with international health insurance to cover medical repatriation, restorative dental surgery and cancer treatments.

Find out more about how an international medical insurance plan can offer you or your family added health protection as expats in Sweden.

Article sponsored by Cigna Global

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Swedish healthcare: all you need to know

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In fact, 12 percent of Sweden's population is foreign-born, with large numbers of expats living and working in Stockholm. What makes Sweden an attractive choice for expats is that they are entitled to receive the same healthcare, education, and welfare benefits as the native population.

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- Public Healthcare:

Mostly owned and financed by the government. Primary care like GPs are privately owned.

Its 21 county councils(council for a division/part of Sweden)  are responsible for hospitals and GPs, while its 290 municipalities(local government in a town or district) provide municipal care. In Sweden, the county councils and municipalities are also the main providers of healthcare, with only about 10% of all health services delivered by private providers.

But both public and private providers are financed largely from public funds. The public funds are created when people pay a sum of money for healthcare services and part og co-payment. Thus the tax rates in Sweden are higher than other European countries.

- Universal access to healthcare:

Sweden provides basic access to healthcare for its people meaning that every Swede has equal access to healthcare services regardless of social class, income or place of residence.

- Choice of having private insurance:

In Sweden there are also private insurance policies such as the Voluntary Health Insurance(VHI).

It is offered as a supplement to publicly financed healthcare.

People who can afford it use it as it provides faster access to medical services at GP's and hospitals.

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- Based on the fundamental belief that all citizens should have access to healthcare services regardless of background or socio-economic status.
- This belief is established on the idea of social and economic equity.
- This system includes comprehensive assistance in the area of healthcare and substantial financial support.

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Health care in Sweden is largely tax-funded, a system that ensures everyone equal access to health care services. Challenges include funding, quality and efficiency of its health care services.

Equal access - the key to keeping Sweden healthy

People in Sweden are living increasingly longer. The average life span is now 84 years for women and 80.4 years for men. This can be attributed in part to falling mortality rates from heart attacks and strokes. In 2016, one in five people was 65 or older. That means Sweden proportionally has one of Europe's largest elderly populations. On the other hand, the number of children born in Sweden has been increasing each year since the late 1990s.

Shared responsibility

The responsibility for health and medical care in Sweden is shared by the central government, county councils and municipalities. The Health and Medical Service Act regulates the responsibilities of county councils and municipalities, and gives local governments more freedom in this area. The role of the central government is to establish principles and guidelines, and to set the political agenda for health and medical care. It does this through laws and ordinances or by reaching agreements with the Swedish Association of Local Authorities and Regions (SALAR), which represents the county councils and municipalities.

Decentralised health care

Responsibility for providing health care is devolved to the county councils and, in some cases, municipal governments. County councils are political bodies whose representatives are elected by county residents every four years on the same day as national general elections. Swedish policy states that every county council must provide residents with good-quality health and medical care, and work to promote good health for the entire population. County councils are also responsible for dental care for local residents up to the age of 21.

Photo: Melker Dahlstrand/
imagebank.sweden.se

What patients pay

Patient fees

The fee for a hospital stay is maximum SEK 100 per day. Patient fees for primary care vary between SEK 100 and 300 depending on the county council. For specialist visits, there is a maximum fee of SEK 400.

High-cost ceiling

A patient never has to pay more than a total of SEK 1,100 in the course of a year for medical consultations; within 12 months any consultations exceeding the SEK 1,100 are free of charge. There is a similar ceiling for prescription medication, so nobody pays more than SEK 2,200 in a given 12-month period.

Shared medical care

Sweden is divided into 290 municipalities and 20 county councils. Three of the county councils: Halland, Skåne and Västra Götaland - as well as Gotland municipality - are called regional councils and have assumed responsibility for regional development from the state.

There is no hierarchical relation between municipalities, county councils and regions. Around 90 per cent of the work of Swedish county councils concerns health care, but they also deal with other areas such as culture and infrastructure.

Sweden's municipalities are responsible for care for the elderly in the home or in special accommodation. Their duties also include care for people with physical disabilities or psychological disorders and providing support and services for people released from hospital care as well as for school health care. Chronic diseases that require monitoring and treatment, and often life-long medication, place significant demands on the system.

International co-operation

Greater mobility among EU citizens has increased the need for cooperation on health and medical care. Sweden is actively involved in collaborating on specialised care, improving patient safety and enhancing patient influence.

There is also discussion of health and medical services outside the EU, particularly in organisations such as the WHO, the OECD, the Council of Europe and the Nordic Council of Ministers. Many of the challenges confronting Swedish health care can also be seen in other countries, and include issues of access, quality, efficiency and funding.

One priority area is patient safety. In early 2011, Sweden enacted a new patient safety law which provides everyone affected by health care - patients, consumers and family members - new opportunities to influence health care content. The aim is to make it easier to report cases of wrong treatment.

Health care ICT and quality

National eHealth

National eHealth is aimed at making better use of information and communications technology to improve health and medical care and make it more efficient. Examples include electronic patient records, e-prescriptions and websites providing health care information. The Patient Data Act enables health care employees, with the patient's consent, to gain electronic access to patient records from different care providers across organisational boundaries.

Measuring quality

The National Patient Survey provides an annual measurement of how patients see the quality of health care. Questions concern treatment, patient involvement, confidence in care and information. The results are used to develop and improve care based on the patient perspective. The Health Care Barometer is a survey reflecting attitudes, knowledge and expectations relating to Swedish health care. This is compiled each year by every county council and region.

Elderly in Sweden have the right to receive care in their own homes.

Photo: Kristin Lidell/
imagebank.sweden.se

Specialist care within 90 days

Waiting times for pre-planned care, such as cataract or hip-replacement surgery, have long been a cause of dissatisfaction. As a result, Sweden introduced a health care guarantee in 2005.

This means all patients should be in contact with a community health care centre the same day they seek help and have a doctor's appointment within seven days. After an initial examination, no patient should have to wait more than 90 days to see a specialist, and no more than 90 days for an operation or treatment, once it has been determined what care is needed. If the waiting time is exceeded, patients are offered care elsewhere; the cost, including any travel costs, is then paid by their county council.

Statistics from 2017 indicate that about 79.1 per cent of the patients see a specialist within 90 days and receive treatment or are operated on within a further 90 days.

Focus on Swedish midwives

Sweden has long had trained professional midwives. Research shows this has resulted in a sharp reduction in mortality among women in childbirth. In the 18th century, the rate was about one in a hundred. By the beginning of the 20th century, mortalities had dropped to 250 women per 100,000 live births.

The first regulations governing midwifery in Sweden were established in 1711, and stipulated that midwives in Stockholm should be trained, assessed and take an oath.

Today, maternal mortality in Sweden is among the lowest in the world; fewer than three out of 1,000 babies and fewer than four women out of 100,000 die in birth. Swedish maternal care is often highlighted as a success story in international contexts, given its long tradition of significant contributions.

PLAYERS WITHIN THE HEALTH CARE FIELD

There are several authorities and organizations involved in health care at the national level.

In 2011, the Swedish Association of Midwives celebrated its 125th anniversary as a professional organisation and 300 years of midwife training.

Photo: Simon Paulin/ imagebank.sweden.se

Costs for care

Costs for health and medical care as a percentage of Sweden's gross domestic product (GDP) is fairly stable and on par with most other European countries. In 2015, health and medical care represented 11 per cent of GDP. The bulk of health and medical costs in Sweden are paid for by county council and municipal taxes. Contributions from the national government are another source of funding, while patient fees cover only a small percentage of costs.

Public sector costs for health and medical care, excluding dental, were SEK 65 billion in 2015, one of the larger expenses for the government.

More private health care providers

It is now more common for county councils to buy services from private health care providers - in 2013, 12 per cent of health care was financed by county councils but carried out by private care providers. An agreement guarantees that patients are covered by the same regulations and fees that apply to municipal care facilities.

Contraceptives

In Sweden, anyone can obtain contraceptives. If someone has an unwanted pregnancy, she is entitled to terminate the pregnancy with an abortion up to and including week 18. After the 18th week, an abortion may be performed only following a decision by the National Board of Health and Welfare and only under exceptional circumstances.

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Health care in Sweden is largely tax-funded, a system that ensures everyone equal access to health care services. Challenges include funding, quality and efficiency of its health care services. People in Sweden are living increasingly longer. The average life span is now 84 years for women and 80.4 years for men.

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- Average life span of is  83.7 years for women and 80.1 years for men.
- Sweden has one of Europe's largest elderly populations.
- The number of children born in Sweden has also been increasing each       year since the late 1990s.
- Total expenditure on health per capita (Intl $, 2014)  is $5,219.
- Total expenditure on health as % of GDP (2014)  is 11.9%.