The Swedish healthcare system
In Sweden, responsibility for health and medical care is divided between the national government, regions and municipalities. The aim of the healthcare system is to achieve good health and healthcare on equal terms for the entire population.
Healthcare shall be provided with respect for the equal value of all humans, and for the dignity of individual human beings. Those who have the greatest need of health and medical care shall be given precedence to care, and health and medical care shall work to prevent ill health.
Three administrative levels
The Swedish healthcare system is divided up into three administrative levels, which are all governed by democratically elected politicians:
- national government
The role of national government is to establish principles and guidelines, and to set the overall political agenda for Swedish health and medical care. This is done by means of laws and ordinances, or through agreements with the Swedish Association of Local Authorities and Regions (SALAR). Example of current agreements concern areas such as shorter waiting times in cancer care, obstetrics and female health, pharmaceutical benefits and support for national quality registers.
The Ministry of Health and Social Affairs is responsible for fulfilling the goals of the Riksdag - the Swedish parliament - and the Government within health and medical care policy. The Ministry is also responsible for administrating that part of the Government budget that concerns areas such as public health and medical care. Reporting to the Ministry are number of public agencies that support the activities of the Ministry, such as the Public Health Agency of Sweden, the Swedish eHealth Agency, the Health and Medical Care Disciplinary Board, the Health and Social Care Inspectorate, the Dental and Pharmaceutical Benefits Agency, the Medical Products Agency, the National Board of Health and Welfare and the Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU).
It is the responsibility of the regions to organise health and medical care in such a way that all citizens have access to good care. Sweden consists of 21 regions. Gotland is a municipality with the tasks and regional development responsibility of a county council, and is therefore also called a region.
The regions are governed by politicians elected by the inhabitants of the county. The regional assembly is the highest decision-making body at regional level. The assembly represents the population and makes decisions on the most important issues for the region, and appoints an executive committee for the region. The regional executive committee leads and coordinates all the work within the region, and is responsible for the finances of the region.
The principle of municipal self-determination is written into the Swedish constitution, and entails that regions can adapt their activities to suit the regional conditions. At the same time, regions must comply with the framework determined by the Riksdag and Government. In addition to specialist legislation, such as the Health and Medical Services Act, the activities of regions are governed by the Local Government Act (SFS 1991:900).
The regions are responsible themselves for the internal control of their activities. Since 2013, the Health and Social Care Inspectorate has been responsible for supervision of health and medical care. The Inspectorate’s supervision covers both operations and health and medical care personnel.
Municipalities are responsible for care for the elderly, care for persons with physical and mental disabilities, support and services to persons who have completed therapy and been discharged from hospital and for school healthcare. There are 290 Swedish municipalities.
Just like regions, municipalities are governed by politicians elected by the citizens. The municipal assembly is the municipality’s highest decision-making body. The assembly decides on the direction, activities and finances of the municipality, and appoints the municipality’s executive committee. The municipal executive committee leads and coordinates the work of the municipality, and is responsible for its finances.
The activities of municipalities are governed by the Local Government Act, and, just like regions, practice self-determination.
The Swedish Association of Local Authorities and Regions (SALAR) is a politically run organisation that represents Sweden’s municipalities and regions. It is the largest employer organisation in Sweden.
SALAR’s duties are for example to:
- support and contribute to the development of municipalities and regions
- act as a network for sharing of knowledge and coordination
- make regional comparisons of quality and efficiency
- scan and highlight changes in the outside world
The care chain
Primary care is the basis in Swedish healthcare. According to the Health Care Act, primary care is defined as healthcare where open care is provided without delimitation in terms of illnesses, age or patient groups. Primary care is responsible for the need for basic medical treatment, nursing, preventive work and rehabilitation that do not require the medical and technical resources of the hospital or other special skills.
Primary care consists of over 1000 health centers, district nurses and other home and family doctoral clinics. According to the Health Care Act, county councils and regions are obliged to introduce healthcare systems that allow citizens to choose between primary care providers. All healthcare providers who meet the requirements of the county councils in the welfare systems have the right to establish themselves in primary care with public compensation.
At health centers, doctors in general medicine work with nurses, physiotherapists, occupational therapists and curators. If a patient is unable to get the correct treatment or diagnosis at the healthcare center, a referral will be written to the appropriate specialist care provider.
The next step in the care chain is county healthcare. In Sweden there are more than twenty county hospitals and about 40 smaller county hospitals. At county hospitals, there are skills and medical equipment covering most areas of disease. The smaller county hospitals do not always have all kinds of specialist receptions. Large parts of the hospitals' activities are closed care, which means that patients are admitted to a department for one or more days. In many cases, hospitals also offer outpatient care.
Regional healthcare is conducted at the seven university hospitals in Sweden. All rare and complicated diseases and injuries are treated there. University hospitals work closely with the medical universities and colleges of education and research. Sweden is divided into six healthcare regions, and within each healthcare region there is at least one university hospital. The regions that do not have their own university hospital have agreements with nearby regions that can give patients highly specialized care.
National specialised medical care
National specialised medical care is defined in the Health Care Act as healthcare carried out by a region and coordinated with the country as a catchment area. This means that some highly specialized care is centralized to one or two hospitals in order to achieve higher quality and better use of resources. It is the National Board of Health and Welfare that investigates and decides what care should be given as national healthcare and which region to conduct the business.
Income and expenses
Swedish healthcare is financed mostly through county council and municipal taxes, and regions and municipalities also receive contributions from the State. Some of the governmental grants are general, others may only be used in areas specifically designated by the State.
In 2017, the regions’ revenues were SEK 348 billion, of which more than 71 % came from the county council taxes. The governmental grants divided into general grants, contributions for the pharmaceutical benefit and specially defines grants, amounted to 20 % of the revenue. A small portion of county councils and regions' revenues, around 3.5%, consisted of patient charges.
In 2017, the regions produced health care services worth SEK 338 billion. Specialized somatic care cost county councils around SEK 156 billion kronor and primary care just over SEK 52 billion.
Following the regions, privately owned companies are the largest healthcare practitioners in Sweden. In 2014, they produced services worth over SEK 63 billion. Private performers are found primarily in open care. Most private caregivers have agreements with regions that allow them to receive the same remuneration as public healthcare providers and charge patients pay the same fee regardless of whether the healthcare provider is private or public.
There is a maximum amount for how much you have to pay for healthcare in Swedish regions. The high-cost threshold means that a patient for a period of twelve months pays no more than SEK 1100 for outpatient care. A region may decide on a lower high-cost amount than SEK 1100. When paid up to the level decided by the region, you will receive a free card valid for the rest of the twelve month period. The high-cost threshold does usually not apply to:
- fees that are paid per day when hospitalized
- certificates and health surveys
- missing visits
- cost of journal copies
- handling fees
In most regions, outpatient care is free of charge for children and adolescents under the age of 20. Patients over the age of 85 do not have to pay either.
There is also a high-cost threshold for prescription medicines. Medicinal products included in the high-cost protection are subsidized by government funds, which means that the state pays a portion of the cost. Based on the Pharmaceutical Benefits Act, the Dental and Pharmaceutical Benefits is the central government agency that determines which medicines are to be covered by the high-cost threshold. The high-cost threshold for medicines means that you pay no more than SEK 2200 for a period of twelve months. Medicines included in the drug benefits are free of charge for children under 18 years of age.
1177 – High-cost protection
Dental and Pharmaceutical Benefits Agency - High-cost threshold for medicines
Dental and Pharmaceutical Benefits Agency - Subsidies towards medicines
Act on Pharmaceutical Benefits (in Swedish)