Sweden: Reforms and Challenges - Healthcare

“Long waiting times have been a longstanding feature of the Swedish health system, and the problem has been subject to numerous debates and policy initiatives since well before the pandemic. The most important policy initiative was the Health Guarantee Act of 2010, which stipulated maximum waiting times for different types of services. Other initiatives included national programmes to incentivise regions to reduce queues (these were abolished in 2015) and increase transparency through regular publication of data on waiting times. This monitoring was initially developed at the regional and national levels, and from 2019 onwards, extended to the individual provider level in primary care, and subsequently, as of 2021, at the hospital level.

“The Swedish Association of Local Authorities and Regions uses four core indicators to measure the care guarantee in accordance with the law: contact with primary care on the same day, a medical assessment within three days, a first visit to specialist care within 90 days, and an intervention within 90 days.

“The disruption of hospital and other health services during the pandemic resulted in substantial increases in waiting times in 2020 and 2021, particularly for specialist care. In March 2020, 80 % of patients had a first consultation with a specialist within 90 days and 71 % had an intervention within 90 days. These shares dropped to 67 % for a specialist consultation and 44 % for an intervention by June/July 2020.

“Focusing on specific interventions, the mean waiting time for patients to get a hip replacement increased from 92 days in 2019 to 112 days in 2020, and continued to increase further in 2021, before it started to fall in 2022. The pattern was similar for knee replacement although the waiting time was generally higher both before and during the pandemic: it increased from 131 days on average in 2019 to 153 days in 2020 and 200 days in 2021, before starting to fall slightly in 2022 (Figure 21). The mean waiting time for these two interventions was higher in Sweden than in Finland in 2021, but lower than in Norway for hip replacement, although the data is not strictly comparable because the measurement of waiting times start earlier in the patient care pathways in Norway.”

Source: OECD/European Observatory on Health Systems and Policies (2023), Sweden: Country Health Profile 2023, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.

“The pandemic brought increased attention to the shortcomings of the long-term care sector in Sweden. Structural issues – such as the persistent lack of staff as a result of unattractive working conditions – affect the quantity, quality and safety of long-term care services. These challenges hindered the response to the pandemic (Statens Offentliga Utredningar, 2022).

“To address these issues, a budget of EUR 452 million from Sweden’s Recovery and Resilience Plan has been allocated to improve long-term care by upskilling and training new staff.⁵ In addition, a national inquiry published in 2022 proposed the adoption of a special Elderly Care Act to complement the existing Social Services Act (Statens Offentliga Utredningar, 2022). The proposal aims to clarify the mission and content of elderly care and to improve quality standards and monitoring. It contains new objectives in terms of prevention and health promotion, and access to services.”

“Antimicrobial resistance (AMR) is a major public health concern in the EU, with estimates of about 35,000 deaths due to antibiotic-resistant infections (ECDC, 2022), and healthcare-associated costs of around EUR 1.1 billion per year (OECD/ECDC, 2019). Antibiotic overprescription and overuse in humans are major contributors to AMR.

“Sweden had one of the lowest rates of antibiotic consumption in the community (excluding hospitals) across EU countries in 2021, and the consumption has gradually decreased over the past decade and during the pandemic (Figure 24).

“Sweden takes a comprehensive approach to address AMR. The strategy for 2020-23 has the overarching goal of preserving the possibility of effective treatment of bacterial infections in humans and animals (Government Offices of Sweden, 2023). It comprises seven objectives, including enhancing monitoring and surveillance systems to track antibiotic consumption and resistance patterns; establishing robust infection prevention and control measures in healthcare settings; promoting a responsible use of antibiotics; and increased public awareness of antibiotic resistance.”

“Health indicators for the population are good—life expectancy and cancer and heart attack survival rates are among the highest in Europe according to Organisation for Economic Co-operation and Development (OECD) figures from 2017, and the country also came in the top five in the Lancet’s most recent Healthcare Access and Quality Index.

“But most Swedes will agree that, in recent years, concerns over whether provision of that care is faltering are being raised on a more regular basis.

“In the run-up to the elections, local media reported on concerns about waiting times, care continuity, under-capacity, and severe staff shortages. According to official data, there are nursing shortages in 80% of the health-care sector. The daily newspaper Svenska Dagbladet said that although the Swedish population has grown by 13% since the end of the 1990s, hospital bed numbers have fallen 30% over the same period. Data from the OECD show that Sweden’s hospital beds shortage is the worst in Europe, with 2·4 available beds per 1000 people in 2015.”

Source: Holt, Ed. Health in Sweden: a political issue. Lancet. 2018 Oct 6;392(10154):1184-1185. doi: 10.1016/S0140-6736(18)32459-0.

“The run-up to parliamentary elections [in 2018], which delivered a hung parliament, saw a strong rise in support for the Sweden Democrats, a nationalist party, and was dominated by debates over immigration and the welfare state.

“As in many previous elections in the country, health care was one of the top issues for voters. But this year, pre-election campaigning highlighted how many Swedes are beginning to raise serious concerns about one of the pillars of the country’s society.

“‘There is a perception among the public that the health-care system is worsening”, Niklas Bolin, a political analyst and associate professor at Mid Sweden University’s Department of Social Sciences, told The Lancet.

“Pre-election polling showed health care was the most important issue for almost 40% of voters.

“Campaigns for these elections happened in amid a scandal over the construction of what is expected to be the most costly hospital in the world, complaints about an increasingly severe lack of resources and capacity at health-care facilities, and failing treatment services for patients.”

Source: Holt, Ed. Health in Sweden: a political issue. Lancet. 2018 Oct 6;392(10154):1184-1185. doi: 10.1016/S0140-6736(18)32459-0.

Sweden: Reforms and Challenges - Healthcare - Waiting Times, Long-Term Care, Anti-Microbial Resistance - National Policies - World Health Systems Facts

World Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems and policies in the US and sixteen other nations.

Page last updated March 31, 2025 by Doug McVay, Editor.