Population Insurance Coverage For A Core Set Of Healthcare Services* (%) (2017):
Public Coverage: 100%; Primary Private Health Coverage: 0%; Total: 100%

*“Population coverage for health care is defined here as the share of the population eligible for a core set of health care services – whether through public programmes or primary private health insurance. The set of services is country-specific but usually includes consultations with doctors, tests and examinations, and hospital care. Public coverage includes both national health systems and social health insurance. On national health systems, most of the financing comes from general taxation, whereas in social health insurance systems, financing typically comes from a combination of payroll contributions and taxation. Financing is linked to ability-to-pay. Primary private health insurance refers to insurance coverage for a core set of services, and can be voluntary or mandatory by law (for some or all of the population.”

Source: OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/4dd50c09-en.

“All residents in Sweden are automatically entitled to publicly funded health services, and the regulation of health service provision to new immigrants has also been improved. Even though Sweden has a broad benefit package and a health care law with a strong focus on equity and needs-based provision, the regional structure with 21 autonomous county councils leads to some disparities in service coverage rules in different parts of the country. To mitigate this structural problem, the National Board for Health Welfare and the Swedish Association of Local Authorities and Regions work together to agree on common guidelines and strategies.”

Source: OECD/European Observatory on Health Systems and Policies (2019), Sweden: Country Health Profile 2019, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.

“Some people report unmet care needs due to financial or non-financial barriers. Unmet medical care needs are low: 1.4 % of all respondents and 2.4 % of respondents on low incomes reported episodes of unmet needs for a medical examination or treatment due to costs, distance to travel or waiting times in 2017. The percentage of people reporting unmet needs for dental care was about 2% overall in 2017, but over 5% among people in the lowest income group (Figure 17).

“User fees for many services can have a rationing effect. National ceilings on fees are separate for care services, prescription medicines, health-related transport and medical aids, but counties have different methods to weigh reimbursement according to health care needs. Consequently, the total annual amount can be substantial for people on low incomes. In addition, dental care is not included in the benefit package and is subject to higher co-payments for adults above the age of 23. The government has commissioned an official inquiry, with the aim of proposing reforms to the dental care system, focusing on tackling inequalities. Its final report is expected to be delivered in 2020.”

Source: OECD/European Observatory on Health Systems and Policies (2019), Sweden: Country Health Profile 2019, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.

“The Swedish system provides coverage for all residents, regardless of nationality, while emergency coverage is provided to all patients from the EU/ EEA and via bilateral agreements. Services are either free or highly subsidised, with user charges set by the regions for primary and specialist care. For 2019, fees were 0-300 kronor (EUR 0-28) for a primary care visit, 200-400 kronor (EUR 19-38) for a specialist visit and 100 kronor (EUR 9.5) per day of hospitalisation for an adult. User fees for medical consultations are capped at 1 150 kronor (EUR 109) per individual per year, as are prescribed medicines at 2,300 kronor (EUR 218). Exemptions from user charges apply for children, adolescents, pregnant women and older people.”

Source: OECD/European Observatory on Health Systems and Policies (2019), Sweden: Country Health Profile 2019, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.

“There is no specific law regulating patients’ rights in Sweden, as opposed to in other Nordic countries. Instead, different rights for patients, such as patient choice or the right to information, are incorporated in other legislation and are formulated in policy agreements between the state and the county councils through the SALAR. Regulations are mainly targeted at the behaviour of personnel and only indirectly at patients’ rights. For instance, personnel are obliged to provide individually tailored information but patients have no articulated right to receive such information (Winblad & Ringard 2009). In March 2001, however, the government appointed a committee of inquiry with the task of investigating how to strengthen the patients’ position and influence over care and develop a proposal for a new patients’ act (Ministry of Health and Social Affairs 2011). Preliminary results are to be delivered in June 2012 and a final proposition no later than in January 2013. The proposal should include how to:
– provide health care on equal terms for the population;
– increase and strengthen patient choice;
– improve access to information and advice;
– encourage different government agencies to go about strengthening the patient’s position; and
– enhance better exchange of information between the patient and the caregiver.

“The basic principle of health care provision in Sweden is that everyone has the same right to good quality care. The 1982 Health and Medical Services Act defines the county councils’ responsibility to provide all their citizens with high-quality health care services. There are several different bodies sharing the task of safeguarding patients’ interests in receiving adequate and safe health care. In 1999, patients’ rights in the health care system were further strengthened when the county councils’ obligations towards them were increased through a change in the Act. According to the revised Act, the health care system is responsible for strengthening the position of the patient through individualized information, opportunities to choose between alternative treatments and the right to a second opinion, when suffering from a life-threatening or other particularly serious disease or injury.

“Moreover, every county council and municipality must have a patients’ committee. The committees should support and help individual patients and contribute to quality development in the health care system by helping patients to get the information they need to safeguard their interests, promoting contact between patients and health care personnel, helping patients to get in touch with the appropriate agency and reporting to care providers and care units any observations and irregularities of significance to patients.”

Source: Anell A, Glenngård AH, Merkur S. Sweden: Health system review. Health Systems in Transition, 2012, 14(5):1–159.

“Swedish people are free to choose their primary care providers and contact specialists directly in most regions. Waiting time guarantees are designed to ensure that patients are able to contact a primary care centre the same day, to receive a medical assessment in primary care within three days, to see a specialist within 90 days and to receive any necessary treatment/surgery within 90 days. When these thresholds for waiting times are exceeded, patients are offered care elsewhere, paid for by their region. Nevertheless, these waiting times thresholds are exceeded in many cases (see Section 5.2).”

Source: OECD/European Observatory on Health Systems and Policies (2019), Sweden: Country Health Profile 2019, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.

“The Swedish health care system is integrated to a high degree. The county councils are responsible for both the financing and organization of health care services. There are few private hospitals, and the number of private primary care providers varies widely between the county councils. In some urban county councils, up to 60% of the primary care providers may be private, whereas in other county councils only a few private providers can be found. The same variation in the public/private mix of providers can be found across the municipalities.

“For private practitioners to be reimbursed by the county council they need to have an agreement with the county (see section 2.8.2 Regulation and governance of providers).

“It is up to each county council to decide on the mechanisms for paying
providers and therefore methods vary across the country. In hospital care, a mix of payment mechanisms is used across the country. Traditionally, most county councils have decentralized a great deal of the financial responsibility to health care districts, through global budgets. There has been a development towards mixed resource-allocation models during the 2000s. Often, fixed prospective per-case payments (based on DRGs), complemented with price or volume ceilings and quality components are used. The use of DRGs and other classification systems for payment varies among regions and county councils. Per-case reimbursements for outliers, such as complicated cases that grossly exceed the average cost per case, may be complemented by per-diem payments. The payments, whether they are based on fixed per-case payments, per-diem reimbursements, global budgets, fee-for-service methods or a combination of these systems, are traditionally based on historical (full) costs.

“Some county councils have developed pay-for-performance (P4P) programmes for hospitals in more recent years covering up to 4% of hospital payment. In general, the programmes are designed to withhold payment if certain targets are not met. Targets may be related to general indicators covering waiting times, preventive care or patient safety but may also be linked to clinical indicators in major disease areas.”

Source: Anell A, Glenngård AH, Merkur S. Sweden: Health system review. Health Systems in Transition, 2012, 14(5):1–159.

“Most health workers across both public and private providers and independent of service sector (hospitals, primary care providers, nursing homes and home care services) are salaried employees. The majority of Swedish health care personnel are members of a professional union that represents them in salary negotiations. The Swedish Association of Health Professionals (Vårdförbundet) is the trade union and professional organization representing about 110 000 registered nurses, midwives, biomedical scientists and radiographers. The Swedish Medical Association (Sveriges läkarförbund) is the union and professional organization representing physicians. About 90% or 43 000 of Sweden’s doctors were member of the organization in 2011. The SALAR works as the employers’ central association for negotiating the framework for local wage bargaining and terms of employment for the personnel employed by the county councils and municipalities (see section 2.3.1 National level).

“A full week’s work is 40 hours. In 2010, the average monthly salary for staff employed by the county councils was SEK 56 600 (€6300) for physicians, SEK 42 200 (€4700) for dentists and about SEK 29 000 (€ 3200) for specialist nurses. This includes compensation for work during non regular working hours (Statistics Sweden, 2011c).”

Source: Anell A, Glenngård AH, Merkur S. Sweden: Health system review. Health Systems in Transition, 2012, 14(5):1–159.

“A county council cannot prevent a practitioner from establishing a private practice; the regulatory power is restricted to controlling the public financing of private practitioners. County councils regulate the establishment of new private primary care practices that are eligible for public funding through conditions for accreditation. A private health care provider must have an agreement with the county council in order to be publicly reimbursed. If the private provider does not have an agreement, the provider is not reimbursed and the patient will have to pay the full charge to the provider. However, there are private providers (physicians and physiotherapists) who are reimbursed by the county councils but based on earlier state regulation (nationella taxan). This old principle for reimbursement of providers operates in parallel, and sometimes in conflict, with more recently adopted principles of payment to private providers. In 2009, in connection with the choice reform in primary care (see section 2.9.2 Patient choice) a law giving private and public providers equal conditions for establishment was adopted (Act on System of Choice in the Public Sector, 2008). According to the law, payment of providers should follow the patients’ choice of provider.

“Since the responsibility for provision of care is decentralized to the 21 county councils and regions the conditions for accreditation vary throughout the country. Regarding the recently implemented primary health care reform, it is regulated by law (Act on Freedom of Choice in the Public Sector) that freedom of establishment applies to all (public and private) health care providers that fulfil the requirements decided by the local county council. The requirements primarily focus on the minimum level of clinical competences represented in the primary care unit. The same requirements apply to both private and public providers.”

Source: Anell A, Glenngård AH, Merkur S. Sweden: Health system review. Health Systems in Transition, 2012, 14(5):1–159.

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

Page last updated May 18, 2021 by Doug McVay, Editor.