Swedish Health System Overview
Health System Rankings
Health System Outcomes
Health System Coverage
Costs for Consumers
Health System Expenditures
Sweden’s COVID-19 Policy
Population Insurance Coverage For A Core Set Of Healthcare Services* (%) (2019):
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 (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/ae3016b9-en.
“All Swedish residents are covered for health services, regardless of nationality. The national government is responsible for regulation and supervision, and the 21 Swedish counties have responsibility for financing, purchasing and providing health services. The counties oversee primary, specialist and psychiatric health care, while the 290 municipalities are responsible for care for people with disabilities, rehabilitation services, home care, social care for children and adults, elderly care and school health care. The governance structures established to manage the COVID-19 pandemic included a variety of authorities across levels of government (Box 2).”
Source: OECD/European Observatory on Health Systems and Policies (2021), Sweden: Country Health Profile 2021, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.
“Before the COVID-19 pandemic, unmet needs for medical care were 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 2019. The percentage of people reporting unmet needs for dental care in Sweden was below 2% in 2019, but it was more than double the overall average among people in the lowest income group (Figure 15).
“Dental care is not included in the basic benefits package, and it is subject to higher co-payments for adults above the age of 24. A recent government report recommended major reform to the dental care system in 2026 to tackle inequalities in access (Ministry of Social Affairs, 2021).”
Source: OECD/European Observatory on Health Systems and Policies (2021), Sweden: Country Health Profile 2021, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.
“Coverage is universal in Sweden, with health services either freely available or with small co-payments. User charges are set by the regions. For 2021, fees were SEK 100-300 (EUR 10-30) for a primary care visit, up to SEK 400 (EUR 40) for a specialist visit – which is lower with a referral – and SEK 100 (EUR 10) per day of hospitalisation for an adult. User fees for medical consultations are capped at SEK 1,150 (EUR 115) per individual per year, and for prescribed medicines at SEK 2,350 (EUR 235). Exemptions from user charges apply for people under 20, older people and pregnant women.”
Source: OECD/European Observatory on Health Systems and Policies (2021), Sweden: Country Health Profile 2021, 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 to contact specialists directly in most regions. Recent efforts have aimed to increase access to health services and shorten waiting times. The waiting times guarantee allows patients to contact a primary care centre on the day they have a health issue; to receive a medical assessment in primary care within three days; and to see a specialist or receive any necessary treatment or surgery within 90 days in the case of a new health problem or a severely deteriorating health condition (see Section 5.2). If these thresholds for waiting times are not met, patients are offered care elsewhere, paid for by their region.”
Source: OECD/European Observatory on Health Systems and Policies (2021), Sweden: Country Health Profile 2021, 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.
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Page last updated Dec. 28, 2022 by Doug McVay, Editor.
