Sweden: Health System Financing - Health Systems Facts

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“As of 2016, the legally set uniform contribution rate is 14.6 percent of gross wages, shared equally by the employer and employees. A previous legally fixed additional contribution rate for employees (0.9%) and supplementary per capita premiums set by sickness funds have been abolished and replaced by a supplementary income-dependent contribution rate determined individually by each sickness fund. In 2015, the supplementary contribution rate was, on average, 0.83 percent—that is, most of the SHI-insured paid less than previously, with rates ranging between 0 and 1.3 percent. For 2016, the average supplementary contribution rate is estimated at 1.1 percent.

“This contribution also covers dependents (nonearning spouses and children). Earnings above EUR50,850 (USD64,994) per year (as of 2016) are exempt from contribution. The sickness funds’ contributions are centrally pooled and then reallocated to individual sickness funds using a risk-adjusted capitation formula, taking into account age, sex, and morbidity from 80 chronic and/or serious illnesses.”

Source: International Health Care System Profiles: Who’s Covered? The Commonwealth Fund. Last accessed Nov. 14, 2019.
https://international.commonwealthfund.org/features/who_covered/

“The Swedish health care system is primarily funded through taxes (Fig. 3.5). Both the county councils and the municipalities levy proportional income taxes on their respective populations. The financing of health care services by local taxes is supplemented by the central government and by user charges. Subsidies for dental care are paid for by national social insurance, and the Swedish Social Insurance Agency generates revenues primarily through employer payroll fees (Fig. 3.6). Subsidies for prescription drugs are paid for through designated state grants to the county councils and then treated as a restriction on the county councils’ fee revenues (section 3.4). As the financial and political responsibility for health care is decentralized to the county councils, it is difficult to make precise connections between the sources of finance and different activities within the county councils. Most county council activities are financed through county tax revenues, but county councils are also responsible for other activities, such as regional transportation and cultural activities.

“County council revenues amounted to SEK 257 billion (€29 billion) in 2009, where 71% originated from local taxes (SALAR, 2010a). County councils and municipalities also receive subsidies and state grants, which are financed through national income taxes and indirect taxes. State grants can be either general or targeted. General grants are paid per inhabitant and are designed to contribute to equalization across local governments with different tax bases and different spending needs. They are based on a formula that partly re-allocates resources across municipalities and county councils with the aim of giving different local government bodies the opportunity to maintain similar standards, irrespective of differences in average income and/or need (see section 3.3.3 Pooling of funds). Each municipality, county council or region can use this money on the basis of local conditions. Targeted grants must be used to finance specific activities, sometimes over a specific period of time. The major part of the subsidies takes the form of reimbursements for pharmaceuticals listed in the Drug Benefit Scheme. Sources of revenue have been stable over the past decade (Table 3.4).”

Source: Anell A, Glenngård AH, Merkur S. Sweden: Health system review. Health Systems in Transition, 2012, 14(5):1–159.
http://www.euro.who.int/en/about-us/partners/observatory/publications/health-system-reviews-hits/full-list-of-country-hits/sweden-hit-2012

“It is the local authorities that decide the levels of the local income taxes and as a result the level of taxation varies between different county councils and municipalities. Administratively, taxes are collected from employers by the national tax authority (Skatteverket). The highest total level of taxation (municipal and county council taxes) was 34.17% (in Ragunda municipality) compared to the lowest level which was 28.89% (in Vellinge municipality). The average level of local taxation in the country was 31.55% in 2011 compared to 31.56% in 2010. The average county tax rate was 10.82% in 2011, and the average municipal tax rate was 20.73% in the same year (Statistics Sweden, 2011b). There are no earmarked taxes for health or health care services, which makes it difficult to specify precisely what proportion of the taxes is directly connected with the provision of these services. About 91% of the county councils’ total expenditures constituted expenditures on health care in 2009 (SALAR, 2010a).”

“There are direct user charges for health care visits in both primary and
specialist care in the form of flat-rate payments. In 2009, the county councils received SEK 6186 million (€687 million) in patients’ fees and other fees (with SEK 2781 million (€309 million) for dental care), which accounted for 2.4% of the county councils’ total revenues. County councils determine the level of the user charges for primary and hospital care.

“In 2011, the fee for consulting a physician in primary care varied between SEK 100 (€11) and SEK 200 (€22) across the county councils. The fee for consulting a specialist at a hospital varied between SEK 230 (€25) and SEK 320 (€35) the same year (see Table 3.5). In almost all county councils, children and young people (under 20 years of age) are exempt from patient fees for health care as well as for dental care. At primary care clinics, vaccinations, health examinations and consultations, and certain types of treatment are provided free of charge to all children of school age. At the ante-natal primary care clinics, regular check-ups are given free of charge during the entire pregnancy. User charges for inpatient care are separate from other user charges. Patients above 20 years of age are charged about SEK 80 (€9) per day of hospitalization with some minor differences across county councils.

“User charges for prescription drugs and dental care and high-cost protection schemes for health care visits are regulated by national law. The national ceiling for OOP payments regulates the maximum amount that an individual will pay within a period of 12 months. From January 2012, the national ceiling for OOP payments for health care visits is SEK 1100 (€122). When the cost ceiling has been reached, the patient pays no further charges for the remainder of the 12-month period, calculated from the date of the patient’s first visit to a physician. In practice, the ceiling constitutes a restriction on the county council fee revenues.”