Sweden’s COVID-19 National Policy
Health System Overview
Health System Rankings
Health System Outcomes
Health System Coverage
Costs for Consumers
Health System Expenditures
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.
https://www.oecd.org/health/health-systems/health-at-a-glance-19991312.htm
Annual household out-of-pocket payment, current USD per capita (2017): $888
Source: Global Health Expenditure Database. Health expenditure series. Geneva: World Health Organization. Last accessed Jan. 10, 2020.
http://apps.who.int/nha/database/
Out-of-Pocket Spending as Share of Final Household Consumption (%) (2017): 3.8%
Source: OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/4dd50c09-en.
https://www.oecd.org/health/health-systems/health-at-a-glance-19991312.htm
“Publicly financed health care: Health expenditures represented 11 percent of GDP in 2014. About 83 percent of this spending was publicly financed, with county councils’ expenditures amounting to almost 57 percent, municipalities’ to 25 percent, and the central government’s to almost 2 percent. The county councils and the municipalities levy proportional income taxes on their populations to help cover health care services. In 2015, 69 percent of the county councils’ total revenues came from local taxes and 17 percent from subsidies and national government grants financed by national income taxes and indirect taxes. General government grants are designed to redistribute resources among municipalities and county councils based on need. Targeted government grants finance specific initiatives, such as reducing waiting times. In 2015, 89 percent of county councils’ total spending was on health care.
“Coverage is universal and automatic. The 1982 Health and Medical Services Act states that the health system must cover all legal residents. Emergency coverage is provided to all patients from European Union/European Economic Area countries and to patients from nine other countries with which Sweden has bilateral agreements. Asylum-seeking and undocumented children have the right to health care services, as do children who are permanent residents. Adult asylum seekers and undocumented adults have the right to receive care that cannot be deferred (e.g., maternity care).
“Private health insurance: Private health insurance, in the form of supplementary coverage, accounts for less than 1 percent of expenditures. Associated mainly with occupational health services, it is purchased primarily to ensure quick access to an ambulatory care specialist and to avoid waiting lists for elective treatment. Insurers are for-profit. In 2016, 635,000 individuals had private insurance, representing roughly 10 percent of all employed individuals aged 15 to 74 years.”
Source: International Health Care System Profiles: Who’s Covered? The Commonwealth Fund. Last accessed Nov. 14, 2019.
https://international.commonwealthfund.org/features/who_covered/
“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/
“Sweden’s health system provides universal population coverage for a broad basket of services. The majority of OOP is thus attributable to cost sharing requirements. These include co-payments for most health services adults use in Sweden, including hospitalization. Co-payments for health care visits and hospitalization vary across the 21 counties although policies have converged over time. Co-payments are differentiated to steer patients towards use of primary care during office hours. Co-payments for visits to specialist doctors without a referral are about twice as much as for a regular visit to a primary care doctor. In most counties children below age 20 are exempt from co-payments. There is a combined cap for each 12 month period determined at the national level, maximizing total co-payments for outpatient care. Deductibles, co-payments and caps for prescription drugs and dental care are determined fully at the national level. Dental care for individuals under age 22 is free. For adults, there is a deductible of SEK 1000 (€103) for prescription drugs followed by a stepwise increase in subsidies ending in a 12 months cap of SEK 2200 (€226). For dental care to adults, the deductible is SEK 3000 (€308), followed by increase in co-insurance to 85% above SEK 15,000 but without an overall cap. Additional minor changes in terms of additional subsidies for dental care to elderly were introduced in 2013. In 2009, prescription cost-sharing policy was changed such that patients now usually pay the full price for generic alternatives that are not the lowest cost generic. In 2012 cost-sharing limits on prescriptions as well as for outpatient services were increased (from SEK 1800 to SEK 2200 (€ 185–226) and SEK 900 to SEK 1100 (€ 92–113) respectively). These increased cost sharing requirements seem not to have had great impact on the average growth rate in 2004–2014, which was lower than in the previous period. This can perhaps be explained by the fact that the requirements were relatively minor and partially offset by better dental benefits.”
Rice, Thomas et al. “Revisiting out-of-pocket requirements: trends in spending, financial access barriers, and policy in ten high-income countries.” BMC health services research vol. 18,1 371. 18 May. 2018, doi:10.1186/s12913-018-3185-8
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5960112/
“Health care in Denmark and Sweden is based on the Beveridge model, but traditionally managed and financed by local government, not by central government, whereas in the Netherlands, it is based on the Bismarck model. The Netherlands, however, spends a similar percentage of its GDP on health care to that of Denmark and Sweden. Hence, differences within the broad categories of the families of Bismarck and Beveridge models may be as important as the differences between these categories.”
Source: Bevan G, Helderman JK, Wilsford D: Changing choices in health care: implications for equity, efficiency and cost. Health Econ Policy Law. 2010, 5 (3): 251-67. 10.1017/S1744133110000022.
https://www.ncbi.nlm.nih.gov/pubmed/20478104
“Health care and other welfare services are considered a public responsibility in Sweden. The Swedish health care system is organized into three levels: the national, regional and local (Fig. 2.1). According to the Swedish Health and Medical Services Act of 1982: “Health and medical services are aimed at assuring the entire population of good health and of care on equal terms. Care shall be provided with due respect for the equal worth of all people and the dignity of the individual. Priority shall be given to those who are in the greatest need of health and medical care”. The responsibility for health care services is divided between the state, county councils/regions and municipalities. The Health and Medical Services Act specifies that the responsibility for ensuring that everyone living in Sweden has access to good health care lies with the county councils/regions and municipalities. The Act is designed to give county councils and municipalities considerable freedom with regard to the organization of their health services. The state, through the Ministry of Health and Social Affairs (Socialdepartementet), is responsible for overall health care policies.
“There are eight government agencies directly involved in the area of health, medical care and public health: the National Board of Health and Welfare, the Swedish Council on Technology Assessment in Health Care (SBU), the HSAN, the MPA, the TLV, the Swedish Agency for Health and Care Services Analysis, the National Institute for Public Health and the Swedish Social Insurance Agency (see section 2.3.1 National level).
“The 17 county councils and 4 regional bodies are responsible for the funding and provision of health care services to their populations. The 290 municipalities are legally obliged to meet the care and housing needs of older people and people with disabilities. In the Social Services Act of 1980, it is explicitly stated that older people have the right to receive public services and help at all stages of life. People with disabilities are entitled to support not only under the Social Services Act but also under special legislation. The Act Concerning Support and Service for People with Certain Functional Impairments of 1993 regulates support for items such as personal assistance and daily activities.
“There is a mix of publicly and privately owned health care facilities but they are generally publicly funded. Primary care forms the foundation of the health care system and there are over 1100 primary care units throughout the country. In contrast to many other countries, however, primary care has no formal gate-keeping function in a majority of the county councils. There are about 70 hospitals at the county level. Highly specialized care, requiring the most advanced technical equipment, is concentrated to the seven regional/ university hospitals. Counties are grouped into six medical care regions to facilitate cooperation regarding tertiary medical care (see sections 5.3–5.5). The responsibility for performing cross-sectoral follow-up and evaluation of the national public health policy lies with the National Institute of Public Health (Folkhälsoinstitutet).”
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
“Patient fees
“– Hospital stay: max SEK 100/day
“– Primary care: SEK 0–300, depending on the county council
“– Specialist visits: max SEK 400
“High-cost ceiling
“A patient never has to pay more than a total of SEK 1,100 for medical consultations in the course of 12 months – any consultations exceeding SEK 1,100 are free of charge. For prescription medication, nobody pays more than SEK 2,250 in a given 12-month period.
(Note: As of September 25, 2019, the exchange rate was 9.75 Swedish Krona (SEK) to one US dollar.)
Source: The Swedish Institute. “Healthcare In Sweden.” Last accessed September 25, 2019.
https://sweden.se/society/health-care-in-sweden/
“Waiting times for pre-planned care, such as cataract or hip-replacement surgery, have long been a cause of dissatisfaction. As a result, Sweden introduced a healthcare guarantee in 2005.
“This means all patients should be in contact with a local health centre the same day they seek help and have a doctor’s appointment within seven days. After an initial examination, no patient should have to wait more than 90 days to see a specialist, and no more than 90 days for an operation or treatment, once it has been determined what care is needed. If the waiting time is exceeded, patients are offered care elsewhere and the cost, including any travel costs, is paid by their county council.
“Statistics from 2017 indicate that about 79.1 per cent of the patients see a specialist within 90 days and receive treatment or are operated on within a further 90 days.”
Source: The Swedish Institute. “Healthcare In Sweden.” Last accessed September 25, 2019.
https://sweden.se/society/health-care-in-sweden/