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

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.

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.

“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 and 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.

“All residents are intended to have equal access to health care services under a largely decentralized system financed mainly through local taxes and some small user charges. Although quality of care and equity of access are good by international standards, long waiting times for elective care have been a cause of dissatisfaction for a number of years.”

Source: Caj Skoglund. “Sweden.” In Voluntary health insurance in Europe: Country experience [Internet]. Sagan A, Thomson S, editors. Copenhagen (Denmark): European Observatory on Health Systems and Policies; 2016. Observatory Studies Series, No. 42.

“The 21 counties in Sweden have responsibility for financing, purchasing and providing health services. The national government is responsible for regulation and supervision. The regions are in charge of primary, specialist and psychiatric health care, while the 290 municipalities are responsible for elderly care, care for people with physical and mental disabilities, rehabilitation services, school health care, home care and social care. Health expenditure is mostly paid through local taxes, along with contributions from the national government via general grants, subsidies to the regions for outpatient medicines and specific national programmes (see Box 1).

“The new government announced in January 2019 that a plan to reduce waiting times for elective surgery would be prepared in cooperation with the regional county councils (Government of Sweden, 2019). The government will also implement a primary care reform to strengthen primary care and improve working conditions for primary care providers, with special priority given to the provision of primary care in rural areas. Other priorities include strengthening emergency care, cancer care, maternity care, psychiatric care and suicide prevention.

“The government will also introduce a national coordination body responsible for long-term planning of health personnel and skills supply (Government of Sweden, 2019).”

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.

“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.

“Some 15 % of health spending in Sweden is funded by out-of-pocket (OOP) expenditure – slightly lower than the EU average. The fees are applied to almost all types of services and goods, with the exceptions for maternal and child health services provided in primary care settings and some services for people aged over 85. The regions set the fees independently, and the fee structure provides an incentive to consult primary care over hospital visits. Only the fees for prescribed medicines and dental services are set at a national level. Most OOP spending goes on pharmaceuticals, dental care and other outpatient care, as these services are generally less covered than hospital inpatient care (Figure 16).”

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.

“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.

“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.

“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.

“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.

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 Sept. 21, 2021 by Doug McVay, Editor.