“Future developments within the Swedish health care sector can be expected to include the implementation of reforms already initiated. Overall, several initiatives initiated recently and under discussion are guided by the emerging performance paradigm in the governance and management of health care. Key words related to the current trend are national quality registers, transparent comparison, value for money, health outcomes from the patient perspective, process orientation and coordinated services. More attention is being focused on the need to establish valid performance indicators and increase abilities to monitor performance on a regular basis by investments in registers and new IT solutions. As a result of increased transparency, more attention is also directed towards differences in results and outcomes across regions and providers and the learning opportunities that such differences provide. In March 2011, a new investigation was commissioned by the national government to prepare for a new act regulating patients’ rights.

“Since 2006, the privatization of providers in outpatient services has been on the agenda at both the national level and across local centre-right governments. The introduction of choice and privatization in primary care is still a new reform in several county councils and the outcome for patients and health care services has not yet been fully evaluated. Conditions for governance and the need for regulation have indeed changed for both the national and local governments. Already when the reforms were implemented, comments were made that cancellation of the previous geographical responsibility would have a detrimental effect on collaboration between primary care and care for older people by municipalities. Developments during the autumn of 2011 have also seen growing criticism of, in particular, the behaviour of large health care corporations owned by venture capitalists. Still, a re-elected centre-right national government in 2010 means continued support for development of more private providers.

“Also for other patient groups, including cancer patients, the too frequent lack of coordinated services and regional differences in, for example, waiting times are perceived as a major problem. The national initiative to form RCCs specifically referred to such problems. New forms of disease-management programmes, focusing on the development of the process of care from a patient perspective, are being developed and tried in several county councils. Experience of the successes and shortcomings of new programmes are so far limited. Nevertheless, this development has an influence on other initiatives. Future development of the national quality registers will most likely include more data capturing patient-reported health outcomes.

“In parallel to attempts to integrate and coordinate care, the specialization and concentration of specialist services continue. The initiative to form RCCs will most likely contribute to increased concentration of curative cancer care at both the national and regional levels. Arguments for such developments include increased cost–effectiveness in services and quality in terms of survival as well as improved opportunities for clinical research. An important obstacle for such a development, however, is the preference for local production across several county councils, local hospitals and, not least, specialists at local hospitals. In addition, concentration of services is not always supported by outcome data available in the quality registers.

“An emerging question is the long-run financing of health care services. The prognosis shows increased demand because of rapid changes in demography, with more older people in the next 10–15 years. The same prognosis also means a funding problem since the workforce is not likely to increase (Lindgren & Lyttkens, 2010). However, the expected gap between the increase in demand and worsened conditions for continued economic growth and funding through a proportional income tax has not resulted in any new investigations of alternative options by the national government. There is no political support for any major changes in the financing of health care.”

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