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European hospital healthcare update: Member State profiles

Roger Molin
Deputy Director Swedish
Association of Local Authorities and Regions

The September 2006 general election gave Sweden its first centre-right government since 1994. It is a four-party coalition where the Moderate Party dominates with its leader Fredrik Reinfeldt as Prime Minister. By Swedish circumstances this is unusual; since 1932 the Social Democratic Party has been out of power for just nine years. The main issues during the election campaign were the high unemployment rate and high level of sick leave. Healthcare was only a marginal issue, partly due to the fact that much of the responsibility for healthcare lies at the regional (county council) and local level (municipalities) rather than central government.

Health policy on a national level will be run by representatives of the Christian Democratic Party and the Moderate Party. Göran Hägglund, leader of the Christian Democratic Party is the Minister for Health and Social Affairs; Maria Larsson, from the same party, is the Minister for Elderly Care and Public Health; and Christina Husmark Pehrsson, Moderate Party, is the Minister for Social Security.

The political majority in most of the county councils and municipalities also shifted to centre-right majorities. The Swedish Association of Local Authorities and Regions also changed political leadership and is now led by Anders Knape of the Moderate Party.

The key themes in the new government’s healthcare policy are freedom of choice of care providers for patients and increasing the number of private care providers. The newly introduced so-called Stop Law, by the former Social Democratic government, which made it impossible for private “for-profit companies” to run hospitals, will be removed. The new government directly supports private care providers and initiatives to move care out of public settings and into privately managed services, although still maintaining public financing. However, today few hospitals are run by private care providers, and only approximately 25% of the health centres at the primary level are run by private care providers, while remaining publicly funded.

The government has proposed additional spending in two areas. The first is health and social care for elderly people. This includes an increase in the number of residential care beds and doctors, improved nutrition and use of drug treatment as well as better care for people with dementia. The freedom to make active choices regarding providers of care and services will also increase for the elderly.

The second area is mental health and psychiatric care. The emphasis will be on professional training and an increase in inpatient beds, as well as preventive care.

The maximum waiting time guarantee, introduced by the former government, will be further emphasised with increased governmental grants. The guarantee was introduced in November 2005, saying that any decided treatment should be given within 90 days. The first follow-ups showed rapidly decreasing waiting times, but improvements have since come to a standstill, and the guarantee does not work fully. As a means to improve the situation, the new majorities within the county councils are increasing the number of private care providers.

The structure of the hospital system is continuing to change. Highly specialised and advanced diagnostics and treatments are gradually becoming concentrated in medium-sized and larger hospitals. Specialised emergency care is also becoming concentrated. Smaller hospitals are increasingly being converted into local hospitals with emphasis on care of the elderly.

The average length of stay in hospital is continuing to decline, but not as rapidly as before, and the number of hospital beds is no longer decreasing.

The main issue of discussion at the moment is the proposals from the Committee on Public Sector Responsibilities. The committee was commissioned to propose changes concerning the division of responsibilities and structural arrangements within the public sector. The main proposal is to remain within a decentralised healthcare system with directly elected regional political bodies with the right to levy taxes. The number of regions is, however, proposed to decrease from 20 county councils to somewhere between six and nine regions. It is proposed that the state’s administrative regional level, the counties, will be reduced in the same way to cover the same regional areas as those of the new regions. This will also apply to national agencies. Moreover, the central government is, in the future, supposed to focus on knowledge management rather than, as today, on action plans and temporary project funding.

If the government and the parliament accept the proposals, the conversion from county councils into regions can take place, at the earliest in connection with the next general election, in autumn 2010.