• Spending overview
• Policy overview
• Diseases overview

Spending overview

Sweden’s healthcare spending has remained fairly stable since the 1980s. Costs for health and medical care amounted to 9.2% of GDP in 2008. Around four-fifths of healthcare spending is funded by public sources in Sweden, one of the highest shares in the OECD and far above the average. Around 70% of healthcare services are financed through revenue from taxation levied by county councils, with around 15% funded through central government grants, while patient fees account for only 3%. The remaining 10% or so comes from other contributions, sales and other sources. Patients pay fees for doctor consultations and hospital stays and contribute towards the cost of pharmaceuticals, subject to annual ceilings. Swedes may take out private health insurance if they choose, or pay on a fee-for-service basis for private care. At present, private health insurance is a small market, although the number of people taking out insurance is increasing.

Rising healthcare costs, as well as the lack of availability of some services in the public sector, have led to the gradual expansion of private-sector providers. Many are publicly funded, mostly small treatment units or specialists, which currently account for around 10% of healthcare provision financed by county councils. The increased demand for private care provision has so far mainly been seen in out-patient health and medical care; in-patient services have shown a decreasing trend. In mid-2007 restrictions on activities at contracted-out hospitals were removed, with the result that county councils are now able to transfer all or part of the operation of hospitals to private for-profit companies. According to the government, this will contribute to more creative and efficient health and medical care. In fact, around 25% of health centres are now privately run by enterprises commissioned by county councils.

Policy overview

Healthcare provision within the national health system is both public and private, with public institutions providing the majority of care. Central government lays down the basic principles for health services, but responsibility for financing and delivering healthcare is primarily devolved to the country’s 20 directly elected county councils. The councils own and run most hospitals and are responsible for the delivery of primary and hospital care, including public health and preventative care. Around 230,000 people are employed in the county council health services, equivalent to 7% of the Swedish workforce. This number has fallen in recent years because of the need to reduce costs.

During the 1990s a number of county councils separated healthcare purchasing from provision, allowing private providers to compete with the public sector for contracts (the so-called Stockholm model). Profit-making private healthcare providers have been encouraged by the government in the areas of primary and elderly care, but are less common in acute and emergency care. Public hospitals have gained greater independence from local authorities in recent years. Hospitals are paid for the services that they provide on a diagnosis-related group basis. Since 2003 Swedes have been entitled to freedom of choice in healthcare, which means patients can seek care anywhere in the country on the same terms as in their own county council area.

Diseases overview

Life expectancy in 2008 averaged an estimated 80.7 years, the highest in the EU and about two and a half years above the OECD average. Average life expectancy is expected to rise to 81.4 years by 2014. The proportion of the population aged 65 or over will rise to 21.7% by 2030. In common with other developed countries, Sweden’s population is ageing, as its fertility and mortality rates continue to decline. The number of people aged under 16 is forecast to fall both in absolute terms and relative to the total population over the forecast period. Between 2009 and 2014 the population aged under 16 will fall to 1.6m, while the population aged 65 or over will rise to 1.74m as the “baby boom” generation reaches retirement age. On the basis of current projected trends, the population aged 65 or over will exceed that aged under 16 from 2009 onwards.

However, there has been a rise in the proportion of overweight persons, particularly children, which the healthcare system is now examining more closely. Sweden’s infant mortality rate (2.8 per 1,000 live births in 2007) will remain among the lowest in the world. The centre-right government is likely to look to improve healthcare services in coming years. Particular emphasis is likely to be placed on strengthening elderly, psychiatric and dental care and reducing waiting lists. At the same time, increased demand to treat chronic, longer-term conditions will intensify cost-containment policies.