Sweden's health care system: history, structure, and comparison with the United States

Swedish Health Care System

All over the world, governments approach their social responsibilities from a wide range of perspectives. For instance, for many industrialized nations, health care is taken to be an example of a social program tailored to benefit the general public. Hence in that regard, the relevance of a well designed health care system cannot be overstated. This paper takes Sweden as a reference point in seeking to map the history, demographics as well as structure (political) that informed the development of the nation's health care system. Further, the major health conditions facing Sweden as well as the organization and financing of the nation's health care system will be discussed. This paper will also demonstrate how Sweden's health care system differs from that of the United States. Lastly, based on the discussion, one lesson the United States can derive from Sweden's health care system will be clearly and concisely highlighted.

Introduction

According to Reid (2009), the Swedish health care system is part of the nation's larger approach to social insurance funded by income taxes of Swedish citizens.

Overall, Swedish health care costs amount to approximately ten percent of the country's GDP, which is more than three times less than the cost of American health care. Most of the health care facilities and services in the country are furnished by physicians and health care workers who comprise of public employees earning wages comparable to those earned by other professionals in areas that require less skill. This in the view of Reid (2009) reflects a fundamental socialist approach that could not be implemented in U.S. Similarly, Swedish citizens are restricted to receiving a significant portion of health care services within their immediate counties (Genser, 1999). Further, as far as the Swedish health care system is concerned, physicians aged 65 years and above may not practice within the public system. This age matches the national retirement age in general.

It can be noted that in Sweden, the entire drug dispensing process is nationalized in a system that requires only the patient's identity card at any dispensary. Patients do pay a nominal fee for physician services amounting to approximately $20 per visit and similarly, they also do pay a nominal amount for prescriptions (all medical expenses are subject to annual caps that would barely pay for most minor surgical services in the U.S.). Preventative care is considered essential and preventative services are included in the health care system (Genser, 1999).

Sweden: An Overview

Located on Northern Europe's Scandinavian Peninsula, Sweden has a population of approximately 9.1 million. Currently, the country's employment rate stands at approximately 5.6%. This significantly differs from that of the United States which currently stands at about 9% according to the Bureau of Labor Statistics (Bureau of Labor Statistics, 2011). Basically, the nation's health care is paid for by the government and in a way, this ensures that almost everyone has health care coverage. It can be noted that the Swedish health care system basically has three layers or levels. These levels include national, local and regional levels. While the regional level is responsible for health care provision as well as financing to the various county councils, the national level has social affairs and health ministry as the ones establishing guidelines for health as well as medical care while the local level is charged with maintaining the social welfare services.

Major Health Conditions

Sweden like many other countries all over the world suffers from a number of health concerns which happen to be prevalent throughout the country. For instance, heart failure is one of the most serious health conditions in the country. In that regard, the condition continues to demand a large chunk of the nation's health care resources. To highlight this, Anderson & Rydean-Bersten (1999) note that in 1995, "heart failure was the fourth most common reason for hospital care…" particularly for those aged 65 years and above. Further, in the period under consideration, heart failure accounted for approximately 14% of all instances of hospital care associated with circulatory system diseases (Anderson & Rydean-Bersten, 1999).

In recent times, Obesity has also been identified as an evolving health issue in Sweden although in comparison to international obesity rates, Sweden's obesity rate still remains low. As Neovius et al. (2006) note, obesity prevalence in recent times has been worrying. This is especially the case given that the condition has been on an upward trend across the spectrum with those affected including children, adolescents and even adults. According to Neovius et al. (2006), the prevalence of obesity particularly amongst adults has in the last twenty years doubled. Thus in that regard, Sweden needs to take deliberate steps to contain the condition before it becomes an epidemic going forward.

Asbestos related health issues, like lung fibrosis, lung cancer, and mesothelioma, are also issues of grave concern in Sweden. With that in mind, laws have been implemented in the recent past to assist in the reduction of asbestos related health issues. However, major reductions in terms of occurrence rates of asbestos related health issues may take quite a while.

Sweden does not have major health conditions related to smoking. Indeed, it is estimated that close to 85% of Swedes do not smoke (Sweden.se, 2011). On this front, Sweden scores highly as very few countries have such a high percentage of non-smokers. The low percentage of smokers in the case of Sweden can hence be said to have contributed to fewer major health conditions related to smoking.

The Organization of Sweden's Health Care System

The health care system in Sweden is largely organized on equal access to services basis. It is financed through tax payers. The health care system in this case is also significantly decentralized. As it is highlighted by Sweden.se (2011), the "responsibility for providing health care is decentralized to the county councils and, in some cases, municipal governments." It can be noted that in this case, county councils are essentially political formations comprising of elected representatives.

It is a Swedish policy for the county council to provide residents of a given county with high quality health care as well as medical care. In this case, the county council is also charged with the duty of promoting good health for residents. Sweden has two hundred and ninety municipalities, eighteen county councils, and two regions. Swedish county councils perform approximately 90% of work touching on health care. Municipalities in the country are basically in charge and accountable for the care of elderly residents with health care in this case being availed at home or in special accommodation. It is also the duty of the municipalities to care for residents with psychological disorders and/or physical disabilities. The support and services for patients released from hospitals is also under the jurisdiction of municipalities. Also under the jurisdiction of Swedish municipalities are health care services thought schools.

It can be noted that Sweden is also working on health care in an international framework. In that regard, the country continues to be on the front line in the corporation with EU for the enhancement of health and medical services. Collaboration in this case touches on the enhancement of patient influence as well as the improvement of patient care (Sweden.se, 2011).

Impact of Health Care on Sweden's Economy

Residents of Sweden have since 1993 had the freedom of choosing their health care. Hence it is possible for patients to seek treatment from any provider or at any location in the country (Swedish Institute, 2011). This freedom has effectively brought about a growing number of private health care providers in the country who have in the recent past begun to compete with public care facilities. It can however be noted that the care rendered by these private providers is still paid for by the social insurance and hence the cost for patients remains the same. The county councils also buy health related services from private health care providers. In that regard, though undertaken by private care providers, approximately 10% of the country's health care has the city council as the financier. In this case, there exists a guarantee dictating that in addition to patients receiving the same care; they should also be covered by similar regulations as well as fees as those patients who receive care from municipal facilities (Swedish Institute, 2011).

Since health care in Sweden is funded using local taxes, opportunities for economic expansion are very limited. This restriction in cost ensures that existing resources are utilized to their fullest capacities. Though correlations between county councils have led to improvements in this line, this has led to lack of national data mainly as a result of the decentralization of health care delivery. As a result, there have been deliberate attempts to come up with frameworks to compare care delivered with the initiative being spearheaded by two bodies including The National Board of Health and Welfare as well as The Swedish Association of Local Authorities and Regions.

Basically, this framework has the aim of availing information in a more accessible form for both the patients and the general public (Swedish Institute 2011). Secondly, the model seeks to provide an opportunity for municipalities and street councils to streamline as well as manage health care in an easier way. Lastly, the Swedish Institute (2011) gives the provision of a superior platform for debates (public) as well as other relevant political considerations touching on health care delivery as yet another key aim of the model.

Sweden's Health Care system Compared to that of the United States

Sweden's health care system is very different from that of the United States. As Hogberg (2007) points out, "Sweden had a single-payer system of health care" for the most part of 20th century. Payment of health care costs in what was referred to as a "single-payer" system remained a responsibility of the government. However, it can be noted that increasing health care expenses is an issue the country has had to deal with just like other jurisdictions having a single-payer system. These increases have caused a strain on the government budget. In a bid to stem this problem, there exists a practice of "rationing health care."

Unlike in Sweden, the health care cost in the U.S. is not funded almost entirely by the government. Instead, the U.S. system is funded in several different ways. According to the Center for Medicare and Medicaid Services (2005), approximately 60% of health spending in the U.S. is funded by the government. The government provides health care coverage for individuals under 65 years old. Such individuals could be having certain disabilities such as renal failure. The U.S. government also provides health care funding to several groups mainly comprising of families and individuals with low incomes. It can be noted that in this case, such individuals must meet the criteria outlined under both federal and state law as far as their recognition as an eligible group is concerned. Hence in basic terms, the U.S. health care system is funded by several different payers (multi-payer) comprising of both private and government participants. On the other hand, Sweden's health care system which can be referred to as a single-payer system is funded almost entirely by the government with little public assistance or participation. It can be noted that in the past, there have been several proposals of America adopting a socialized health care delivery approach or a single-payer system. However, at this time, the multi-payer system continues to be in place in the U.S.

The current U.S. president, Barack Obama, has in the past floated the possibility of adopting a health care delivery system controlled by the U.S. government. The goal of the proposal is to ensure that the health care system in such a case has tighter controls in addition to enhancing the availability of health care for all U.S. residents.

Potential Lessons for U.S. Based on Sweden's Health Care System

Despite the fact that some of the major features of the Swedish health care system cannot be implemented under the existing U.S. laws, their approach to health care provides several potentially important lessons in terms of access, cost and perhaps, quality. In principle, however, it is possible to incorporate some of the better features and approaches of Swedish health care into U.S. health care so as to improve at least two important elements. First, and perhaps most importantly, the Swedish system demonstrates how crucial it is to have a public health care option competing against private-sector health care service providers. Since most of the costs of private health care services in the U.S. are paid through private, for-profit health insurance companies that have no public counterpart, they are free to and have continually raised the prices of their premiums to the point where health insurance (and therefore health care) becomes in-affordable to nearly half the U.S. population (Kennedy, 2006). Without going as far as nationalizing and making all health care services public, the Swedish system illustrates why having a public health insurance option is essential within the U.S. health care best interests. By competing against the private health insurance companies, the public option would dramatically reduce costs and thereby increase the availability of health care in the U.S. (Kennedy, 2006).

On the other hand, it should be noted that the quality of services available in the Swedish system is not necessarily as good as the health care services available in other nations such as in Britain, primarily because Sweden (like the U.S.) does not emphasize results in its health care professional compensation scheme. According to Genser (1999), Sweden simply limits the salaries of physicians in general within the socialist approach to social equality. By comparison, Britain factors the effectiveness of treatment directly into the salaries earned by physicians and this in turn promotes the best care practices in addition to the most aggressive and effective preventative medicine.

Conclusion

In conclusion, it can be noted that the Swedish health care system is not perfect and as I have already pointed out in the text above; some of its main features are fundamentally incompatible with the existing U.S. laws. However, it provides a rough model or framework for some of the important elements that could greatly improve American health care. Amongst the most important of these elements is the extent to which a public health insurance option comes across as being an absolute necessity in the U.S. If American health care costs are to ever be substantially reduced as a function of GDP and if health care access is ever to be equally available to all citizens.