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Health Care system on equal terms and according to need


Is a framework that works together with other legislations on health care; ... Ageing Population and Health Care Expenditure = Health care Reform? ... – PowerPoint PPT presentation

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Title: Health Care system on equal terms and according to need

Health Care system on equal terms and according
to need Swedish case
  • Dr Ilija Batljan,
  • Mayor, Municipality of Nynäshamn
  • Researcher, Aging Research Center, Karolinska
    Institutet and Stockholm University
  • Former Chief Analyst, Ministry of Health and
    Social Affairs, Sweden

Agenda, Mars 12th
  • Introductory overview
  • Swedish Health Care system ACCORDING TO NEED
  • Infants/Maternity care, an example
  • Supervision and Quality
  • Swedish policy for the elderly Long-term care
  • Conclusions

Some demographic information, Sweden
  • Population 9 million
  • Population density 20 persons/km2
  • Ca 85 of population lives in
  • the cities
  • The share of population 65 18
  • estimated to grow to 25 by year 2050

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Organisation of Health Care services
  • Three political and administrative levels

State Ministry of Health and Social
Affairs Central government agencies
20 County Councils 1 local authority
290 local authorities (municipalities)
Responsible for organising, offering and
providing health and medical services to all
residents Promoting good public health
Responsible for care of elderly and
disabled Support for people suffering from
long-term mental illness
Legislation Supervision Evaluation, follow-up

Health is Wealth
  • Health is not equally distributed,
  • Large differences in health status
    (socio-economic disparities) exist between
    population groups within countries. These may be
    partly caused by barriers in access to needed
    services that affect disadvantaged populations
    disproportionately (OECD 2005).
  • Wealth is not equally distributed

Health is Wealth
  • Wealth is not equally distributed
  • The outcome of financial and other barriers (as
    the impact of user fees on lower-income groups,
    differences in insurance coverage across the
    population, and so on) can be poorer health,
    which further fuels economic isolation and social
  • Pour Wealth Pour Health
  • Investment in health Large benefits for both
    individual and society (WHO 2001)

National targets for Swedish Health Care
  • Health care should be provided to all citizens on
    equal terms and according to need,
  • be under democratic control,
  • financed on the basis of solidarity
  • and, as far as possible, provided in consultation
    with the patient.

The Health and Medical Services Act
  • Sets out the responsibilities of County Councils
    and Municipalities towards their residents
  • Give County Councils and Municipalities
    considerable freedom regarding how to organise
    and provide their health care services
  • Is a framework that works together with other
    legislations on health care
  • Health professionals, Pharmaceuticals, Social
    Services Act, Dental act, Psychiatric
    legislation, etc

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Low co-payment
  • How much is paid per visit?
  • District nurse, 8-10 Euro
  • General practitioner, 13-15 Euro
  • Specialist doctor, 25-30 Euro
  • Max 100 Euro per 12-moths.

Pharmaceuticals CO-PAYMENT
  • You pay 100 until 100 Euro
  • Next step is 50, then 25, then 10, when you
    are up to 200 Euro 0
  • Max 200 Euro per 12-months.

Infant mortality / Maternity care
  • Infant mortality
  • Well-developed and successful work at Maternity
    and Childcare Centres
  • Infant mortality decreased by 50 between 1984
    and 1994
  • Today, 3 deaths per 1 000 newborn (third place
    globally after Iceland and Japan)
  • Maternity Care
  • An integrated part of the healthcare system, free
    of charge
  • Provides medical examinations, pregnancy
    monitoring and parental advice for mothers
  • More than 95 percent of all pregnant women
    participate in these programmes

Supervising and Follow-up/evaluation Quality
  • Health care systems have quality problems.
  • Across OECD-countries, there is a large and
    expanding bank of evidence of serious
    shortcomings in quality (examples services are
    provided when, according to medical practice
    standards, they should not be or people who could
    benefit from certain basic services do not always
    get them. (OECD 2005))

Supervising and Follow-up/evaluation of Health
  • Better supervision and follow-up contributes to
  • Strengthening the patients position
  • Improving patients safety
  • Supervising and Follow-up/evaluation system is
    very important. It must be independent based on
    sound research evidence.

Supervising and Follow-up/evaluation of Health
  • In Sweden Increased monitoring by the National
    Board of Health and Welfare and the Medical
    Products Agency
  • Increasing importance when private-public mix.

Low coverage High cost
  • Private insurance (like US case) may lead to
    double burden (costly for individuals and for
  • - 40-50 millions Americans do not have access to
    health care insurance
  • -US has highest health care expenditures
  • The increasing health care cost and ageing
    population are often cited as reasons for health
    care reform

Ageing Population and Health Care Expenditure
Health care Reform?
Long term care is an importantchallenge
  • An already old population is growing even older ?
    a demographical challenge
  • People need protection against the risk of
    incurring large expenses for long-term care.
  • According to OECD, different approaches can work,
    such as tax-funded in-kind services (as in Sweden
    and Norway) or mandatory public insurance (as in
    Luxembourg, Netherlands and Japan), and a mix of
    public and mandatory private insurance (as in

Swedish policy forthe elderly - The Social
Services Act
  • Long-term care for the elderly is mainly financed
    out of taxation revenue and responsibility for
    achieving the objective is divided between three
    levels of government.
  • At the national level, the Parliament and the
    Government set out policy aims and directives by
    means of legislation and economic steering
  • At the regional level, 21 county councils are
    responsible for the provision of health and
    medical care.
  • Finally, at the local level, since 1 January
    1992, Swedens 290 municipalities are
    comprehensively responsible for long-term service
    and care for the elderly and people with

Swedish policy forthe elderly - The Social
Services Act
  • The Swedish system for service provision to the
    elderly is extensive and can be divided into
    special housing accommodation (institutional
    care) and home care.
  • Support programmes for family caregivers (respite
    and relief services, support and educational
    groups for carers and economic support for
    caring). Swedish municipalities have also the
    statutory responsibility to provide assistive
    devices according to the needs in the elderly
  • In the case the elderly stay at acute care or
    geriatric hospitals after the medical treatment
    is completed, the municipalities have to pay to
    the county councils for that care.

Swedish policy forthe elderly - Funding and
  • The largest part (above 80) financed by taxes
    levied by the municipality from its residents. A
    smaller part of the elderly care is financed by
    state grants directed to the municipalities.
  • About 4 of the costs are finances by fees. The
    fees are often related to assessed needs and
  • In 2006 municipal expenditure on caring services
    for the elderly amounted to 2,7 of GDP
  • The biggest item of expenditure concerns caring
    services in special housing accommodation.

  • Health is wealth
  • Health care should be provided to all citizens on
    equal terms and according to need, financed on
    the basis of solidarity (trying to avoid tax on
  • Low co-payment
  • All citizens confidence in the health care
    sector is important
  • Minimize mixing private-public
  • Develop supervision and follow-up
  • Long term care is a challenge

Ilija Batljan, Mayor 46 8 520 681
72 http//www.nynashamn