Health Care system on equal terms and according to need

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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
• ilija.batljan_at_nynashamn.se

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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

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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
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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

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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
  exclusion.
• Pour Wealth Pour Health
• Investment in health Large benefits for both
  individual and society (WHO 2001)

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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.

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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.

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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.

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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

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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))

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Supervising and Follow-up/evaluation of Health
Care

• 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.

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Supervising and Follow-up/evaluation of Health
Care

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

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Low coverage High cost

• Private insurance (like US case) may lead to
  double burden (costly for individuals and for
  society
• - 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

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Ageing Population and Health Care Expenditure
Health care Reform?
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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
  Germany).

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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
  measures.
• 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
  disabilities.

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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
  population.
• 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.

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Swedish policy forthe elderly - Funding and
expenditure

• 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
  income.
• 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.

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Conclusions

• 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
  disease)
• 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

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THANK YOU HVALA
Ilija Batljan, Mayor 46 8 520 681
72 ilija.batljan_at_nynashamn.se http//www.nynashamn
.se