Sweden sanitary system 1992

SWEDISH  HEALTH SYSTEMS

A.Fabre                                              February 1998 

Sweden, with  lower population  (8.6 million) has a major economic place. Swedish Health System was, bak in the thirties; a precursor, since the 30s, has been put in place a highly advanced organization of care and welfare policy. Allthough some recent problems;  Sweden remains in a position of excellence in many areas, particularly regarding medical research and the health status of all the population.

 HEALTH  STRUCTURES  

THE MINISTRY OF HEALTH

The role of the Ministry of Health is organizing the cohesion and monitoring of national policy santé.

A recent  Insurance Law (Act 1982 the public health and medical services) has set the overall direction of the Swedish health care system.

 ROLE OF THE REGIONS

Regional  prerogatives are particularly important in  health policy and financing of health services.

 COMMUNAL STRUCTURES

The role of the 288 municipalities in the territory is mainly organizational, particularly in the area of the elderly and the physically or mentally disabled .

 MEDICAL COTPORATION

 Medical demography is around one physician for 330 inhabitants, about 26,000 physicians.

It is important to understand that the medical care of the Swedish population is mainly centered on hospitals and health centers, with four broad categories: physicians

  MEDICAL DISTRICTS

They theoretically take the place of "family physicians," their number is relatively limited in the urban sites, their role is primarily rural and northern areas of Sweden

  MEDICAL CARE CENTRES

The exercise care center can be compared to what we mean by "medical clinic": the role of physicians is particularly important in urban areas.

  HOSPITAL PHYSICIANS

This type of exercise is particularly developed in Sweden but there has been lately  a huge development of "external care" in hospitals with an obligation for all hospital doctor "clinician" to  participate. This activity can be exercised in premises in outside the hospital.

  PRIVATE PHYSICIANS

Thz  "private sector" in medical practice has been often  challenged by the government  nut, still, many physicians use their right to a "private sector".

A highly characteristic element of Swedish medicine is the proportion higher than elsewhere in Europe of he number of specialists (physicians 4 of 5) compared with generalists.

  HEALTH PERSONAL

 Nurses corporation is divided in  "district nurses' (85,000) and" aides "(81.000) ..

Functional therapy and, in particular, kinesitherapists have  a particularly important place in Sweden (6000 and 5000 kinesitherapeutes occupational therapists.

  HOSPITALS

Main Regional Hospitals are in total number of 10; each of  recognized international reputation such Karolinska Sjukhuset Sahlgrenslka Sjukhuset in Stockholm and Gothenburg).

Moreover, the extent of the territory, are divided departement 80 hospitals and district hospitals, to a size (number of beds) generally supéerieure to French hospitals of the same structure.

The whole area is "grid" of a large number of "outpatients clinics" ("Vard Centraler" centers and Maternal and Child Health

This whole network is under a  strict control in terms of coordination and complementarity from the general councils and municipalities.

 SOCIAL PROTECTION

  Three basic principles in the medical-device social protection: universality, fee. Choice of doctor and financial. Participation

  CONSULTATIONS

The level of participation was increased to 100 SK (SK 1 = 0.76 FF) for consultation in "general medicine", 200 SK for specialist xonsultations.

The principle of free choice is effective, access to specialist is however subject to a fairly strict regulation within the public sector as dependent on an initial direction set by the GP. However; in  case of chronic medical problems or conditions already defined, the patient can appeal direct to the specialist.

  HOSPITALIZATIONS

The patient is required to use hospital services in his ^district. There is a daily fee the amount of which is fixed periodically by the General Council (currently around 100 SK)

  DRUGS

A quota system has been in use since several years : SK .160 for the first prescription drug for the SK and 60 for other

. The total drug costs paid by the patient is "capped" around 2000 SK per year

 FINANCING THE HEALTH SYSTEM

The investment is financed by the tax on income of the entire Swedish population.

The state intervenes in the laws of the control and guidance of the Health Insurance but the direct management of the system is the responsibility of the Generals advice.

Sweden occupies undoubtedly a position of excellence in the field of public health:

The statistics are particularly eloquent for infant mortality (3.8 per thousand) and life expectancy (18% of Swedish were over 65 in 1996 and the average lifespan is now DE76 years for men and 81 years for women)

The rate of cardiovascular disease, which was the main scourge of the Swedish population has declined significantly since 1980

The number of road accidents and suicide, especially among young people, it also significantly decreased in recent years.

The bad thing is, the percentage importantly of all cancer deaths (direct consequence of longer life?)

  HEALTH EXPENDITURE

In 1994, the overall rate of health spending stood at 7% of GDP, which is located, outside Scandinavia, well below most industrialized countries (USA: 16% of GDP, Canada: 10% )

Use of methods of evaluation and accreditation in the health sector are to be deveopped : the creation of the National Council for the Evaluation of Medicales Techniques (SBU), abandonment of the overall budget and remuneration of hospitals based on the results, implementation of the principle of "purchase-offer" medical benefits.

 PROGRAM FOR THE NEXT YEARS

Two main objectives:

                . Maintain the high standard of living on the ensemblme. population

                . Increase prevention and health information

  

a.fabre.fl@gmail.com

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