THE HONG KONG POLYTECHNIC UNIVERSITY MSc. In Management (Health Services) Health Systems Reform in Tax based Systems in Sweden Problem3: How effective are these measures and policies? Current Issues in Health Services Management MGT 557

Group Members Cho Lai Shan, Doris G Kwong Pui Man, Monica G Lam Ka Yin, Katherine G Lo Chi Yung, Owen G Siu Chun Bong G Tam Fung Kit, Sandy G

Health Care System Sweden From each according to ability To each according to needs

Health Care System Sweden Offers UNIVERSAL ACCESS to health care for the entire population Desire to provide equal access regardless of residence The system provides quality health care by international standards

Health Care System Sweden The physician, as the Fiscal gatekeeper may not have the incentive for social insurance cost containment

Social Democracy Economic development & efficiency Economic well-being for ALL Solidarity Universality & Equality Democracy & cooperation Education & Access to information Pragmatism

Social Democracy Egalitarian approach Successful when the mean of level of health reduced inequality exists

Average Unemployment Rates for Sweden, the U.S. and Other Developed Countries, Country or Group Average Rate of of Countries Unemployment Sweden 2.4% All OECD countries 5.2% 15 European Union Members 5.6% United States 6.0% Canada 7.3% Source: Olsen 1999.

Health Care System Sweden Single-payer system Vs Multiple sources of finance

Health Care System Sweden Identify DEMAND for Health Care Evaluate the MEANS to fulfill

Health Care System Sweden Health resources between Acute in-patient care Ambulatory services Pharmaceuticals

Health Care System Sweden Collective bargaining structure with separate negotiations amongst Central Government Municipals County Councils

Health Care System Sweden Primary Care Services Integration of Medical and Social Services for the elderly

Health Care System Sweden Regulated market Separation of purchaser & provider roles within the County Councils

Health Care System Sweden Budgetary incentives Introduction of performance- related reimbursement for hospitals

Health Care System Sweden Patient Choice Rationing

Major problems and challenges Problems and challengesMeasures and policies adopted 1.Increasing medical expenditure 2.Resources allocation Cost containment 3. Facing aging population and longer life expectancy Promoting community care 4. Long waiting timeNational Treatment Guarantee

Promoting community care Output of Elderly (Adel) reform (Sundstrom & Johansson, 2005) –Shift care from public hospital to community care –↓no. of hospital bed & length of stay –Service contracted out to private provider –Income support payment ->informal caregiver –Swedish care leave

Promoting community care Elderly reform, achievement: –↓societal cost –↑efficiency & effectiveness in acute care setting

Promoting community care ↓no. of hospital bed & length of stay –↓no. of Bed blocker –The rapid reduction of institutional beds for elderly care increases the pressure on other parts of the care system

Promoting community care Source: Health at a glance: OECD indicators 2005

Promoting community care ↑expenditure on community care Current expenditure by medical services, medical goods & collective care, 2003 Source: Health at a glance: OECD indicators 2005

Promoting community care ↓length of stay Average length of stay for acute care, 1990 & 2002 Source:Health at a glance: OECD indicators 2005

The cost of elerly patient with long term care need could be significantly reduced by: Decrease in length of stay in acute care hospital Decrease in number of acute bed in hospital Increase in expenditure for ambulatory care and home care Summary

Major problems and challenges Problems and challengesMeasures and policies adopted 1.Increasing medical expenditure 2.Resources allocation Cost containment 3. Facing aging population and longer life expectancy Promoting community care 4. Long waiting timeNational Treatment Guarantee

Maximum waiting time guarantee (MWG) Offered for 12 selected procedures <3/12< If not, patient be treated in other hospital at the expense of home hospital

Maximum waiting time guarantee (MWG) Output –↓No. of patient waiting >3/12 –↓backlog –↑provider awareness the need to ↓waiting time –Improved resource use within hospitals –Not crowding out other procedures that were not subject to the maximum waiting time (Hanning, 1996)

Maximum waiting time guarantee (MWG) Source:Hanning, M. (2005). Maximum waiting-time guarantee- a remedy to long waiting lists? Assessment of the Swedish waiting-time guarantee policy

Hanning study in 2005 shows that most departments can offer care to patients within the stipulated time limit. It was the result of better resource use because of better efficiency and improved medical technology. Summary

Health Care System Sweden Home of the People From Cradle to Grave