1. 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

2. Group Members Cho Lai Shan, Doris 04703507G Kwong Pui Man, Monica 02715793G Lam Ka Yin, Katherine 05412738G Lo Chi Yung, Owen 03700833G Siu Chun Bong 03705299G Tam Fung Kit, Sandy 04717905G

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

4. 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

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

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

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

8. Average Unemployment Rates for Sweden, the U.S. and Other Developed Countries, 1960-1994 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.

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

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

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

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

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

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

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

16. Health Care System Sweden Patient Choice Rationing

17. 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

18. 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

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

20. 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

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

22. 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

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

24. 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

25. 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

26. 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

27. 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)

28. 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 1992-1996

29. 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

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