1. The Evolving Role of Health Sector Research in Sweden Richard B. Saltman Ph.D Emory University European Observatory on health Systems and Policies Brussels 1

2. Initial Caveats This presentation: An outsider’s view through the keyhole: - partial - episodic - thematic Focussing on health services and health policy research broadly defined 2

3. The Broad Picture I Health Sector Research in Sweden has developed considerable international respect: third or fourth best-known across Europe: - UK/England - Netherlands - ? Sweden - ? Finland (recently Spain?) 3

4. The Broad Picture II Several key reasons: - Good academic base - Publishing in English - Interesting topics often tied to tax-funded health system (lots of international interest in those days) 4

5. The Broad Picture III Started relatively small: - relatively small number of researchers in 1980s and 1990s (Uppsala, Lund/IHE, Handelshogskolan, Linkoping, a few others) - mostly limited focus on Swedish domestic issues (tax-funded health system) - mostly permanently salaried posts for academics (discourages self-exploitation ) - limited funding sources: - Academic Research Council (national funds) - County council funded/focussed - SPRI - Landstingforbundet 5

6. The Broad Picture IV Recent expansions of resources/personnel in 2000s: - MMC at Karolinska/Stockholm - Jonkoping Academy (quality, IHI) -New Growth in Universities (Lund, Gothenburg, Linkoping, Uppsala, others) -Vardanalyse (Ministry) -Vinnova projects/grants (State) -Open Comparisons data (Ministry) 6

7. The New Research Challenge I How to focus this new, larger set of health sector research resources: - Domestic or comparative/international? - HSR or broader policy issues? - “System linked” (existing institutions and issues) or “System developing” (new/emerging institutions and issues)? 7

8. What Would be Interesting Internationally I Greater focus on how tax-funded system is changing: Diversity of providers in primary/home care - New not-for-profit private actors (including Praktikertjanst) - New for-profit private actors (small vs. large /stock-issuing vs risk-capital) Dynamism in the delivery system - new roles for innovation and entrepreneurialism (in public as well as private sector) - overcoming the health/social interface (chronically ill elderly) - stimulating greater patient co-production/ co-responsibility for services (new technologies/public sector fiscal pressures) 8

9. What Would be Interesting Internationally II Greater focus on how tax-funded systems aren’t changing: -Stability or Stasis in the public sector? -Stability or Stasis in the personnel union sector? -Stability or Stasis in the professional sector (physicians, nurses)? - Rapidity of adoption of (rapidly increasing) international standard of care (new technology, new procedures) - Medical Tourism (Swedes going to EU/Thailand) 9

10. What Would be Interesting Internationally III Assessing key questions looking forward: Implications for public finance of slowing national economy (eg John Appleby’s 2013 England study) Understanding the resilience of the county councils How to better incorporate patient/choice in health decision-making Can health personnel unions become engines for reform/new models? Fiscal and staffing impact of genetics and personalized medicine? Likely policy outcomes of re-distributing democratic authority among three levels of government (including possible new role for the State/Ministry (more centralization vs targeted regulation?) 10

11. What Would be Interesting Internationally IV Applying both economic and social dimensions to existing and proposed policy strategies - stretching across academic disciplines - presenting a more comprehensive picture - providing an academic baseline from which to assess the work of political “think tanks” (eg Timbro, Arena, LO) 11

12. Overall Objective: Do More! Broaden the remit on topics and policies Focus projects on where Swedish health system will likely head in near future: A more diverse, complex, but also more innovative and dynamic set of institutions and policies 12