1. Contents The Swedish Model Comparative Statistics Swedish Healthcare system Reform attempts Today

2. Sweden Swedish Model  “ The Swedish Model of today is a social and economic system characterized by increased privatization where tax-financed public services still play a vital role. Its guiding principles are full employment, equal pay for equal work and the collective welfare of society as a whole.” (http://www.sweden.se/eng/Home/Work/Swedish_model/What-is-the-Swedish-model/)  Based on a high degree of public financing (http://www.sweden.se/eng/Home/Work/Swedish_model/What-is-the-Swedish- model/Reading/The-Swedish-Model-in-practice/http://www.sweden.se/eng/Home/Work/Swedish_model/What-is-the-Swedish- model/Reading/The-Swedish-Model-in-practice/  (Work tab)  Known as a reformist -welfare state -moving towards that in the 60’s – high taxation and slowed growth.  Different models– pre 1960, 1970-1980s, or today  1980s-1990’s- Government reversed course- reduced tax laws, industry deregulation- to spur growth, reduced corporate income tax  1998 – enacted pension reform modeled on Chilean private pension system

3. Sweden Statistics  About the same size geographically as California, population size of N.C. (pop. 9.2m)  GDP spending – 9.2% of GDP ($52B/480B)  Rising pharma spending – 13.4% (2007) still below average of 17.1%  81.7% of health spending funded by public sources (U.S. %45.4)  Patient fees about 3% of funding. OECD (Organization for Economic Cooperation and Development)  3.6 physicians, 10.8 nurses per 1000  2.1 acute beds per 1000 - falling coinciding with lower avg. length of stay  Life expectancy Male –79 female 83  Infant mortality – 2.5 deaths per 1000  Elderly population growth –  Smoking 14.5% of population

4. Sweden Healthcare System  Overview - System  21 County councils, 290 municipalities, grouped into 6 regions  Much of the work of a county council is re: healthcare  Wide regional variations  Informally divided up into 7 sections – Close to home care (primary, maternity,outpatient psychiatric clinics, etc), emergency, elective, in-patient, out- patient, specialist and dental.  70 county hospitals, 1000 health centers, 8 regional hospitals (yglesias)  Most physicians employed by counties, hospitals run by counties  Private practices can be established but are heavily regulated by counties.

5. Sweden Healthcare System  Overview - Patients  Patients pay capped out of pocket cost per year (est. $125US)  Patients pay part of pharma cost (state run) – capped ceiling – determines usage by drug effectiveness.  Children and adolescents free – 19 yrs.  Taxed according to income bracket – higher personal lower corporate  Elderly and disabled fully covered  Cost control SBU- Swedish council on Technology Assessment in Health Care  Budgeting by County to control costs – elected officials

6. Sweden-counties

7. Sweden Reform Attempts  Dagmar reform of 1985 – capitation by number of patients seen  Led to fixed budgets which lead to rationing of care.  Did contain some costs  1990’s Stockholm model – private ownership of health care providers  30% decline in lab services  The purchaser provider split was not universally implemented and contained weak language allowing a ‘fallback’ to the old way. No penalties for losing patients.  2005 Health Care guarantee – no more than 90 day wait time – once care is determined  2008 study 75% patients received care within 90 day window  Privatization plan – insurance, pharma  3% currently privatized – primary advantage avoid wait times.  Pharma –July 2009 – private pharmacies- availability and lower costs

8. Sweden Good/Bad  Arguments for and against  Family oriented – childcare, birth, disability, elderly, adolescent, pension  Social insurance- (http://www.sweden.se/eng/Home/Work/Swedish_model/What-is- the-Swedish-model/Reading/The-Swedish-Model-in-practice/)http://www.sweden.se/eng/Home/Work/Swedish_model/What-is- the-Swedish-model/Reading/The-Swedish-Model-in-practice/ Fact sheet ministry of Health  Less innovation in healthcare -  Market forces not at work – underperforming entities don’t fail  Access, wait times, public perception, taxation

9. Sweden Today  Healthcare costs are continuing to rise  Access to surgeries are on the rise again  Studies show the risk of death goes up when on wait lists – more than just pain, anxiety, money  Anders Borg: several of the distinctive institutional characteristics usually attributed to the Swedish welfare system are favourable for economic development. Economic research also provides good support for the contribution to increasing labour force participation, especially of women, made by access to childcare and care for the elderly, a well- functioning basic education, and the absence of individual taxation of spouses. Correspondingly, a high-quality education system and infrastructure improvements contribute to higher productivity

10. Sweden Sources  http://www.sweden.se/eng/Home/Work/Swedish_model/What-is-the-Swedish-model/Reading/The-Swedish-Model-in- practice/ http://www.sweden.se/eng/Home/Work/Swedish_model/What-is-the-Swedish-model/Reading/The-Swedish-Model-in- practice/  http://www.oecd.org/home/0,2987,en_2649_201185_1_1_1_1_1,00.html http://www.oecd.org/home/0,2987,en_2649_201185_1_1_1_1_1,00.html  Sweden's Single-Payer Health System Provides a Warning to Other Nations David Hogberg, PhD. http://www.nationalcenter.org/NPA555_Sweden_Health_Care.html  http://yglesias.thinkprogress.org/archives/2009/10/health-care-in-sweden.php http://yglesias.thinkprogress.org/archives/2009/10/health-care-in-sweden.php matthew yglesias Oct. 1 st 2009  http://www.aihw.gov.au/mortality/life_expectancy/compares.cfm http://www.aihw.gov.au/mortality/life_expectancy/compares.cfm  life expectancy rates  http://www.ncpa.org/sub/dpd/index.php?Article_ID=17699 http://www.ncpa.org/sub/dpd/index.php?Article_ID=17699  http://www.global-economic-symposium.org/solutions/the-global-society/ageing-and- growth/strategyperspectivefolder/reconstructing-the-swedish-model http://www.global-economic-symposium.org/solutions/the-global-society/ageing-and- growth/strategyperspectivefolder/reconstructing-the-swedish-model Anders Borg -undated