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 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

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, 1960-1994

Country or Group                     Average Rate ofof 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 challengesProblems and challenges Measures 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 time National Treatment Guarantee

Promoting community care

• Output of Elderly (Adel) reform (Sundstrom & Johanss

on, 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 caregive

r– Swedish care leave

Promoting community care

• Elderly reform, achievement:– ↓societal cost– ↑efficiency & effectiveness in acute care settin

g

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

0

2

4

6

1980 1985 1990 1995 2000

Year

Fig 1: Acute care bed, density per 1000 population, 1980 to 2000of Sweden

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 stayAverage length of stay for acute care, 1990 & 2002

Source: Health at a glance: OECD indicators 2005

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 challengesProblems and challenges Measures 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 time National 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 >3/1

2 – ↓backlog– ↑provider awareness the n

eed 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)

0%

20%

40%

60%

80%

100%

Aug-91 Feb-92 Aug-92 Feb-93 Aug-93 Feb-94

% of waiting time <3/12

Source: Hanning, M. (2005). Maximum waiting-time guarantee- a remedy to long waiting lists? Assessment of the Swedish waiting-time guarantee policy 1992-1996

• 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