sweden comparative health care

Comparative Health Care Systems Project:

Comparative Health Care Systems Project Sweden and The United States Team 6 Members: Megan Connelly, Tiffany Hillyard , Elicia Jocheim , Laura Schram

Key Characteristics United States and Sweden:

Key Characteristics United States and Sweden

Population:

Population U.S. Size – 313,232,044 Distribution in Relation to Age – 0-14yrs = 20.1%, 15-64yrs = 66.8%, 65+yrs = 13.1% Gender – Male =154,264,615 Female =158,967,429 Ethnicity-White – 79.96%, Black – 12.85%, Asian – 4.45%, American Indian & Alaskan Native – 0.97%, Native Hawaiian & Pacific Islander 0.18% Language – English Literacy – 99% (of age 15 and over) Immigration - 3,850,000 Sweden Size – 9,088,728 Distribution in Relation to Age – 0-14yrs=15.4%, 15-64yrs=64.8%, 65+yrs=19.7% Gender – Male=4,504,995 Female=4,583,733 Ethnicity – Swedish, Finnish, Sami Language – Official: Swedish Literacy – 99% (of age 15 and over) Immigration – 13.8% of the total population

Geography:

Geography United States Location – In North America bordered by Canada and Mexico Size – 9,826,675 sq. Kilometer Distribution – 82% of the population live in urban areas Major Population Centers – New York/Newark, Los Angels, Chicago Transportation-personal vehicles, railways, buses, metropolitan m ass t ransit (subways, taxis) Climate – Wide variety of climate, some areas are sub arctic while others are tropical, certain areas prone to extreme weather such as hurricanes and tornados Sweden Location – in Northern Europe, bordered by Finland and Norway Size – 450295 sq. Kilometer Distribution – 85% of the total population live in urban areas Major Population Centers – Stockholm, Gothenburg Transportation – Personal vehicles, airports, railways, waterways with ports Climate – Subarctic in the north. Remainder of the country is more temperate.

Historical and Current Socio-cultural and economic features:

Historical and Current Socio-cultural and economic features United States Unemployment - 9.7% Major Industry - Service – 79.1% Ag – 0.7% Manufacturing – 20.3% Exports – Ag products (soybeans & corn), Industrial Supply (Organic Chemicals), Capital goods (transistors, aircraft), Consumer goods (crude oil, automobiles, clothing, medications, Imports – crude oil, automobiles, clothing, medications, toys Per Capita Income – $47,284 Poverty – 12.5% Major Religions - Protestant (51.3%), Catholic (23.9%) Sweden Unemployment – 8.3% Major Industry – Service – 70.7% Ag – 1.1% Manufacturing – 28.2% Exports – Machinery & Transportation Equipment, Industrial Machinery, Chemical and Rubber Products, Electronics, Telecommunications Imports – Electronics and telecommunication, Food Stuffs, Road Vehicles, Minerals Per Capita Income – $48,875 Poverty – 6.5% Major Religions – Evangelical Lutheran (Church of Sweden)

Historical and Current Socio-cultural and Economic Features (cont):

Historical and Current Socio-cultural and Economic Features ( cont ) Standard of Living Comparison – Both Sweden and the United States are considered to be Countries that have high standards of living. The US does not seem to have as high of a standard of living though when you look at the poverty and unemployment levels in comparison to Sweden. Another factor in Sweden having a slightly higher standard of living is the fact that they are a considered a welfare state. In their society the higher earners are taxed and these taxes are returned to the lower earners in subsidizes in an effort to more evenly distribute earnings amongst the population.

Historical and Current Socio-Cultural and Economic Features (cont):

Historical and Current Socio-Cultural and Economic Features ( cont ) United States Educational System -Mandated at the State level -Typically attend primary and secondary school from ages 6-18 -Many attend higher education after high school completion Sweden Educational System -Mandated by the Swedish Government -Typically attend compulsory school from age 7-16 -Upper secondary school offered after compulsory school which is either university preparatory or vocational

Historical and Current Socio-Cultural and Economic Features (cont):

Historical and Current Socio-Cultural and Economic Features ( cont ) United States Lifestyle Issues – -Nutrition -Physical Activity -Sleep Deprivation -Stress -Substance Abuse -Obesity-especially childhood Sweden Lifestyle Issues – -Tobacco Use-smoking, moist snuff -Obesity -Substance Abuse -Nutrition – diets lacking in fruits and vegetables

Historical and Current Socio-Cultural and Economic Features (cont):

Historical and Current Socio-Cultural and Economic Features ( cont ) United States Role of Family Members in Medical Decision Making – Family Centered Care is the model of Nursing Care that is most often provided to facilitate the American way of family decision making. Societal Issues – Teenage Pregnancy, Homelessness, Immigration, Health Care Reform Sweden Role of Family Members in Medical Decision Making – Democratic Family with emphasis on gender equality and autonomy for children. Societal Issues – Teenage Pregnancy, Gender Equality,

Health Information and Vital Statistics:

Health Information and Vital Statistics United States Birth Rate – 13.83 per 1,000 in the population Death Rate – 8.38 per 1,000 in the population Major Causes of Death/Illness – Cancer, Diabetes, Cardiovascular Disease, Obesity, Mental Illness Life Expectancy – 78.37 years Sweden Birth Rate – 10.18 per 1,000 in the population Death Rate – 10.2 per 1,000 in the population Major Causes of Death/Illness – Heart Disease, Cerebrovascular Disease, Alzheimer's, Mental Illness, Lung related Cancers (bronchus, trachea, lung) Life Expectancy – 81.07 years

Government:

Government United States Type – Constitutional Federal Republic Organization – Executive Branch President – Chief and Head of State Cabinet – Presidential Advisors, Responsible to Senate Legislative Branch Congress – Bicameral Senate House of Representatives Judicial Branch Supreme Court United States Courts of Appeal District Court State Court County Court Role of the Public - Voting Sweden Type – Constitutional Monarchy Organization - Executive Branch Monarch – Head of State Prime Minister – Head of Government Cabinet – Responsible to the Parliament Legislative Branch Riksdag – Unicameral Parliament Judicial Branch District Courts (84) Appeal Courts (10) Superior Courts (2) Role of the Public – Voting

Organization of Health Care:

Organization of Health Care Sweden Single payer Universal health care Publicly operated United States Private Insurance Public Insurance Medicare Medicaid Veterans Health Administration The Children’s Health Insurance TRICARE For Profit Not for Profit

Decision Making:

Decision Making 3 Levels Central government (federal) County Councils (regional) Municipals (local) Central government Establishes principles and guidelines for health care and sets the political agenda for health and medical care

Decision Making (cont):

Decision Making (cont) County Councils 21 county councils Responsible for providing health and medical care, as well as dental care for local residents up to the age of 20 Own and run the hospitals and employ medical personnel

Decision Making (cont):

Decision Making (cont) Municipals 290 municipalities Responsible for care for the elderly, those with physical disabilities, psychological disorders, providing support and services for people released from the hospital care as well as for school health care

Government Role:

Government Role The Ministry of Health and Social Affairs Responsible for ensuring that the health care system runs efficiently and supervises the health care activities of the county councils. It also provides research and advice to the Swedish government on legislation and policy matters regarding health care The Health and Medical Service Act Regulates the responsibilities of the county councils and municipalities

Providers:

Providers 7 sections Close-to-home-care, emergent care, elective care, in-patient care, out-patient care, specialist care and dental care Public vs. Private Licensure S upervised by The National Board of Health and Welfare (Socialstyrelsen)

Delivery of Care:

Delivery of Care 60 hospitals total Provide specialist care and emergency care 8 regional hospitals Highly specialized care, teaching, research Public clinics Accessible to all citizens of Sweden Private clinics 10% of health services Dental care Free of charge to children up to age 20 (www.sweden.se)

Access to Care:

Access to Care Patients have the right to choose what physician they see, whether it be general or specialty practice provider. General physician will contact the specialist Pharmacies are in the same network County councils are buying services from private providers Decreasing waiting time for care

Utilization of Care:

Utilization of Care Source: The Common Wealth Fund

Funding of Health Care:

Funding of Health Care Source: National Policy Analysis

Cost of Care:

Cost of Care Medical Cost Maximum annual patient out of pocket costs for health care is 800 SEK ($111 USD) Pharmaceutical Cost Maximum annual patient out of pocket cost for prescription costs is 1,800 SEK ($249 USD )

2006:

2006 Sources: The Commonwealth Fund

Major Expenditures & Reimbursement:

Major Expenditures & Reimbursement Primary care accounts for the largest cost of care and continues to increase Unemployment rates have a major effect on the amount of money the county will provide for health care Reimbursement provided by government

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Per Capita Cost for Health C are (2005) Purchasing power taken into consideration (US-dollars*)

Slide 26:

Health Care as a Percentage of GDP

Measures Used to Control Cost:

Measures Used to Control Cost “If o verall medical costs are on public budgets, then officials have powerful incentives to restrain increases in medical costs to avoid reducing the funds for other public programs or having to raise taxes” (Marmor, 2009)

Measures Used to Control Cost:

Measures Used to Control Cost Sweden Global budgets are established periodically County councils and municipalities meet limit cost increases and taxes Swedish Council on Technology Assessment in Health Care Continuously assesses new and established technologies in health care United States Choosing generic prescription medications Use of preferred health care providers Nurse hot lines to answer questions Health Savings Accounts (HSA)

Issues with Cost Control:

Issues with Cost Control Sweden Overcrowded clinics Lack of available procedures Quality of care United States Spends more than any other country on health care $2.1 trillion in 2006 Economic Impact 9.7% unemployment rate Strain on insurance coverage Lack of preventative care

Sweden’s Quality Assurance of Healthcare:

Sweden’s Quality Assurance of Healthcare Governmental review of healthcare quality The National Board of Health and Welfare Monitors medical services, environmental health, communicable disease prevention and epidemiology ( www.socialstyrelsen.se ) A health-care guarantee was offered by Sweden to it’s citizens in 2005. If the citizens can not get access to care, the government pays to have health care given elsewhere ( www.sweden.se )

M & M:

M & M Cardiovascular diseases and diabetes, deaths per 100,000 (age-standardized estimate) Source: World Health Organization

M & M:

M & M Cancer, deaths per 100,000 (age-standardized estimate) Source: World Health Organization

Life Expectancy - Years:

Life Expectancy - Years Sweden: Data projected those born 2004- 2008 from Population Statistics, Statistics Sweden US: 2008 Data from CDC

Wait Time:

Wait Time Source: National Database on Waiting Times, Swedish Association of Local Authorities and Regions

Wait Time:

Wait Time Source: National Database on Waiting Times, Swedish Association of Local Authorities and Regions

Wait Time:

Wait Time Source: National Database on Waiting Times, Swedish Association of Local Authorities and Regions

Immunizations - Percent :

Immunizations - Percent Sweden: Data Swedish Institute for Infectious Disease Control and Infectious Disease Control Units in County Councils US: 2008 Data from CDC

Satisfaction:

Satisfaction Source: National Database on Waiting Times, Swedish Association of Local Authorities and Regions

Satisfaction:

Satisfaction Source: National Database on Waiting Times, Swedish Association of Local Authorities and Regions

Satisfaction:

Satisfaction Source: National Database on Waiting Times, Swedish Association of Local Authorities and Regions

Strengths of Sweden’s Health Care System:

Strengths of Sweden’s Health Care System Every citizen receives health care i.e., Medical Provider, Hospital, Prescriptions Underprivileged are cared for by Municipals (local) Oversight of system by National Board of Health and Welfare (Socialstyrelsen) Maximum medical out of pocket only $111 Cost containment

Limitations of Sweden’s Health Care System:

Limitations of Sweden’s Health Care System The potential t ime it takes to receive healthcare Question of quality Lack of availability of specialty services

Ethical Issues:

Ethical Issues Wait time Quality Saftey being the #1 priority

Application of the Principles of Sweden’s System of Health Care on US Health Care Reform:

Application of the Principles of Sweden’s System of Health Care on US Health Care Reform A Government agency to mandate costs Division of financial r esponsibility a mongst v arious l evels of government Equal Care for everyone

Application of Principles (cont):

Application of Principles ( cont ) A g overnment a gency to mandate costs. -Rationale – Having costs mandated and capped by government would ensure that patients get the same care for the same cost, and it would also ensure equality between physicians. -Evidence – Sweden has enforced caps on what physicians can charge for services this has eliminated some of the inequities in physician utilization.

Application of Principles (cont):

Application of Principles ( cont ) 2 . Division of financial responsibility amongst various levels of government -Rationale – With the cost of health care rising, and the amount of variation from state to state in what the cost of health care is, if the US would divide up financial responsibility between the different levels of government (national, state, city) each area could tax citizens based on regional needs. -Evidence – The Swedish spend much less per capita on health care than the US.

Application of Principles (cont):

Application of Principles ( cont ) 3 . Equal care for everyone -Rationale - Providing all US citizens with accessible, quality care would improve overall outcomes and cost. -Evidence - It is known that if patients don’t have access to affordable, quality, preventative, primary care then they are more likely not seek care which will compound their medical conditions. The more complicated or severe that the condition is the more costly it is to treat and the more difficult it is to treat.

Policy recommendation for the United States:

Policy recommendation for the United States Universal Health Care Provide a basic level of health care to all people Lower health care costs Promote preventative health care

Policy recommendation for the United States:

Policy recommendation for the United States Reasons why it may be successful Everyone will have access to health insurance Encourage preventive care Pre-existing conditions Eliminate the “middle man” Reduce the number of uninsured people going to the ER for primary care visits Ease medical professionals concern of insurance and malpractice liability

Policy Recommendation for the United States:

Policy Recommendation for the United States Reasons why it may not be successful Extended wait times to see a doctor or specialist Lack of funding for future research Overall quality of care will decrease

References:

References Anderson, G.F., Squires, D.A. (June 2010). Measuring the U.S. Health Care System: A Cross-National Comparison. Commonwealth Fund, 90. Retrieved June 13, 2011 from www.commonwealthfund.org Anderson, W.L. (2002, May 9). Sweden: Poorer Than You Think. Mises Daily. Retrieved from http://mises.org/ daily Bein , B. (2010, May 17). Residencies Seek to Boost Training in Obesity Management, Lifestyle Issues. AAFP News Now . Retrieved from http://www.aafp.org/online/en/home/publications/ news Central Intelligence Agency. (2011). The World Factbook . Retrieved June 10, 2011 from http://www.cia.gov/library/publications/the-world- factbook.html Department of Health and Human Services. (2009, July 15). New data say uninsured account for nearly one-fifth of emergency room visits. Retrieved from http:// www.ahrq.gov/news/press/pr2009/hhsuninserpr.htm Glenngard , A.H., Hjalte , F., Svensson , M., Anell , A., Bankauskaite , V. (2005). Health Systems in Transition: Sweden . Retrieved from http:// www.euro.who.in t Hogberg , D. (2007 May). Sweden's Single-Payer Health System Provides a Warning to Other Nations . National Policy Analysis, 555. Retrieved June 11, 2011 from http:// www.nationalcenter.org

Slide 52:

Kochanek , K.D., Xu , J., Murphy, S.L., Minino , A.M., & Kung, H. (2011). Deaths: preliminary data for 2009 . National Vital Statistics Report , 59(4). Retrieved on June 11, 2011 from http://www.cdc.gov Larson , S. R. (2008). Lessons from Sweden’s Universal Health System: Tales from the health-care crypt. Journal of American Physicians and Surgeons, 13 (1), 21-22. Legido -Quigley, H., McKee, M, Nolte, E. & Glinos , I.A. (2008). Assuring the quality of health care in the European Union – a case for action. World Health Organization. Retrieved on June 11, 2011 from http://www.euro.who.int Marleise , R. (2007, Jan-Mar). A Universal Healthcare System: Is it right for the United States? Nursing Forum, 42 (1), 3-11. Marmor , T., Oberlander , J., & White, J. (2009, April 7). The Obama administration’s options for health care cost control: Hope versus reality. Annals of Internal Medicine, 150 (7), 485-489. ( n.d. ) Swedish Health Care. Retrieved June 12, 2011 from http:// www.swedishhealthcare.se Sweden.se . Health care in Sweden. Retrieved June 11, 2011 from http://www.sweden.se Swedish Association of Local Authorities and Regions. (2008). The Swedish healthcare System: How does it compare with other EU countries the United States and Norway? Retrieved June 12, 2011 from http://brs.skl.se/brsbibl/kata_documents/doc39498_1.pdf

Slide 53:

Swedish Association of Local Authorities and Regions & Socialstyrelsen (2009). Quality and efficiency in Swedish health care – regional comparisons 2009. Retrieved June 11, 2011 from http://www.socialstyrelsen.se Swedish Government Offices. (2009). Sweden’s Democratic System . Retrieved June 10, 2011 from http://www.sweden.gov.se Swedish Health Care (2005). Swedish association of local authorities and regions (SALAR); Swedish health care in an international context - a comparison of care needs, costs, and outcomes. Retrieved June 11, 2011 from http ://www.swedishhealthcare.se Triggle , N. (2005, November 28). How the NHS could learn from Sweden. BBC News. Retrieved from http :/ /news.bbc.co.uk Walker, Emily. (2010, February 12). Health insurers post record profits. Retrieved from http ://abcnews.go.com/Health/HealthCare/health-insurers-post-record-profits/story?id=9818 World Health Organization. (2011). Sweden: Selected Basic Statistics. Retrieved June 10, 2011 from http:/ / www.euro.who.int