Learning from Sweden's Health Care System
The Commonwealth Fund has consistently ranked Sweden’s universal health care system above Canada’s.
In fact, their last two international health care studies found that Sweden spends about the same on health care as Canada (as a % of GDP), but yet they deliver better results. (For their 2017 study, click here and click here for the 2021 study).
Like Canada, the Swedish system covers all citizens. We wondered – how are they able to provide better care?
With that in mind, SecondStreet.org travelled to Sweden in May of 2023 to learn more.
After speaking with several experts in Stockholm, we learned about some key differences between their system and the Canadian model.
Collaborative Approach With The Private Sector
As noted in our short documentary, Fixing Canada’s Health Care: Lessons from Sweden (see above to watch), Sweden takes a more collaborative approach with the private sector.
The Swedes seem to put patients, not ideology, at the centre of their health care system. The Swedish government will deliver services through private facilities or government-run hospitals. It also doesn’t matter if a health care facility uses unionized or non-unionized staff. Again, the care provided to patients is what matters most.
Consider what the Economist magazine noted in 2013:
“Sweden has gone further than any other European country in embracing the purchaser-provider split—that is, in using government money to buy public services from whichever providers, public or private, offer the best combination of price and quality.”
This differs from Canada where many activists and politicians will criticize the very mention of exploring whether or not a private provider might be able to deliver high-quality surgery and diagnostic scans to patients.
Across Canada, family doctors’ offices are private businesses. Many provinces also hire, at least on a limited basis, private clinics to provide elective surgery to patients in the public system. In Saskatchewan, surgeries performed in private facilities are estimated to cost between 26-45% less than government-run hospitals. In Ontario, the province’s Auditor General found that private clinics provided surgeries anywhere from 20-40% less than in government-run hospitals. Many other provinces have also proven that these relationships can work quite well – same quality of services, lower cost.
Despite these examples of success, hiring private clinics to provide more services regularly turns into an ideological debate instead of questioning whether or not it could help patients.
For instance, during the last Alberta election, the very idea of private hospitals became a divisive issue. Similarly, the “Ontario Health Coalition” has been vocal in opposition to the government partnering with more private clinics to provide surgeries to patients in the public system. There were no proposals with actual analysis presented, the activists were just opposed to the government even considering the idea.
In Sweden, their system goes farther than Canada when it comes to partnering with the private sector.
Perhaps the best example of Sweden’s willingness to partner with private companies is the St. Göran hospital – a government-owned hospital that is funded by the government but managed by the private firm Capio. This relationship has been praised by several observers and organizations, including the Montreal Economic Institute, the Economist magazine and the British government to name a few.
The hospital’s CEO indicated that services provided by the hospital cost the government approximately 30% less than what the same services cost at nearby government-run hospitals. Gustaf Drougge, a health care expert who founded the Swedish think tank Synaps, estimated the savings were a bit lower, telling SecondStreet.org they were in the 15-20% range. Either way, it’s a positive story if quality health care is being delivered for a significantly lower cost – the savings ultimately mean there are more dollars available to help patients.
The Commonwealth Fund describes Sweden’s overall hospitals situation:
“There are seven university hospitals, all public, and about 70 public community hospitals owned by the regions. There are also six private hospitals, of which three are not-for-profit. Private hospitals include emergency, orthopedic, and surgery centers. All hospital staff are salaried employees.”
But it’s not just surgery and hospitals where Sweden collaborates with the private sector.
SecondStreet.org spoke with Kalle Conneryd Lundgren, the Chief Operating Officer of Kry, a Sweden-based digital health care provider. Their digital tool allows patients to connect with nurses, doctors, psychologists and other health care staff through videoconferencing. Alternatively, patients can visit one of their health care centres for an in-person appointment.
The company’s rates are quite reasonable. For example, in the Stockholm area, those 19 and under, and patients over 85, do not have to pay to meet with health care staff online. Those in the 20-84 age range pay nothing to speak with a nurse, but pay about 100 SEK ($12.38 CAD) to speak with a doctor or psychologist. At the same time, Kry bills the government for each patient visit. This is similar to how your family doctor’s office bills the government after your visit.
Canada also has digital health tools such as Telus Health, Maple and MyCare, but the relationship with the government is quite different. Ottawa has actually cut back funding to provincial governments because it takes exception to these companies charging patients for appointments.
It was interesting to hear Lundgren explain how his tool is saving the Swedish health care system a significant amount of money. The reason is that by treating patients virtually, Kry is preventing some of these patients from visiting an emergency room – a service that costs the government “hundreds” of dollars per visit. Conversely, his firm will bill the government “$30 or so.”
Sweden provides its citizens with a “healthcare guarantee”.
In short, health regions must provide patients with timely health care or pay for the patient to receive the care in another region.
Consider the guarantee by service:
Assessment by a physician: 3 days
Appointment with a specialist: 90 days
Treatment: 90 days
In total, if you need, say, a hip operation, the Swedish system makes it very hard for health regions to string patients along for a year, two years or longer (like we see in Canada). The guarantee aims for a maximum of six months.
Finally, Swedish patients have the right to choose outside of the public system. If they don’t want to wait upwards of, say, six months for the public system to provide treatment, they can always pay for private insurance.
According to the Commonwealth Fund, approximately 13% of employed people in Sweden have private insurance. What this does is help take pressure off of the public system, while giving Swedes more choice and helping to drive innovation at the same time.
More to come…