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KCE reports 57 Musculoskeletal & Neurological Rehabilitation 177
8.6 SWEDEN nn
8.6.1 Health care organisation in general
The Swedish health care sector has undergone several important reforms during the
past decades. Generally, national reforms that have had an impact on the health care
system have focused on three broad areas: the responsibilities of provision of health
care services, priorities and patient’s rights in health care and cost containment.
8.6.1.1 Health insurance
The social insurance system is managed by the Swedish Social Insurance Agency. No
basic or essential health care or drug package is defined within Swedish health care.
Insurance is mandatory. It covers individuals’ expenditures for health care and
prescribed drugs.
There are direct, small fees for medical attention payable by patients; these fees are in
the form of flat-rate payments. County councils have been able to determine their own
user charges for hospital and primary care within the national framework since 1991.
This practice has resulted in increased and differentiated patients’ fees. Ceiling amounts
are defined on the total amount that any citizen must pay in any 12-month period. The
ceiling for individual co-payments for prescribed drugs is separated from the other
health care services.
In 2002, a new fee system was introduced for care of the elderly and the disabled. The
purpose is to ensure that all individuals have a certain amount of money to cover living
expenses (a reserve sum) once all fees are paid. For elderly and the handicapped, and
depending on the level of service and care, together with the number of hours of
assistance accorded per month, each municipality sets its own fee schedule in
accordance with nationally determined reserve sums and maximum fees.
The market for voluntary health insurance is growing. One of the reasons is the long
waiting lists for elective treatment under the county councils. The main benefit of having
supplementary insurance is that it allows quick access to a specialist in ambulatory care
when necessary. Another benefit might be the possibility of jumping waiting lists for
elective treatment.
8.6.1.2 Health care policy making and organisation
The Swedish health care system is organized on three levels: national, regional and local.
Health and medical care is separted into three levels:
• regional health care
• county health care
• primary health care (health centres)
Hospitals are mostly independent public facilities. The degree of privatization in
hospitals varies among counties. There are nine regional hospitals, some 70 county and
provincial hospitals and just over 1000 health centres.
More than half of Sweden’s county councils and regions are currently planning to
change the structure of their health care organisation. The main elements of the
changes involve a combination of extended primary care and specialised hospital care,
which is to be concentrated and centralised. Technological developments, competence
requirements and cost efficiency are steering the development, so that hospitals and
clinics focus on certain specialties or operations.
For highly specialized care, Sweden is divided into six large medical care regions, within
which the county councils cooperate to provide the population with highly specialized
nn HIT-report and http://www.sweden.se/templates/cs/BasicFactsheet____6856.aspx