JANUARY

SWEDEN
Care, which promotes use of cost-effective health care technologies, has a mandate to review and evaluate new
treatments from medical, economic, ethical, and social points of view. Information from the council’s reviews
is disseminated to central and local government officials and medical staff to provide basic data for decisionmaking
purposes.
The principal agency for assessing pharmaceuticals is the Dental and Pharmaceutical Benefits Agency. Since
2002, it has had a mandate to decide whether particular drugs should be included in the National Drug Benefit
Scheme; prescription drugs are priced in part on the basis of their value. The agency’s mandate also includes
dental care. The Medical Products Agency, meanwhile, is the Swedish national authority responsible for the
regulation and surveillance of the development, manufacture, and sale of drugs and other medicinal products.
What are the major strategies to ensure quality of care?
County councils are responsible for accrediting health care providers and following up on conditions for
accreditation. These activities include assessing whether quality targets—those associated with a pay-forperformance
scheme or tied to requirements for continued accreditation—have been achieved. Providers are
evaluated based on information from patient registries and national quality registries, surveys related to patient
satisfaction, and clinical audits.
Concern for patient safety has increased during the past decade, and patient safety indicators are compared
regionally (see below). Eight priority target areas for preventing adverse events have been specified: health
care–associated urinary tract infections; central line infections; surgical site infections; falls and fall injuries;
pressure ulcers; malnutrition; medication errors in health care transitions; and drug-related problems (SALAR,
2011).
The National Board of Health and Social Welfare, together with the National Institute for Public Health and the
Dental and Pharmaceutical Benefits Agency, conducts systematic reviews of evidence and develops guidance
for establishing priorities in support of disease management programs developed at the county council level.
International guidelines and specialists are also central to the development of these local programs. There is
a tendency to develop regional guidelines to inform the setting of priorities in order to avoid unnecessary
variation in clinical practice. For example, the National Cancer Strategy was established in 2009, and six
Regional Cancer Centers (RCCs) were formed in 2011. The RCCs’ role is to contribute to more equitable, safe,
and effective cancer care through regional and national collaboration.
The 90 or so national quality registries are used for monitoring and evaluating quality among providers and for
assessing treatment options and clinical practice. Registries contain individualized data on diagnosis, treatment,
and treatment outcomes. They are monitored annually by an executive committee, funded by the central
government and by county councils, and managed by specialist organizations.
Since 2006, the government has published annual performance comparisons and rankings of the county
councils’ health care services, using data from the national quality registers, the National Health Care Barometer
Survey, the National Waiting Time Survey, and the National Patient Surveys. The 2012 publication included 169
indicators, organized into various categories such as prevention, patient satisfaction, waiting times, trust, access,
surgical treatment, and drug treatment. Some 50 indicators are shown also for hospitals, but without rankings.
Statistics on patient experiences and waiting times in primary care are also made available through the Internet
(www.skl.se) to help guide people in their choice of provider.
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The Commonwealth Fund