final paper for 400

Running head: SWEDISH HEALTH CARE 1
Swedish Health Care
Rachel Kohlway
HCS 400: Dr. Lewis
Alvernia University

SWEDISH HEALTH CARE 2
Abstract
This paper will discuss the similarities and differences between Sweden’s health care system and
the United States’ health care system. The paper will focus on topics such as history,
organization, cost, health statistics and outcomes. The main focus of the paper will be about
Sweden and their health care services while relating them to how the United States works. The
paper will end by discussing future developments of Sweden’s health care services.

Most people only think of the United States when discussing health care. However, there
is a whole world out there providing health care to their citizens. One country, often used as a
blueprint for other countries healthcare systems, is Sweden (Swedish healthcare: All you need to
know, 2013). Sweden is a relatively large European country located between Norway and
Finland. The population of Sweden is 9.7 million people, with 15% of them being foreigners
(compared to America with over 312 million people) (Quick Facts About Sweden, 2015). In
Sweden, everyone (not just their citizens) is entitled to equal, worthy healthcare. Sweden spends
less than half of what American spends on their healthcare, based on domestic growth profit, and
still has better health outcomes, including life expectancy and infant mortality rates (Swedish
healthcare: All you need to know, 2013). As times change, Sweden is dedicated to making sure
their health care system stays current and continues to improve.
The health care system Sweden has today has been constructed from a long history of
trying to find the best solutions. The Serafimerhosptial was Sweden’s first public hospital
established in 1752. At that time, the hospital only had eight beds (Anell, Glenngard, & Merkur,
2012). Then, in 1765 in response to needing more medical facilities local authorities were
granted permission to collect resources that would be used to build more hospitals. By the 1860’s
there were around fifty hospitals in Sweden (Anell, Glenngard, & Merkur, 2012). In 1862,
county councils were developed and began taking ownership over the hospitals, however, it was
not until 1928 with the Hospitals Act that these councils became legally responsible for
providing hospital care (Anell, Glenngard, & Merkur, 2012). Also during this time county
councils began to obtain the power to put limitations on pharmaceutical companies pertaining to
cost. During the 1970’s there was a reform giving county councils legal ownership of outpatient
services as well as mental health services. During this time, doctors switched from getting paid

by a fee-for-service method to having a fixed salary, much like they have today (Anell,
Glenngard, & Merkur, 2012). Then in 1985 the council became responsible for paying private
doctors as well. Not all doctors work for the public health care system; there is a small
percentage of people and facilities that work under as a private facility. This is because Swedish
citizens can decide if they want to use the public health insurance, or if they want to have their
own private health insurance (Anell, Glenngard, & Merkur, 2012). Throughout the last twenty
years, the councils have created guidelines on cost, efficiency, value, and putting greater
emphasis on quality (Anell, Glenngard, & Merkur, 2012). A national action plan was created in
2000, supported by governmental grants, to develop better/more primary care and care for the
elderly. More recently, in 2009, decisions were made to allow new owners to run/own
pharmacies, increasing the number of pharmacies by twenty percent. Today, Sweden is focusing
on developing increased interest in “knowledge-based form of governance over health care
services” (Anell, Glenngard, & Merkur, 2012).
At the present time, Sweden’s health care system is divided into three levels; the
national/state level, the regional level, and the local level. Due to the 1982 Health and Medical
Services Act, Sweden now has a responsibility to provide access to good health care in both the
regional and local levels. The act also gives the regional and local levels greater freedom in how
they want to organize all of the health services (Anell, Glenngard, & Merkur, 2012). The
national level is charged with being accountable for the all-encompassing health care policy. The
regional level is responsible for how all of the health care is delivered to Sweden’s citizens. At
the local level, decisions about costs, tax levels, and budgets are discussed (Anell, Glenngard, &
Merkur, 2012). There are eight different agencies that govern all of the levels; national, regional,
local; to ensure proper health care is being provided. These eight agencies include the National

Board of Health and Welfare, the HSAN, the Swedish Agency for Health and Care Services
Analysis, the Swedish Social Insurance Agency, and the National Institute for Public Health
(Anell, Glenngard, & Merkur, 2012). Sweden’s health care system is also divided by whether it
is public or privately run. The publicly run is ‘universal health care’ and more commonly used.
Over ninety percent of the Swedish population use public health services. In contrast, only two
point five percent of the population use private health care services. However, they are still an
option for Swedish citizens. Private health care services consist of private health insurance,
access to care in the private division, and often times faster access to care (Anell, Glenngard, &
Merkur, 2012). The health care system in Sweden also requires all health care providers to,
“work in accordance with scientific knowledge and accepted standards of practice” (Anell,
Glenngard, & Merkur, 2012). Furthermore, they use evidence-based guidelines while providing
care, much like they do in the United States (Anell, Glenngard, & Merkur, 2012).
Compared to the United States, the structure in which Sweden runs its healthcare system
is vastly different. The Affordable Care Act of 2010 was created by the federal government, and
is run by the federal government. At the state level, individual states were able to decide how
they were going to implement the reforms found within the policy. They also decided how they
were going to expand their Medicaid program for those in poverty. Locally, at the county level,
mental health services, substance abuse services, and public health services are provided and
paid for. Both counties do have health agencies that oversee the health care given to their citizens
to keep them safe. The agencies also help make sure that every citizen is getting the best health
care possible and that the health care organizations are using evidence-based and best practices.
One big difference is that Sweden's government regulates pharmaceutical companies, where the
United States does not. This is why a medication can go up five-hundred percent in price in just

one night in the United States, but not in Sweden. Due to the fact that Sweden regulates
pharmaceutical companies they are able to regulate the price of medications so that they are
affordable for all of their citizens. This makes it easier for Sweden's citizens to abide by their
doctors’ orders because they can afford to take their medications, thus staying healthier. This
tends to be a big problem for many Americans because even if they want to better their health,
when medications are required, they often cannot afford them. This is because there are no
regulating factors when it comes to pharmaceutical prices. Something else that is similar is that
both countries have either public or privately run health care and/or insurance. Public health care
in America consists of the Affordable Care Act (which includes the health exchange market
where health insurance can be purchased), Medicaid, and Medicare. As of right now, more
Americans use private health insurance rather than public health insurance. One big difference is
that everyone in Sweden is eligible for all public health care services. In America to use
Medicaid an individual must fall below 138% of the poverty line. To receive Medicare an
individual must be 65 or older (certain diseases also qualify for Medicare). Also, to be covered
by the Affordable Care Act an individual must a legal, US citizen. In Sweden, no one is denied
health care services because of age, income, or citizenship status. Sweden believes that health
care is a right, not a privilege, and all people deserve to be covered.
Sweden believes that health care is a “public responsibility” (Anell, Glenngard, &
Merkur, 2012), so health care coverage is universal. This means that everyone in Sweden is
entitled to health care. Services included in Sweden’s public health care consist of hospital care
(both inpatient and outpatient), prescription medications, mental health care, dental for
children/young adults under the age of twenty, rehabilitation services, disability support services,
patient transport services (such as ambulance rides), home health care, and nursing home care

(Anell, 2008). Another service offered is personal injury insurance for all college students. The
coverage includes injuries that happen on campus, as well as on the drive to and from college
and home (Health care in Sweden, 2015). An additional incredibly useful service is the
Stockholm Health Care Guide hotline, known in Sweden as Vardguiden. The hotline service runs
twenty-four hours a day, three-hundred and sixty-five days a year. Vardguiden gives people
advice on health care issues including facilities to go to or providers to see. The service is able to
provide advice in a variety of different languages so that even those who are foreign will still be
able to access Sweden’s health care (Health care in Sweden, 2015). This is very different from
the United States because in America there is no twenty-four hour, year round hotline people can
call if they need medical advice. If someone has a medical question, they would have to call their
primary care physician. Even then, it may take hours or days to get a response back. If the
situation is more urgent or if a person does not have a primary care physician, they are left with
basically only two options. One, they could drive to a clinic or visit an emergency room, which
takes time and money. The other option would be to ask friends and family for advice, or even to
look up the information of the internet (which is not always very accurate). Overall, there is no
‘one stop shop’ phone line in the United States like there is in Sweden. Sweden also tries to
make it very easy for their citizens to be able to have access to health care facilities. Per county
there are one thousand one hundred primary care units and seventy hospitals. Regionally, there
are seven hospitals that have very advanced technology to be able to provide specialized care
(Anell, Glenngard, & Merkur, 2012). In Sweden, general/primary care units are centers that
provide non-urgent and non-life-threatening medical care. These are primary care
givers/physicians and specialists. Sweden also has emergency centers for urgent care. If a person
needs an ambulance, it is covered by Sweden’s public health care (Health care in Sweden, 2015).

This is very similar to how the United States health care system works. United States citizens
generally have a primary care physician, and sometimes see specialists for minor health care
issues. Emergency rooms in hospitals in the United States are supposed to be used to treat urgent
medical issues. Both countries have established medical centers along with clinics and hospitals.
One downfall that many Swedish citizens felt came along with universal health care was
long wait times to see specialists and for surgeries. Due to the overwhelming demand, Sweden
created the Health Care Guarantee of 2005 (Health care in Sweden, Sept. 2015). This guarantee
stated that after an initial health exam by their primary care physician, it should take no more
than ninety days for any patient to see a specialist or receive treatment/and or surgery. If a patient
is unable to receive what they need within the ninety-day time frame, Sweden will cover the
entire cost so the patient can see a specialist, receive treatment, or have their surgery elsewhere.
The individual counties are the ones that pay the travel fee, lodging, and the health care bills (3).
By 2013, nine out of ten citizens were able to get their health care within the ninety days. In
addition, based on a survey done in 2013, seventy-eight percent of Swedish citizens felt that they
received the health care they needed, four percentage points higher than when the survey was
done in 2006 (Health care in Sweden, Sept. 2015).
Annually, Sweden spends around nine percent of their domestic growth profit on health
care (significantly less than other industrialized countries) (Anell, Glenngard, & Merkur, 2012).
Public funding accounts for eighty-five percent of the total health expenditure, where private
health insurance only accounts for one percent, as of 2005. Out of pocket payments make up
thirteen point nine percent of the total health expenditure (Anell, 2008). Sweden’s health care is
funded mainly by taxes at the regional and local levels. Along with public funding (taxes),
Sweden also participates in a cost-sharing plan. Citizens pay SEK one hundred to one hundred

and fifty (fifteen to twenty-three dollars) per primary care visit, SEK two hundred to three
hundred (thirty to forty-six dollars) per specialist visit or emergency room visit, up to SEK eighty
(twelve dollars) per day to stay in the hospital, and citizens pays full price for prescription
medications up to SEK nine hundred (one hundred and thirty-seven dollars) a year. In a one-year
period citizens will only pay up to SEK nine hundred (one hundred and thirty-seven dollars) for
their prescription medications and SEK one thousand eight hundred (two hundred and seventy-
four dollars) for all other health care services. After a person reaches these caps, the Swedish
government will begin paying for the rest of a citizens’ health care costs. This program is set up
to be a “safety-net” (Anell, 2008) of sorts so that Sweden’s citizens do not have the burden of not
being able to afford their health care (Anell, 2008). Young adults and children under the age of
twenty are exempt from the cost-sharing program (Anell, Glenngard, & Merkur, 2012).
Sweden’s government controls health care costs in a variety of ways. One way is that
counties are legally required to set budgets annually, and must stick to them. In fact, some
countries have been fined, in the past, for raising their income tax above a certain level. This was
because it should have been set in the annual budget. Another way Sweden controls cost is by
putting limitations on pharmaceutical companies. The final way the Swedish government
controls the cost of health care is because health care providers work for the government, so they
are paid by set salaries, instead of a fee-for-service type of method (Anell, 2008).
Similarly, the United States pays for much of their health care through taxes. However,
where only nine percent of Sweden’s domestic growth profit is spent on health care, the United
States spends almost double with sixteen percent of their growth domestic profit being spent on
health care. The United States government (public health care) accounts for forty-six point five
percent of the total health expenditure, versus Sweden’s eighty-five percent. Furthermore, the

United States out of pocket costs account for fourteen percent of the total health expenditure, and
private insurance accounts for thirty percent. Out of pocket expenses are almost equal for both
countries, but where Sweden’s total health expenditure is much higher for public health care,
their private insurance is far lower than the United States. When comparing the two countries
attempts to control health care costs, Sweden seems to have a better grasp and have more support
within their government.
Overall, the citizens of Sweden tend to be fairly healthy, especially when compared to the
United States. One study done in 2011 found the five most common diseases in Sweden. The
diseases were acute upper respiratory tract infection, hypertension, a cough, dorsalgia (back
pain), and acute tonsillitis (Wandell, P., Carlsson, AC., Wettermark, B., Lord, G., Cars, T., &
Ljunggren, G., 2013). As far as disease go these are very mild and often related to allergies
(possibly caused by farmlands and lush plant life). An additional study looked at hospital stays
for chronic diseases per one hundred thousand people who are fifteen years of age and older. For
Sweden, asthma was twenty-five people, chronic obstructive pulmonary disorder was one
hundred and ninety-two people, hypertension was sixty-one people, and amputations caused by
diabetes was twelve people (Squires, 2011). Every category except for hypertension was
significantly lower than the United States numbers. When just focusing on asthma and
amputations due to diabetes the United States numbers were more than double Sweden’s, with
numbers of one hundred and twenty people and thirty-six people respectively (Squires, 2011).
When comparing Sweden to the United States based on health statistics/outcomes,
Sweden tends to have much better statistics. When looking at life expectancy at birth (both male
and female) Sweden is ranked sixteenth, where the United States is only ranked forty-seventh
(Country vs. country, 2015). Many people realize that obesity is an immense problem in the

United States, but even more so now that it is ranked first in the nation. This means that around
thirty point six percent of the United States’ population is obese. Sweden is much farther behind
at a ranking of only twenty-one, with nine point seven percent of their population being obese
(Country vs. country, 2015). Another category looked at how many physicians there were per
one thousand people/citizens. In Sweden, there are around three physicians per one thousand
people, ranking them at fourteenth. The United States is ranked thirty-first with around two
physicians per one thousand people. That is forty-three percent less than Sweden (Country vs.
country, 2015). Something else examined was the probability of citizens, both male and female,
not reaching the age of sixty. Of Sweden’s population, eight percent are said not to be able to
reach the age of sixty, giving the country a rating of forty-eight. Twelve point eight percent of
the United States’ population are reported that will not reach the age of sixty, giving America a
ranking of twenty-four. Sweden’s are sixty percent more likely to reach the age of sixty as
compared to Americans (Country vs. country, 2015). One of the final categories looked at the
quality of the health care system when it came to cost. Sweden was ranked fifth in the nation,
where the United States was ranked forty-first. That makes Sweden seventy-six percentage
higher in quality of health related to cost versus the United States (Country vs. country). A final
comparison looked at average life span. In Sweden, the average woman lives to be eighty-three
point seven years old, and the average man lives to be eighty point one years old (Health care in
Sweden, Sept. 2015), putting Sweden in the top ten nations of longest living citizens (Shah,
2014). In the United States, the average woman lives to be eighty-one point one years old, and
the average man lives to be seventy-six years old (Country vs. country, 2015). Many researchers
believe that there are distinct reasons that Swedish citizens live so long. One thought is because
of their Nordic diet. This diet has been shown to reduce cholesterol and be heart healthy,

possibly leading to a longer life. Another reason could be due to their clean environment.
Sweden is ranked number two in cleanest air, and has the cleanest water (Shah, 2014). With less
pollution affecting their lungs, it could help increase Sweden’s citizens’ lifespan. Additionally,
Sweden provides a wide-range of elderly care options, so each individual is able to get the best
possible care for them leading to longer, healthier lives (Shah, 2014). A final reason for the
longevity of Swedish citizens’ lives may be in part to their fitness-full lifestyle. One poll shows
that seven out of ten Swedish citizens exercise weekly, most saying they work out twice a week
(Shah, 2014). Not only are the citizens working out often, but they are also more likely to walk
or bicycle to work, providing them if exercise (Shah, 2014). All of these combined together may
be why the Swedish are living longer than many other nations citizens.
As Sweden looks towards the future, they hope to become even better and more precise
with their health care services. As always, Sweden continues to work on and fine tune health
initiatives already created. One thing Sweden is looking to do is be able to monitor and create
“valid performance indicators” (Anell, Glenngard, & Merkur, 2012), possibly by using new
technology options. Sweden is also looking for new learning opportunities for all health care
providers. Furthermore, Sweden is trying to find new programs designed to manage diseases.
They are also looking to change their care model so that it is designed from a patients’ view and
perspective. Finally, Sweden plans on continuing cancer research, much like the United States
(Anell, Glenngard, & Merkur, 2012). Sweden continues to push forward to create the best health
care possible for all of their citizens.

References
Anell, A. (2008, February 1). The Swedish Health Care System. Retrieved from
http://www.commonwealthfund.org/~/media/files/resources/2008/health-care-system-
profiles/sweden_country_profile_2008-pdf.pdf
Anell, A., Glenngard, A., & Merkur, S. (2012). Sweden health system review. World Health
Organization, 14(5), 1-187. Retrieved from
http://www.euro.who.int/__data/assets/pdf_file/0008/164096/e96455.pdf
Country vs country: Sweden and United States compared: Health stats. (2015). Retrieved from
http://www.nationmaster.com/country-info/compare/Sweden/United-States/Health
Health care in Sweden. (2015, April 1). Retrieved from
https://www.kth.se/en/student/studentliv/new-in-sweden/health-care-in-sweden-1.359368
Health care in Sweden. (2015, September 1). Retrieved from https://sweden.se/society/health-
care-in-sweden/
Quick facts about Sweden. (2015). Retrieved from https://studyinsweden.se/why-sweden/quick-
facts-about-sweden/
Shah, Y. (2014, May 1). 5 Reasons Sweden Is Superior When It Comes to Aging. Retrieved
from http://www.huffingtonpost.com/2014/05/27/sweden-live-longest-_n_5375229.html
Squires, D. (2011). The U.S. Health System in Perspective: A Comparison of Twelve
Industrialized Nations. Retrieved from
http://www.commonwealthfund.org/~/media/Files/Publications/Issue
Brief/2011/Jul/1532_Squires_US_hlt_sys_comparison_12_nations_intl_brief_v2.pdf
Swedish healthcare: All you need to know. (2013, March 27). Retrieved from
http://www.thelocal.se/20130327/46910

Wandell, P., Carlsson, AC., Wettermark, B., Lord, G., Cars, T., & Ljunggren, G. (2013). Most
common diseases diagnosed in primary care in Stockholm, Sweden, in 2011. Family
Practice Journal, 30(5), 506-513. http://dx.doi.org/10.1093/fampra/cmt033

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