Sweden: #8 in the 2024 World Index of Healthcare Innovation

Introduction 

In the 2024 World Index of Healthcare Innovation, Sweden maintained its 8th place position from 2022. The country achieved significant improvements in Quality, ascending from 3rd to 1st place. Appropriately, given its association with the Nobel Prize, Sweden also excelled in Science and Technology, ranking 6th. 

Background

Since the Health and Medical Services Act of 1982, Sweden’s healthcare system has ensured universal coverage for all legal residents. The system guarantees both automatic and universal health insurance, and extends emergency healthcare services to residents from the EU, EEA, and additional countries with which Sweden has established bilateral agreements.

The Swedish healthcare system is managed across three levels of government. The national level, led by the Ministry of Health and Social Affairs, is tasked with setting health policies, budgets, and distributing grants to regions. Implementation of these policies is carried out by 21 regional bodies, responsible for financing and providing direct health services, and 290 local municipalities that manage care for the elderly and disabled. These bodies are coordinated by the Swedish Association of Local Authorities and Regions (SALAR), which also plays a significant role in healthcare financing and provision.

Sweden’s healthcare infrastructure primarily consists of public hospitals. However, private health insurance has grown in popularity, accounting for approximately 15 percent of the market, as it often provides faster access to a broader range of services. Sweden enforces caps on cost-sharing at SEK 1,150 ($125 USD) for healthcare services and SEK 2,250 ($246 USD) for pharmaceuticals per individual annually.

Despite maintaining a low debt-to-GDP ratio at around 38 percent, healthcare spending has increased significantly, constituting about 11 percent of GDP in recent years. This growth in spending has negatively affected Sweden’s Fiscal Sustainability. Sweden remains a hub for pharmaceutical innovation, historically home to companies like Astra AB (now AstraZeneca) and Pharmacia (now part of Pfizer).

In response to the COVID-19 pandemic, Sweden’s strategy of minimal restrictions led to a higher mortality rate compared to its neighbors, but helped preserve economic stability. The mortality rate during the pandemic peaked at approximately 1,400 deaths per million, higher than the average in comparable countries. In the aftermath, there has been a strategic shift towards enhancing public health preparedness and system resilience.

Sweden operates a tax-funded healthcare system where the majority of services are free at the point of use, primarily financed through regional taxes and supplemented by governmental funds. This facilitates a comprehensive service model that emphasizes equitable access and high-quality care. Approximately 85 percent of healthcare funding is sourced from public channels, reflecting Sweden’s commitment to a health system based on solidarity and equality. The system prioritizes preventive care and extensive public health measures, aiming to align closely with the nation’s health policy objectives of promoting overall well-being and reducing healthcare disparities.

Dimension Performance

Quality

Sweden achieved the top ranking in Quality, improving by two positions from the previous year. In 2022, Sweden was ranked 3rd in measures of preventable disease and improved its pandemic preparedness from 13th to 10th. Additionally, investments in hospital infrastructure elevated its ranking from 17th to 9th. Sweden also advanced to 1st in patient-centered care, highlighting its commitment to healthcare excellence.

Choice

Sweden ranks 19th in the Choice dimension, achieving moderate positions across all components within this dimension. Specifically, it places 13th in access to new treatments, driven by a high generic drug market share and high degree of coverage of essential care. It also placed 18th for the affordability of health insurance and 22nd in the freedom to choose healthcare services. Despite its single-payer system, Swedes have a wide choice of providers and affordable coverage that bolsters its standing across these elements.

Science and Technology

Sweden has shown outstanding performance in the Science and Technology sector, securing the 6th position overall. Notably, the country ranked 6th in medical advances, led by better than average performances in health care patents and the approval of new drugs. It also placed 8th in scientific discoveries, owing mostly to a high degree of cited scientific research. Finally, Sweden ranked 5th in health digitization, driven by a 100 percent electronic health record adoption rate.

Fiscal Sustainability

In Fiscal Sustainability, Sweden faced challenges, earning the 23rd position overall. Despite the Swedish economy’s strength and a commendable low debt-to-GDP ratio that earned it a 6th place in national solvency, it encountered difficulties in public healthcare spending, ranking 29th in aggregate expenditure. Nevertheless, Sweden showed improvement in the growth of public health spending, where it ranked 8th, reflecting an increase in health spending relative to GDP over time.