Sweden: #18 in the 2021 World Index of Healthcare Innovation
Sweden, a world leader in digital health care, is experiencing a rapid rise in public health spending.
By Gregg Girvan, Mark Dornauer, and Avik Roy
Introduction
Sweden ranked 18th overall in the 2021 WIHI Analysis. In 2020, it ranked three spots higher at 15th. Interestingly, Sweden saw drops in its two best Dimensions from 2020 – Science & Technology (from 4th to 6th) and Quality (from 10th to 21st). Fittingly, for the country best known for establishing and awarding the Nobel Prize, Sweden ranked highest in the Dimension for Science & Technology.
Background
In 1982, the Health and Medical Services Act declared that Sweden’s health care system must cover all legal residents. Health insurance coverage became automatic and universal. Likewise, Sweden extended emergency coverage to all patients from the European Union, European Economic Area countries, and nine other nations with which Sweden held bilateral trade agreements.
The Act, along with other legislation, partitioned the administration of health care among Sweden’s three levels of government. Nationally, the Ministry of Health and Social Affairs crafts Swedish health policy, sets budgets, and provides grants to independent regions. Subsequently, 21 regional bodies finance and deliver health services to all Swedish residents, and 290 local municipalities care for the elderly and disabled (this includes long-term care). Notably, the regional and local bodies are guided by local priorities and are represented — collectively — by the Swedish Association of Local Authorities and Regions (SALAR).
While the Ministry of Health and Social Affairs provides national policy and regulation, SALAR plays a leading role in financing and providing health care. Most hospitals in Sweden are public. Sweden imposes caps on cost-sharing at SEK 1,100 ($120 U.S.) for health services and SEK 2,200 ($246 U.S.) for drugs per individual. Furthermore, private health insurance gained market share in Sweden over the last several years, mainly because it offered faster access to a broader range of health care services.
While Sweden’s debt-to-GDP ratio is under 40 percent, growth in health care spending rose rapidly (leading to a poor score in the WIHI Dimension for Fiscal Sustainability). Moreover, Sweden has long been a home of innovative pharmaceutical companies, including Astra AB (now a part of AstraZeneca) and Pharmacia (now a part of Pfizer). Lastly, during the COVID-19 pandemic, Sweden took the controversial path of minimizing economic restrictions, which led to a higher mortality rate than other countries but maintained its economy.
Quality
Sweden ranked 21st in the WIHI Dimension for Quality. Admittedly, this represented a ten-place slide from the year before, when Sweden sat at 10th. While Sweden earned the same ranking for the Element “Measures of Preventable Disease” (4th), it struggled during the Covid-19 pandemic and placed 24th in the Element “Pandemic Preparedness and Response.” Likewise, Sweden’s aging hospital system caused a below-average standing for the Element “Infrastructure” (26th). Lastly, Sweden ranked 18th in the metric for “Patient-Centered Care.”
Choice
Sweden ranked 23rd in the WIHI Dimension for Choice. While it ranked 10th in the Element “Access to New Treatments,” Sweden was weighted down by below-average showings in the Elements “Affordability of Health Insurance” (20th) and the “Freedom to Choose Health Care Services” (19th).
Science & Technology
Sweden performed exceptionally well in the Dimension for Science & Technology at 6th overall. Accordingly, each Element in the Dimension hovered around this overall standing. Sweden’s “Medical Advances” ranked 7th, its “Scientific Discoveries” ranked 8th, and its “IT” adoption ranked 6th.
Fiscal Sustainability
Sweden struggled in the WIHI Dimension for Fiscal Sustainability, ranking 27th overall. The Swedish economy remained strong and maintained a low debt-to-GDP ratio, which allowed Sweden to rank 7th in the WIHI Element “National Solvency.” However, Sweden struggled in the two Elements measuring aggregate public health spending (“Public Health Care Spending” at 29th) and the rate of growth for public health spending (“Growth in Public Health Spending” at 31st).
