Transcript Paul Hunt - Friedrich-Ebert

Health Care system on equal terms and
according to need –
Swedish case
Dr Ilija Batljan,
Mayor, Municipality of Nynäshamn;
Researcher, Aging Research Center, Karolinska Institutet and
Stockholm University;
Former Chief Analyst, Ministry of Health and Social Affairs, Sweden
[email protected]
Agenda, Mars 12th
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Introductory overview
Swedish Health Care system ACCORDING TO
NEED
Infants/Maternity care, an example
Supervision and Quality
Swedish policy for the elderly & Long-term care
Conclusions
Some demographic
information, Sweden
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Population: 9 million
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Population density: 20 persons/km2
Ca 85 % of population lives in
the cities
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The share of population 65+: 18%
estimated to grow to 25 % by year 2050
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The democratic system in Sweden
Local government
National government
Elections to the parliament
The parliament elect prime minister
who create the government
Elections to the municipality (city) council
The municipality council elect the board
Regional government
Elections to the county council
The county council elect the board
21 county council
290 municipalities
Organisation of Health
Care services
Three political and administrative levels:
State
20 County Councils
290 local authorities
Ministry of Health and Social Affairs
+ 1 local authority
(municipalities)
Responsible for organising, offering
and providing health and medical
services to all residents
Responsible for care of elderly and
disabled
Central government agencies
Legislation
Supervision
Evaluation, follow-up
Promoting good public health
Support for people suffering from
long-term mental illness
Ministry of Health and
Social Affairs (Health Care Unit)
National Board of
Health and
Welfare
Medical Products
Agency
Council on
Technology
Assessment in
Health Care
National Medical
Responsibility
Board
Pharmaceutical
Benefits Board
* Legislation
* Policy,
permittance
* Supervising
* Follow-up/
evaluation
* Financing
The Swedish Association of
Local Authorities and Regions
20 + 1
Councils
- 6 Medical
care regions
- 9 Regional
hospitals
~ 70 County
hospitals
~ 1 000 Health
centres
290
Municipalities
- Institutional
housing and
care facilities
for the elderly
and disabled
* Financing
* Organisation,
cooperation
* Provisioning
* Follow-up,
evaluation
Health is Wealth
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Health is not equally distributed,
Large differences in health status (socioeconomic disparities) exist between
population groups within countries. These
may be partly caused by barriers in access to
needed services that affect disadvantaged
populations disproportionately (OECD 2005).
Wealth is not equally distributed
Health is Wealth
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Wealth is not equally distributed
The outcome of financial and other barriers
(as the impact of user fees on lower-income
groups, differences in insurance coverage
across the population, and so on) can be
poorer health, which further fuels economic
isolation and social exclusion.
Pour Wealth = Pour Health
Investment in health = Large benefits for both
individual and society (WHO 2001)
National “targets” for
Swedish Health Care
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Health care should be provided to all citizens
on equal terms and according to need,
be under democratic control,
financed on the basis of solidarity
and, as far as possible, provided in
consultation with the patient.
The Health and
Medical Services Act
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Sets out the responsibilities of County Councils
and Municipalities towards their residents
Give County Councils and Municipalities
considerable freedom regarding how to organise
and provide their health care services
Is a framework that works together with other
legislations on health care;
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Health professionals, Pharmaceuticals, Social Services Act, Dental
act, Psychiatric legislation, etc
Sales of
Centr.
Governm. Operation &
Pharmaceut. Services
6%
Grant
Centr. 10%
Governm.
Transfers
6%
Centr.
Governm.
Conditional
Grants
2%
Other Grants
& Incomes
2%
Tax income
71%
Patient fees
3%
Low co-payment
How much is paid per visit?
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District nurse, 8-10 Euro
General practitioner, 13-15 Euro
Specialist doctor, 25-30 Euro
Max 100 Euro per 12-moths.
Pharmaceuticals – CO-PAYMENT
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You pay 100% until 100 Euro
Next step is 50%, then 25%, then 10%, when you
are up to 200 Euro = 0%
Max 200 Euro per 12-months.
Infant mortality / Maternity care
Infant mortality
 Well-developed and successful work at
Maternity and Childcare Centres
 Infant mortality decreased by 50 %
between 1984 and 1994
 Today, 3 deaths per 1 000 newborn
(third place globally after Iceland and
Japan)
Maternity Care
 An integrated part of the healthcare
system, free of charge
 Provides medical examinations,
pregnancy monitoring and parental
advice for mothers
 More than 95 percent of all pregnant
women participate in these
programmes
Supervising and Followup/evaluation = Quality
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Health care systems have quality problems.
Across OECD-countries, there is a large and
expanding bank of evidence of serious
shortcomings in quality (examples: services
are provided when, according to medical
practice standards, they should not be or
people who could benefit from certain basic
services do not always get them. (OECD
2005))
Supervising and Followup/evaluation of Health Care
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Better supervision and follow-up contributes
to
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Strengthening the patient’s position
Improving patient’s safety
Supervising and Follow-up/evaluation system
is very important. It must be independent
based on sound research evidence.
Supervising and Followup/evaluation of Health Care
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In Sweden: Increased monitoring by the
National Board of Health and Welfare and
the Medical Products Agency
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Increasing importance when private-public
mix.
Low coverage = High cost
Private insurance (like US case) may lead to
double burden (costly for individuals and for
society
- 40-50 millions Americans do not have access
to health care insurance
-US has highest health care expenditures
 The increasing health care cost and ageing
population are often cited as reasons for
health care reform
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Ageing Population and Health Care Expenditure =
Health care Reform?
14
United States
13
% GDP on Health
12
Switzerland
11
Germany
10
France
Canada
9
Australia
8
Sweden
Denmark
Japan
Spain
7
Finland
Ireland
6
5
10
11
12
13
14
15
16
% Population Over 65
17
18
19
Long term care is an important
challenge
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An already old population is growing even older
 a demographical challenge…
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People need protection against the risk of incurring
large expenses for long-term care.
According to OECD, different approaches can work,
such as tax-funded in-kind services (as in Sweden
and Norway) or mandatory public insurance (as in
Luxembourg, Netherlands and Japan), and a mix of
public and mandatory private insurance (as in
Germany).
Swedish policy for
the elderly - The Social Services Act
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Long-term care for the elderly is mainly financed out of
taxation revenue and responsibility for achieving the
objective is divided between three levels of government.
At the national level, the Parliament and the Government
set out policy aims and directives by means of legislation
and economic steering measures.
At the regional level, 21 county councils are responsible
for the provision of health and medical care.
Finally, at the local level, since 1 January 1992, Sweden’s
290 municipalities are comprehensively responsible for
long-term service and care for the elderly and people with
disabilities.
Swedish policy for
the elderly - The Social Services Act
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The Swedish system for service provision to the elderly is
extensive and can be divided into special housing
accommodation (institutional care) and home care.
Support programmes for family caregivers (respite and
relief services, support and educational groups for carers
and economic support for caring). Swedish municipalities
have also the statutory responsibility to provide assistive
devices according to the needs in the elderly population.
In the case the elderly stay at acute care or geriatric
hospitals after the medical treatment is completed, the
municipalities have to pay to the county councils for that
care.
Swedish policy for
the elderly - Funding and expenditure
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The largest part (above 80%) financed by taxes
levied by the municipality from its residents. A
smaller part of the elderly care is financed by
state grants directed to the municipalities.
About 4 % of the costs are finances by fees. The
fees are often related to assessed needs and
income.
In 2006 municipal expenditure on caring services
for the elderly amounted to 2,7 % of GDP
The biggest item of expenditure concerns caring
services in special housing accommodation.
Conclusions
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Health is wealth
Health care should be provided to all citizens on
equal terms and according to need, financed on the
basis of solidarity (trying to avoid “tax on disease”)
Low co-payment
All citizen’s confidence in the health care sector is
important
Minimize mixing private-public
Develop supervision and follow-up
Long term care is a challenge
THANK YOU
HVALA
Ilija Batljan,
Mayor
+46 8 520 681 72
[email protected]
http://www.nynashamn.se