Transcript Health Services in Sweden Shiv Chandra Mathur Professor of Preventive and Social Medicine and Director State Institute of Health and Family Welfare,Rajasthan,Jaipur India.

Health Services in Sweden
Shiv Chandra Mathur
Professor of Preventive and Social Medicine and Director
State Institute of Health and Family Welfare,Rajasthan,Jaipur
India
Sweden
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Capital
Other large cities
Area
Population
Language
Religion
Life Expectancy
Currency
Government
Prime Minister
11/7/2015
: Stockholm
: Goteborg,Malmo,Uppsala
: 449,793 sq kms
: 9,001,774
: Swedish
: Lutherans Christians (87%)
: 80.3 years
: Krona ($1=7.79)
: Constitutional Monarchy
:Goran Persson
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Swedish Government
• Four separate constitutional documents
• Succession of King/Queen first born regardless of sex
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Political power rests with Cabinet
Ministries are small units
Parliament by direct elections
23 County administration
286 Municipalities
Fiscal year from July to June
• Nine years of compulsory education from 6-7 years of age
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Swedish Economy
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Forests, Iron ore and water power are the basis
Pulp and Paper, motor vehicles and steel industries*
GDP is around 2000 billion SEK
Labor force(16-64 years) is >half the population
• Local gov’t followed by mining/manufacturing is main labor force
• Normal statutory week is 40 hours
* ABB, Ericsson, Electrolux, Saab, Volvo account for 60% of employment and 80% of
exports of manufactured goods.
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Health Scenario
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IMR is 3.4 per 1000 LB
CV conditions account for half of all deaths
Magnitude of allergic disorders is very high
One-fifth population is 65 and above
Growing proportion of overweight children
• Mental Health, psychosomatic problems on increase
• One Physicians per 320 inhabitants
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Demographic/Social Indicators
(Source:SWPR-2005,UNFPA)
Sweden
India
0.3
1.5
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1.68
2.92
100
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Public Health
Expenditure % of GDP
7.8
1.3
Under-five mortality M/F
4/4
90/95
Average Population
Growth Rate
% urban population
TFR
% births by SBA
Access to safe water
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100%
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Year -
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Midwife Assisted Delivery
- MMR
1850
27
410
1860
37
350
1865
40
350
1870
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280
1875
55
250
1880
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190
1890
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130
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ICPD Goals
(Source:SWPR-2005,UNFPA)
Sweden
IMR
Life Expectancy M/F
MMR
Birth/1000 W 15-19
India
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78.2/82.7
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7
Contraceptive Prevalence
78
HIV Prevalence(15-49)M/F
0.1/0.0
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IMR
Life Expectancy M/F
MMR
Birth/1000 women 15-19
64
62.4/65.7
540
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Contraceptive Prevalence 15-49M/F 78
HIV Prevalence(15-49)M/F
1.2/0.6
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Family Planning in Sweden
• RFSU founded in 1934
• Sex Education compulsory part of school curriculum by 1954
• Absolute ban on abortions lifted in 1938,amended in 1946 and 1963
including socioeconomic distress and fetal disorders for legal
abortions. Legal abortions rose from 16000 in 1974 to 30600 in
1974. 93% of abortions are before 12th week of Pregnancy.
• Economic growth of sixties led to change in social attitude towards
sexuality
• 1976 sterilization act; 7’ to 10 ‘000 sterilizations every year
• 70% of sexually active couples use contraceptives; ¾ of them use
conventional contraceptives
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Child Care
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Loss of earnings due to childbirth and illnesses are compensated
Free maternity health care throughout pregnancy
Free health and dental care all through school
< 10% children start school before 7 years
Parents are responsible for their children until they are eighteen
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45 % marriages are dissolved but 80% children live with both parents
Custodial parent is guaranteed maintenance advance by other parent
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Gender Equality Policy
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Equality Affairs is part of Ministry of Labor
Women and Men are equally assiduous voters
Women make up half of the labor force
Economic independence through gainful employment for all
Measures foe women and men to combine jobs with parenthood
>40 % of 349 MP’s are women
Violence against women – a serious offence
National Centre for women victims of battering, rape
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Social Insurance in Sweden
• National Health Insurance – financed from taxation revenue and
contributions from social insurance budget.
• National Pension Insurance – elderly and disabled are provided
basic/partial pensions
• Work Injury Insurance
• Unemployment Insurance
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Management and Planning
Central Government
County Councils
Local Authority
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Central Government
• Ministry of Health and Social Affairs
• Laws and ordinances for health services
(Health and Medical Services Act 1982)
• National Board of Health and Welfare
• Swedish Council of Technology Assessment in Health Care (SBU)
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County Councils
• 23 county councils
• 60 000 – 1.8 million people
• 230 000 people employed in county council health services (7%)
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24 hour casualty department
Freedom for Patient to choose their provider
Referral system is not mandatory
Six Medical Care Regions for highly specialized care
Award financial compensation to patients who have
suffered injuries/infections during treatment
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Health Care System
Primary care system is wide and large
• Everyone has the right to choose their own family doctor i.e. GP
(Only 20% of Doctors are General Practitioners)
• Child clinics
• Maternity clinics
• Occupational health services
• School Health Services
65 Central/District County Hospitals
somatic care in a number of specialist fields
(deliberate emphasis on outpatient care)
9 Regional Hospitals
Neurosurgery, Thoracic Surgery, Plastic Surgery
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Finances
• Costs for health care services is SEK 178 billion in 2000
• 8.5% of GNP and 80% financed by county councils
• Average salary of specialist is 46 000SEK / Nurse is 22000 SEK pm
• SEK 80 per day is charged for stay in hospital
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Number of Beds for short term care fell from 4.4(1985) to 2.4 per 1000 inhabitants in
2002. Corresponding figure for psychiatric care fell from 2.5 in 1985 to 0.6 in 2001
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Pharmaceutical Preparations
• Registration of Medical Products Agency is mandatory
• 6000 registered medical preparations
• Pharmaceutical Board constituted in 2002
• Costs for drugs rose from 8%(1990) to 15%(2000) proportion
• Social Insurance Scheme provides ceiling on cost to be borne by
patient
• 900 Pharmacies nationwide under Apoteket AB
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Training
DOCTORS
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NURSES
Universities:
Lund,Gothenberg,Linkoping,Stockholm
,Uppsala,Umea
1100 students join Medical schools
every year
5 1/2 years basic training and 18
months pre-registration houseman
ship
Specialization after five years service
62 recognized specialist fields
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Three years training
30 centers
5500 students join each year
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Swedish Projects in India
• MAMTA-RFSU collaboration
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Create relevant database on key YRSHR issues
Strengthen resource and training base to capacitate stakeholders
Strengthen network of 150 NGO’s to integrate YRSHR in the state policies
Develop effective for a for global partnerships for ensuring YRSHR
• LAWYERS COLLECTIVE
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Promote awareness of HIV/AIDS related issues in different segments
Enhance capacity of legal community regarding HIV/AIDS
Advocate for change, development of the judicial response
• INTEGRATED WATER RESOURCE MANAGEMENT
AND POLICY ADVOCACY IN RAJASTHAN
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Specific Projects
• Injury Prevention (Safe Communities)
• Sexual and Reproductive Health Rights
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