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03 February 2025 | Country Update
Investment in increased care capacity and shorter waiting times -
28 November 2024 | Country Update
An efficiency delegation for the regions is being established -
31 May 2024 | Country Update
A strengthened waiting time guarantee to shorten the queues in specialized care -
10 January 2024 | Country Update
Parliamentary committee will investigate a full or partial state principalship of healthcare
6.2. Future developments
With a view towards future health care challenges including the growing burden of disease, resource and staff shortages, accelerating health-tech development, and increased expectations from patients and the population, stakeholders in Swedish health care largely agree that overall health system efficiency and effectiveness need to increase. Ongoing attempts to develop and strengthen primary care are seen as an important contribution to this end, together with innovative changes to the delivery of health care services more generally. At the same time, decision-makers are pressed by acute problems in terms of staff shortages, waiting times and limited inpatient capacity. In contrast to the general agreement on the overall challenges, opinions vary on what needs to be done more specifically, including the preferred form of governance at national and local levels.
In contrast to Denmark and Norway that have strengthened the role of the national government in different ways, the overall governance model in Swedish health care has not yet been changed. The advantages of developing six to 10 regions, and the role of the national government and parliament in relation to regions and municipalities, have been debated throughout the new millennium. In 2016, a government commission suggested a new organizational map that contained six regions (SOU, 2016:48), but the national government decided not to proceed with this suggestion. Minor changes have been made over the period in terms of merging national agencies. Following the COVID-19 pandemic, national agencies, as well as regions and municipalities, have been criticized by a government-initiated commission for being slow and unprepared (SOU, 2022:10).
Future developments most likely include continued discussion on a more decisive role for the national government. The number of targeted national government grants to regions and municipalities has increased in the last decade, for example, focusing on improved access to care (several grants), improved coordination and continuity, mental health, chronic diseases and women’s health. Although frequently used, such grants have been criticized for being an inefficient form of development support both recently (AHCSA, 2022d) and in the past (Riksrevisionsverket, 2003; Statskontoret, 2014). The regions through SALAR often take the position that government grants should be general and linked to areas or programmes that may not be compatible with regional priorities.
Problems related to waiting times persist, in part related to experiences of a poor work environment by health care staff, which causes both recruitment and retention problems (see section 4.2.2 Trends in the health workforce). From some quarters, and from one of the conservative parties, suggestions have been made to replace the decentralized model with a national health system. The new centre-right government that came into office following the 2022 elections has promised to initiate an investigation with the objective to propose a transfer of responsibilities from the regions to the national level. However, the present political landscape at the national level and in the parliament, and the fact that municipal self-government constitutes part of the constitution suggest that centralization reforms for the foreseeable future will probably have to favour incremental rather than radical change. Similar to the national level, local governments in many municipalities and regions involve alliances between parties that are unlikely to support radical changes, including additional steps towards privatization and choice in major cities.
Increasingly, governance and management models that support innovative changes and enhanced health system efficiency are called for. Innovative changes include taking advantage of digitalization opportunities. In this area, the growth of private digital health care providers is likely to spur a continued debate about how these providers can be further integrated into the health system to ensure that guidelines for needs-based priorities and cost-effectiveness are met. Additional topics discussed are how governance and management can support collaboration across regions, and an integration of the National System for Knowledge-driven Management with existing principles of governance and management in each region. An additional theme likely to fuel the future debate involves complaints about the increased administrative workload and failing and non-integrated digital systems, not least from physicians. These themes will also be fuelled by a need to ensure working conditions that can attract and retain human resources.
Authors
The government sees a need to support the regions in the implementation of measures to handle structural changes and improve the overall efficiency of the healthcare sector. The government, therefore, intends to establish a temporary efficiency delegation for healthcare, with the task of examining applications for state subsidies in order to strengthen efficiency in the healthcare sector. The purpose of the delegation is to support regions in the implementation of structural measures to make their operations more efficient. Regions will be able to apply for funds.
The efficiency delegation will be responsible for the grant decisions and will prioritize the measures that are deemed to fulfill the purpose to the greatest extent. The delegation shall, among other things, assess whether the measures for which grants are sought are suitable for fulfilling the purpose of strengtheningthe efficiency of healthcare or whether there are more appropriate measures. The delegation must also spread good examples of efficiency measures and, if necessary, propose measures to increase efficiency. For the delegation’s work and contribution to efficiency measures, the government intends to set aside SEK 250 million per year from 2025 to 2028. The regulation on temporary state subsidies is proposed to end at the end of 2030.
Authors
Swedish healthcare is generally of high quality, but long waiting times and large regional differences have been a problem for a long time. In recent years, waiting times have continued to increase, and the statutory waiting time guarantee has never been fulfilled since its introduction in 2010.
In May 2024, the government decided to conduct an inquiry to analyse and propose a new and strengthened waiting time guarantee. The new guarantee for specialized care must be based on the patient’s needs and have significantly shorter time limits than today’s 90 days to the first visit and 90 days to treatment (after a decision). Patients must also be given the opportunity to receive care earlier than today from a healthcare provider outside their own region, at no extra cost to the patient. In cases where the waiting time guarantee is not fulfilled, investigators must also analyse and submit proposals for measures that supervisory authorities can take against the principals, without imposing financial sanctions on the region or extra costs for the patient. The investigation must also map the need for continuity and coherent care and make suggestions on how patients can gain access to fixed medical contacts in relevant parts of specialized care.