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US Sweden Healthcare Systems

US Sweden Healthcare Systems

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Published by Gail Watt

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Published by: Gail Watt on Dec 06, 2010
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12/06/2010

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2010-08-01Hi …….!Here are my comments to your "conservative" friend. Remember that I am writing as aSwedish conservative politician - active member of the leading party in the present governingcoalition since 2006. We won that position after the social democrats had held the politicalmajority at the national level in 65 of the previous 72 years. Btw, ……, I am still a UScitizen, not a Swedish citizen. Non-Swedish citizens can vote and hold office here at the localand county level. Health care in Sweden is primarily a county responsibility, but a municipalresponsibility for in-home care of the elderly and functionally disadvantaged. The nationalgovernment is involved, of course, but the systems are primarily funded by county andmunicipal taxation.Clearly we Swedish "conservatives" are constantly reforming our health system, but in noway revolutionizating (a word?) the basic fundamentals. We are making pragmatic changesthat lead to more free choice, encouraging even more "private" actors to become operatives inthe one-payer system, streamlining the health care bureaucracy, and investing heavily in ITsupport - all cost effectiveness measures. We are also in the process of privatizing the medicaldrug distribution system. In our one payer system (everyone is free to buy additionalcomplementary insurance or choose to pay totally from their own pocket for totally "private"health care –yes, we do have totally "private" hospitals which also work on contract for the public system) all pay about 10% of their taxable income to the "public" system which provides over (I'm guessing a bit) 95% of the country's health care. In other words, we havea pay according to your ability system that most Americans might call socialistic. Anindividual here pays above that 10% tax rate, a maximum of $250. per year on drugs and $15. per doctor visit. Our dental system is not a part of what I describe here. It has its owninsurance system.Hope you don't mind if I share all this with some political colleagues even more directlyinvolved in health care management than I. My area of political responsibility is with theschool systems. Now to the specific comments to your friend (my comments in italics)
Subject: Re: Health Care Comment from Swedish friendSweden's health care system offers two lessons for the policymakers of the United States.The first is that a single-payer system is not the answer to the problems faced asAmericans. Sweden's system does not hold down costs and results in rationing of care.
 Hopefully we have more than 2 lessons for the US policymakers. However, of course, eachnation must find its own solutions based on its own experiences.Obviously I think the single-payer system with complementary private plans is the right way for the US to go - efficient and predictable revenue intake. Holding costs down is then a function of the political system that is accountable to the people at the election booth and between elections by intensive debate - and with health care being always a primary interest f the voter, the politicians should be under real pressure to deliver cost effective service - muchmore so that totally private actors, I would argue, where the pressure is and perhaps should be always on for higher and higher salaries-bonuses-profits. An American conservative
 
argues that holds costs down. A Swedish conservative says "not necessarily" .Certainly the Swedish system of central medical drug purchasing and freer use of generics isholding those costs in check. Remember we are paying only about 9% of GNP to the system,half of what the USA is paying. Yes, you could call the Swedish health system as a rationing  system, but so is the American in which private insurance companies and employers aremanaging the rationing. I would suggest the Swedish system, therefore, has moreaccountability built in, to say the least.
 
The second lesson is that market-oriented reforms must permit the market to work.Specifically, government should not protect health care providers that fail to providepatients with a quality service from going out of business.
 A Swedish conservative has no trouble with this. And even a lot of the modern social democrats would have no problem with that. A number of "more market oriented reforms" have in fact been put in place by the earlier social democratic majority governments. Sincethe Swedish system more and more is putting health care providers (including the government run providers) into competitive bidding, we are strengthening the positives of the so called "market" while we try to diminish the negatives. And while on the "market" issue, I would like to make one more point. Health care in myworld can never be an "insurance" issue. Something like 70-80% of all medical costs occur in the last 2-3 years of our lives.... a very predictable event. Insurance is for unpredictableoccurrences where a collective of payers share the risk for the unpredictable. To me healthcare is a fundamental social right, managed as such and paid for by all more or lessaccording to their ability to pay. To me that is pragmatism, not socialism or any other "ism" that conjures up a lot of "hot" feelings among people.
Researchers studying Swedes waiting for hip or knee replacement concluded that"almost every aspect of daily life is affected by the indeterminate wait for surgery andthe related experiences of pain and disability.
 
We now have a 3-month care guarantee in place which means if that or any other operation/treatment is not underway, the patient can go to another county where their carecapacity might be more for just that treatment/operation and could thus treat quickly. The"home" county then pays the treating country for the procedures. There are a number of other reforms that have reduced the "popularity" of clinics to run "wait lists" - so popular during the social democratic years - that also use more market oriented mechanisms toimprove health facility and personal usage. While we can always improve, we think we havedone a lot to keep the "pain and disability" level as low as possible. In a small country wherewe have an easier time to measure cause and effect than you do in the USA, we also see that we are more quickly getting people off the "sickness income insurance system" and morequickly back to being taxpayer than was the case earlier.
While rationing may permit the government to save on costs and thereby restrain healthcare budgets, putting patients on waiting lists is not cost-free. One study that examinedover 1,400 Swedes on a waiting list for cataract surgery found that 5.2 million kronaswere spent on hospital stays and home health care for patients waiting for surgery. Thatwas the equivalent of what it would have cost to give 800 patients cataract surgery.

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