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Structural patterns in Swedish health policy: a 30-year perspective

Published online by Cambridge University Press:  31 July 2014

Richard B. Saltman*
Affiliation:
Professor of Health Policy and Management, Emory University, USA
*
*Correspondence to: Richard B. Saltman, Professor of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, Georgia 30338, USA. Email: [email protected]

Abstract

This perspective reviews key institutional and organizational patterns in Swedish health care over the last 30 years, probing the roots of several complicated policy questions that concern present-day Swedish decision-makers. It explores in particular the ongoing structural tension between stability, on the one hand, and the necessary levels of innovation and dynamism demanded by the current period of major clinical, technological, economic, social and supranational (EU) change. Where useful, the article compares Swedish developments with those in the other three European Nordic countries as well as other northern European health systems. Sweden’s health sector evolution can provide valuable insight for other countries into the complexity involved in re-thinking tradeoffs between policies that emphasize stability as against those that encourage innovation in health sector governance and provision.

Type
Perspectives
Copyright
© Cambridge University Press 2014 

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References

Alesina, A. and Giavazzi, F. (2008), The Future of Europe: Reform or Decline, Cambridge, MA: MIT Press.Google Scholar
Andersson, G. (2014), Personal communication, 19 March.Google Scholar
Anell, A. (2011a), ‘Choice and privatization in Swedish primary care’, Health Economics, Policy and Law, 6(4): 549569.CrossRefGoogle ScholarPubMed
Anell, A. (2011b), ‘Hälso och sjukvårdstjänster i privat regi’, in L. Hartman (ed.), Konkurrensen konsekvenser. Vad händer med svensk välfärd [The consequences of competition. What is happening with Swedish welfare?], Stockholm: SNS, 181214.Google Scholar
Anell, A., Glenngard, A. H. and Merkur, S. (2012), Sweden: Health System Review. Health Systems in Transition Series, Volume 14 No. 5, Brussels: European Observatory on Health Systems and Policies.Google Scholar
Atun, R. and McKee, M. (2005), ‘Is the private finance initiative dead?’, British Medical Journal, 331(4): 792793.CrossRefGoogle ScholarPubMed
Bruce, A. and Jonsson, E. (1996), Competition in the Provision of Health Care: The Experience of the US, Sweden and Britain, London: Ashgate Publishing Company.Google Scholar
Calltorp, J. (2012), Personal communication, 18 September.Google Scholar
Department of Finance (2003), Health Service Reform Program, 18 June, Dublin.Google Scholar
Edwards, N. (2011), ‘England’, in R. B. Saltman, A. Duran and H. W. F. Dubois (eds), Governing Public Hospitals: Recent Strategies and the Movement Toward Institutional Autonomy, Brussels: Observatory Studies Series No. 25. European Observatory on Health Systems and Policies, 113140.Google Scholar
Fagerstrom, C. and Willman, A. (2012), ‘Sweden’, in N. Genet, W. Boerma, M. Koimann, A. Hutchenson and R. B. Saltman (eds), Home Care across Europe: Current Structure and Future Challenges, Volume I. Observatory Studies Series No. 27, Brussels: European Observatory on Health Systems and Policies, 272279.Google Scholar
Ferriman, A. (1999), ‘Dobson defends use of PFI for hospital building’, British Medical Journal, 319(275): 1.Google Scholar
Genet, N., Boerma, W. and Rissanen, S. (2012), ‘Finland’, in N. Genet, W. Boerma, M. Koimann, A. Hutchenson and R. B. Saltman (eds), Home Care across Europe: Current Structure and Future Challenges, Volume I. Observatory Studies Series No. 27, Brussels: European Observatory on Health Systems and Policies, 8697.Google Scholar
Genet, N., Boerma, W., Koimann, M., Hutchenson, A. and Saltman, R. B. (eds) (2012), Home Care across Europe: Current Structure and Future Challenges, Volume I. Observatory Studies Series No. 27, Brussels: European Observatory on Health Systems and Policies.Google Scholar
Harrison, M. and Calltorp, J. (2000), ‘The reorientation of market-oriented reforms in Swedish health-care’, Health Policy, 50(3): 219240.CrossRefGoogle ScholarPubMed
Hutchinson, A. (2012), ‘England’, in N. Genet, W. Boerma, M. Koimann, A. Hutchenson and R. B. Saltman (eds), Home Care across Europe: Current Structure and Future Challenges, Volume I. Observatory Studies Series No. 27, Brussels: European Observatory on Health Systems and Policies, 6778.Google Scholar
Johansson, L. (1997), ‘Decentralization from acute to home care settings in Sweden’, Health Policy, 41(Supplement): S131S144.Google Scholar
Jonsson, P.-M. (2014), Personal communication, 16 April.Google Scholar
King, S. D. (2010), Losing Control: The Emerging Threats to Western Prosperity, London: Yale University Press.Google Scholar
King, S. D. (2013), When the Money Runs Out: The End of Western Affluence, London: Yale University Press.Google Scholar
Landstingsforbundet (1991), Vagval: Halso och Sjukvardens overgripande structure och framtiden [The Pathway: Health care’s overall structure and future], Stockholm: Landstingsforbundet.Google Scholar
Martinussen, P. and Magnussen, J. (2009), ‘Health Care Reforms: The Nordic Experience’, in J. Magnussen, K. Vrangbaek and R. B. Saltman (eds), Nordic Health Care Systems: Recent Reforms and Current Policy Challenges, Maidenhead, UK: McGraw-Hill Education, 2152.Google Scholar
Mollstedt, B. (1983), Personal communication, 15 April.Google Scholar
Mor, V., Leone, T. and Maresso, A. (2014), Regulating Long Term Care: An International Comparison, Cambridge, England: Cambridge University Press.CrossRefGoogle Scholar
Ohrming, J. (1990), Kvarters Akuten, Stockholm: Arbetslivscentrum.Google Scholar
Olejaz, M., Nielsen, A. J., Rudkobing, A., Birk, H. O., Krasnik, A. and Hernandez-Quevado, C. (2012), Denmark: Health System Review. Health Systems in Transition Series, Brussels: European Observatory on Health Systems and Policies.Google Scholar
Oliver, A. (2007), ‘The Veterans Health Administration: An American Success Story’, Milbank Quarterly, 85(1): 535.Google Scholar
Oliver, A. and Mossialos, E. A. (2005), ‘European Health Systems Reforms: Looking Backward to See Forward?’, Journal of Health Politics, Policy and Law, 30(1–2): 728.Google Scholar
Palm, W. and Glinos, I. (2010), ‘Enabling Patient Mobility in the European Union: Between Free Movement and Coordination’, in E. Mossialos, G. Permanand, R. Baeten and T. K. Hervey (eds), Health Systems Governance in Europe, Cambridge, UK: Cambridge University Press, 509560.CrossRefGoogle Scholar
Rechel, B., Wright, S., Edwards, N., Dowdeswell, B. and McKee, M. (eds) (2009), Investing in Hospitals of the Future. Observatory Studies Series No. 16., Brussels: European Observatory on Health Systems and Policies.Google Scholar
Ringard, A., Sagan, A., Saunes, I. S. and Lindahl, A. K. (2013), Norway: Health System Review. Health Systems in Transition Series, Volume 15 No. 8, Brussels: European Observatory on Health Systems and Policies.Google Scholar
Robinson, R. and LeGrand, J., (eds) (1994), Evaluating the NHS reforms, King’s Fund, London.Google Scholar
Roos, K., Hultin, H., Bengtsson, J., Johansson, H., Stenstrom, O. and Brogren, P.-O. (2014), Tankesmedjan Natverket for Halso-och Sjukvard, Lakaretidningen, Stockholm. (forthcoming).Google Scholar
Saltman, R. B. (1992), Patientmakt over varden [Patient Power over Healthcare], Stockholm: SNS Forlag.Google Scholar
Saltman, R. B. and von Otter, C. (1987), ‘Re-Vitalizing Public Health Care Systems: A Proposal for Public Competition in Sweden’, Health Policy, 7: 2140.Google Scholar
Saltman, R. B. and Bergman, S. E. (2005), ‘Renovating the Commons: Swedish Health Care Reforms in Perspective’, Journal of Health Politics, Policy and Law, 30(1): 253276.Google Scholar
Saltman, R. B. and Bankauskaite, V. (2006), ‘Conceptualizing Decentralization in European Health Systems: A Functional Perspective’, Health Economics, Policy and Law, 1(2): 127147.Google Scholar
Saltman, R. B. and Cahn, Z. (2013), ‘Re-structuring health systems for an era of prolonged austerity’, British Medical Journal 2013; 346: f3972.Google Scholar
Saltman, R. and Vrangbaek, K. (2009), ‘Looking Forward: Future Policy Issues’, in J. Magnussen, K. Vrangbaek and R. B. Saltman (eds), Nordic Health Care Systems: Recent Reforms and Current Policy Challenges, Maidenhead, UK: McGraw-Hill Education, 78104.Google Scholar
Saltman, R. B., Duran, A. and Dubois, H. W. F. (eds) (2011a), Governing Public Hospitals: Recent Strategies and the Movement Toward Institutional Autonomy, Brussels: European Observatory on Health Systems and Policies.Google Scholar
Saltman, R. B., Calltorp, J. and de Roo, A. (2011b), Health Sector Innovation and Partnership: Policy Reponses to the New Economic Context, Paris: DELSA/HEA Organization for Economic Cooperation and Development (OECD), 17.Google Scholar
Saltman, R. B., Vrangbaek, K., Lehto, J. and Winblad, U. (2012), ‘Consolidating National Authority in Nordic Health Systems’, Eurohealth, 18(3): 2125.Google Scholar
Serner, U. (1980), ‘Swedish Health Legislation: Milestones in Re-Organization Since 1945’, in A. J. Heidenheimer and N. Elvander (eds), The Shaping of the Swedish Health System, New York: St. Martin’s Press, 99118.Google Scholar
SOU (2007), 10 Ansvarskommitténs slutbetänkande – Hållbar samhällsorganisation med utvecklingskraft. Stockholm.Google Scholar
SOU (2012), 33. Gor Det Enklare! Slutbetankande av Statens Vard och Omsorgsutredning. (Make it Simpler! Final Report of the Government Investigation on Health and Social Care), Stockholm.Google Scholar
Stockholm County (2013), New Karolinska Solna, Stockholm, http://www.nyakarolinskasolna.se/en/The-New-Hospital [30 May 2014].Google Scholar
Sundhedsstyrelsen (2009), Evaluerings rapport forloebsydelsen for diabetesomsorg in almen praksis, Copenhagen.Google Scholar
Voipio-Pulkki, L.-M. (2013), Personal communication, 13 December.Google Scholar
Vrangbaek, K. (2012), Personal communication, 21 April.Google Scholar
Vuorenkoski, L., Mladovsky, P. and Mossialos, E. A. (2008), Finland: Health System Review. Health Systems in Transition Series, Volume 10 No. 4, Brussels: European Observatory on Health Systems and Policies.Google Scholar
Winblad, U. and Ringard, A. (2009), ‘Meeting Rising Public Expectations: The Changing Roles of Patients and Citizens’, in J. Magnussen, K. Vrangbaek and R. B. Saltman (eds), Nordic Health Care Systems: Recent Reforms and Current Policy Challenges, Maidenhead, UK: McGraw-Hill Education, 126150.Google Scholar
Winblad, U. (2014), Personnal communication, 21 May.Google Scholar