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The Swedish Health Care System
Pages and Files
History and Origins of Sweden's Health Care System
The Organization and Delivery of Care
Financing of the Swedish Health Care System
A Comparison of Health Outcomes--The United States and Sweden
Lessons from Sweden
Lessons from Sweden
Lessons for the United States
There is little debate that the American health care system is in need of reform. Indeed, the current system uses expensive health plans to pay for inefficient, uncoordinated care that has made racial and income disparities in access and health outcomes the status quo.
Insured Americans are subject to moral hazard and thus tend to overuse care; under- and uninsured Americans tend to delay or forgo preventative care. If the moral argument against such inequality does not speak strongly enough for the need for reform, the financial repercussions certainly do: By 2015, an estimated one in five dollars will be spent on health care, which will take away from other government-funded programs like national defense and public education. And, with Americans’ equation of new technology with quality health care, the spending trend is not predicted to letup.
The vast majority of Americans—about 85%—are insured, making it difficult to reform a system that, to the insured, appears to be working. In order to develop the best possible plan for the American people—one that will reduce costs and appease the majority—Washington should examine other countries' health care models to learn which aspects of the systems work well and which do not. As a county that has incorporated a unique combination of socialized and privatized care, Sweden offers several policies for U.S. health care reformers to consider:
Offer protection for Americans against bankruptcy from catastrophic illness.
Sweden’s Health and Medical Services Act of 1982 specifies that public or government-contracted hospitals that provide inpatient or long-term psychiatric care and/or provide disposable articles (mentioned previously) may not charge patients so much that “the charges… amount to so much that the individual does not retain sufficient of his charge base to cover personal needs and other normal living costs” and so the “spouse or partner of the care recipient… incur[s] an oppressive impairment of his or her financial situation” (1:XXVI). Furthermore, Sweden has a cost-ceiling so that no individual must pay annually more than $131 for medical care and/or more than $263 USD for prescription drugs.
According to the 2007 Commonwealth Survey of Health Insurance, of low-income Americans about half pay more than 10% of their annual income on out of pocket costs and premiums; indeed, health costs present a much greater burden on low-income individuals than for high-income individuals. The problem is that low-income individuals who have health care needs cannot necessarily defer care. As a result, one of the leading causes of personal debt in America is medical indebtedness.
Admittedly, implementing a medical expense cap in America would be very difficult to do in America, since it would likely increase taxes and/or decrease the “quality” of health care in the form of prioritized allocation of care and/or lessening the availability of technologically-advanced treatments. If such a law was to have a chance of being passed, policymakers would have to convince the insured majority of their moral obligation to provide for the common good of the country. Given that America has failed to such socialist-type reforms in the past largely because of America's emphasis on the individual over the common good, it is difficult to say whether enough public support could be gathered in favor of such a reform.
Implement a proportional—as opposed to a regressive—health care tax.
Sweden’s central and local governments cover 81.7% of Sweden’s total health care expenditures; the government is able to cover so much of the cost because medicine is socialized in Sweden. Citizens are required to pay into a health care fund that gets divided among the county councils and municipalities in order to maintain uniform health care standards throughout the country.
As stated previously, the majority of Americans are insured and are therefore generally not strong supporters of health care reform. One of the big fears associated with health care reform is the thought of introducing “socialized” medicine to democratic America. According to public opinions polls from October 2009, 84% of Americans are in support of health care refo
rm in general; however, support drops dramatically—down to about 38%—when a specific proposal for reform is introduced, as the majority of Americans believe they will be worse off personally under a plan designed to give Americans better access to health care. Democracy and capitalism is so deeply embedded in the American tradition that Americans are not interested in paying more to cover those who cannot afford to pay themselves. While a health care tax will not be popular—as Americans are traditionally also resistant to government regulation and taxation—a flat rate tax for all Americans may appear “fair enough" to the people so as to win support. Unfortunately, implementing yet another tax will pose a greater burden on low-income individuals; although, the reality is that the voting majority is the wealthier, insured citizens.
If the United States levied a health care tax to subsidize care and equalize care throughout the country like Sweden, access to health care would increase and it is possible that out-of-pocket spending would decrease, thereby lessening the cost burden currently experienced by low-income individuals.
Emphasize regional health care centers.
Sweden has a limited number of regional care centers, which house the specialists and the high-end medical technology. This helps limit health care costs, as all of the costly equipment and specialists are concentrated in just a handful of areas throughout the country. Thus, Sweden does not have the same problem as the United States where every area hospital may own a million dollar MRI that sits unused for half of the day. The regional hospitals in Sweden guarantee that any costly equipment in which the country invests is well used. Additionally, since all of the specialists concentrated at just a few hospitals, the specialists stay busy, constantly practicing their trade. This helps the physicians truly perfect their skills, which improves patients’ outcomes.
While perhaps not as organized as Sweden’s regional care system, America has hospitals that specialize in particular ailments and physicians who specialize in specific treatments. The problem is, however, that these centers are heavily concentrated in only a few areas of the country; therefore, Americans do not have equal access to specialized services. America would benefit from establishing the equivalent of Sweden’s regional care centers at regular intervals throughout the country and from closing the centers that are not widely used. This would promote access to health care, allow physicians’ to gain more expertise in their fields, and thus, provide Americans with better care overall.
Increased spending does not translate to better health.
Based on the statistics
from both countries, Sweden's
health care system appears to be more effective. The
difference in infant mortality rates between the United States and Sweden is
outrageous. Although the United States has a high premature birth rate which would tilt the statistics, they have a rate that is more than double Sweden's. Although some areas were not too different such as the tobacco consumption and cancer population, Sweden's health approach seems to be better because they have some improvement statistics on their side. From 1960 to 2005 their cancer population decreased more than the United States and it originally had a higher rating. One area in which the United States seemed to have better data was the suicide rates, but even that was not a major difference in numbers. Based upon statistical data, Sweden's health care system should be a model for the United States. The major lesson to be learned by the United States is Sweden's money management. They have lower ratings in the major health care categories and they spend less. While Sweden is spending less and being more healthy than the United States, the U.S. is spending double and not getting better results. Also, the life expectancy in Sweden is longer even though they spend less money; therefore, more spending does not always mean better results.
Possibility of Implementing Similar Plan in the United States
One of the key elements in the United States' health care system is the strong establishment of private industries in the health care (e.g insurance companies and hospitals). If the Swedish system was proposed as a possible alternative to the current system it would pose a serious threat to these private industries, primarily insurance companies. However, the possibility that such proposals would be implemented is slim to none. These private industries would never agree to a system that is funded primarily by the local government, and due to their strong lobbying powers, they could prevent such legislation from occurring. Along with industries medical association have strong lobbying powers as well. In fact, the American Medical Association, in the past, has exerted its lobbying powers to thwart legislation for universal coverage.
Even if legislation could be passed, implementing such a plan would not be wise, especially for the current state of our economy. First of all, these private industries, most predominantly health insurance companies, have a large stake in the stock market. Their removal from the market, which would more than likely result from such legislation, would be detrimental to the already damaged condition of our economy. To make matters worse it would increase the unemployment rate as a result of these companies shutting down, leaving many previous employees without work in an economy where a good job is hard to come by.
Even more importantly though, Sweden's government funded "private" market has been as inefficient if not more inefficient than the United States' private market in health care. The system has failed to function as a private market should as competition between health care providers for patients is weak and more importantly a faltering provider is not allowed to shut down. Many counties have resorted to the older system of health care, where government owns health care facilities providing all the necessary funding. Thus, despite problems with the private market in the United States, it would be unwise to implement a plan that has major problems of its own. If a lesson could be taken from this, it would just provide another example of how free market cannot function properly in the health care industry.
Financial Difficulties With Implementing a Swedish-Style Health System in the United States
Although the Swedish health care system is so effective, it comes with a high price. The taxes imposed on Swedish citizens are some of the highest in the world. These taxes do alleviate the costs of health care that would otherwise have to come from out of pocket. With Americans already unhappy with taxes in the United States, implementing a health care system based on higher taxes would not be popular with the public. One of the largest problems faced by health care reformers in the United States is opposition from those who do not want to lose their private health care. Those in Sweden do not have to worry about private health care, as health insurance is covered by the government. Those against health care reform in the United States argue that private industry could not possibly compete with the government and its low-cost health plan. While the upfront costs may be much less, Americans will be sure to pay the difference in higher taxes. This is not something that is feasible in the state of today's economy, where unemployment hovers around 10
. Until the American economy becomes more stabilized, extreme changes will not be possible in the United States health care system.
We see that Swedish citizens are happy with their health care system and are accustomed to the high taxes. To dramatically raise taxes would financially hurt many Americans, as we are not accustomed to relatively high taxes. Also, the largest question, if a similar system were to pass in the United States, is who would regulate the system? Would it be a wholly nationalized system, or a divided county system like Sweden's? With states essentially representing Swedish counties, there is already a similar structure. Federal support to states would need to be greatly increased to make this program work. All of these reform ideas are also coming at times where federal money to states is being cut, because both the Federal and state governments are in need of increased capital. Ultimately, from a financial standpoint, a health care system modeling Sweden's would not be the best fit for the United States.
Barr, Donald A.
Introduction to U.S. Health Policy: The Organization, Financing, and Delivery of Health Care in America
. Baltimore: The Johns Hopkins University Press, 2007.
Blendon, Robert J. and Benson, John M. “The American Public and the Next Phase of the Health Care Reform Debate.” 2009.
Core Health Indicators
. 2008. World Health Organization. 4 Dec. 2009 <
Commonwealth Fund 2007 Survey of Health Insurance
Your Money of Your Life: Strong Medicine for America’s Healthcare System
. New York: Oxford University Press, 2004.
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