The Swedish
Government
and SALAR in
2015–2018
implemented a
national effort to
shorten waiting
times and
reduce regional
differences in
cancer care by
introducing
cancer patient
pathways
In parallel, work on level structuring and
standardised care processes in cancer care is
ongoing. Proposals have also been submitted on
how to make the Swedish healthcare more
efficient by improving community care. In 2018,
a new law on cooperation at discharge from
inpatient healthcare was implemented. The aim
is to improve the care for those people who need
both outpatient healthcare and the assistance of
the municipal social services.
The regions have, one by one, enabled patients
to access their own patient records online.
In 2013, a new legislation on health and
medical care to foreigners who stay in Sweden
without necessary permissions as implemented.
The regions have to offer these people health and
dental care who urgently require it.
The Swedish Parliament has recently decided
to reform the training of doctors in 2020.
Could you present two/three elements on
the impact of such reforms on hospital and/
or healthcare sectors that your organisation/
country has identified?
The new Patient Act, introduced in 2015, has had
at least two noticeable effects. First of all, the new
legislation, together with the EU Patient Mobility
Directive from 2011, has widened Swedish
patients’ access to European healthcare. Since
2015, the most generous region sets the bar
concerning the patient’s rights to care and
reimbursement. If one region offers a specific
treatment, all Swedish patients have the right to
receive this care on equal conditions also in
another EU/EES member state.
Similarly, the legislation has allowed patients
to make medical appointments and have video
consultations via smartphone, personal computer
or tablet across regional borders. A healthcare
provider offering digital services can now
establish in just one region and serve the entire
country. In Sweden, each region decides on their
own patient fees, mechanisms for paying the
providers and remunerations, but because of
these new cross-border digital services, there
was a need for SALAR to adopt recommendations
concerning the level of remuneration to the
providers and uniform patient fees.
Concerning level structuring and standardised
care processes in cancer care, the Swedish
Government and SALAR in 2015–2018
implemented a national effort to shorten waiting
times and reduce regional differences in cancer
care by introducing cancer patient pathways.
These pathways aim to shorten the time
between a well-founded suspicion of cancer and
the start of the first treatment. Another goal was
to create a more equal and predictable care with
increased quality and improved patient
experience.
This national effort is monitored by following
the waiting times and patient reported experience
measures (PREMs). The measurements show high
overall patient satisfaction with the cancer care
and the national effort has also led to better
communication within and between hospitals
and regions. But so far, it has been difficult to
influence waiting times, partly due to problems
of lack of staff.
THE NETHERLANDS
Mr Sander Gerritsen
HOPE Governor, Dutch Hospital Association
Could you describe the last hospital and/
or healthcare reforms implemented in your
country in the past 5 years?
A significant healthcare reform took place in
2006. It replaced the division between public and
private insurance with one universal social health
insurance. It also introduced managed
competition as a driving mechanism. Although
this reform was initiated over a decade ago and
the principles of the new system have since then
remained intact, its stepwise implementation
continues to bring changes in the healthcare
system.
Since 2015, there is one integrated
reimbursement rate for hospital treatments. Until
then costs were claimed partially by doctors and
partially by hospitals. In the new system hospitals
claim the entire costs for the treatment. It is up to
them to distribute the money. This has led to new
forms of cooperation between the doctors and the
hospital management.
In 2015, the General Act on Exceptional
Medical Expenses, which related to long-term
care and nursing, was dismantled. The costs were
running out of control and the government
decided to act. Most of the tasks were
decentralised and became the responsibility of
the municipalities.
SWEDEN
Total current health expenditure as % of Gross Domestic Product (GDP)
General government/compulsory current health expenditure as % of total current health expenditure
Hospital current health expenditure, as % of total current health expenditure
Household out-of-pocket health expenditure as % of total current health expenditure
All hospital beds per 100,000 inhabitants
Acute care hospital beds per 100,000 inhabitants
Acute care admissions/discharges per 100 inhabitants
Average length of stay for acute care hospitals (bed-days)
Practising physicians per 100,000 inhabitants
Practising nurses per 100,000 inhabitants
23
HHE 2019 | hospitalhealthcare.com
2002
8.4%
82.2%
n.a.
16.8%
313.0
283.0
15.3
6.5
328.0
1014.0
2008 2016
8.3%
10.9%
81.9%
83.5%
38.2%
38.5%
16.9%
15.2%
281.0
234.0
255.0
215.0
15.7
14.3
6.2
5.6
374.0
427.0
1096.0
1106.0