HHE HOPE 2019 - Page 23

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