THE HONG KONG POLYTECHNIC UNIVERSITY MSc' In Management Health Services

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THE HONG KONG POLYTECHNIC UNIVERSITY
MSc. In Management (Health Services)
Current Issues in Health Services Management MGT
557

• Healthcare Systems Reform in Tax based Systems
  in Sweden
• Problem 1 What are the existing major problems
  and challenges confronting the country?

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Group Members

• Cho Lai Shan, Doris 04703507G
  
• Kwong Pui Man, Monica 02715793G
• Lam Ka Yin, Katherine 05412738G
• Lo Chi Yung, Owen 03700833G
• Siu Chun Bong 03705299G
  
• Tam Fung Kit, Sandy 04717905G

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Location of Sweden
Source www.sweden.se
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Sweden Export
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Capital of Sweden-Stockholm
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The Presentation Outline

• The country and its people
• Demography
• Household structure and family
• Economy
• Health status
• Life expectancy
• Main causes of death
• Life style
• Health Care system
• Problem and challenges

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Demographic Data

• Area 450,000 sq Km (53 forests, 11
  mountains), 400 times of H.K.
• Population 9 million (people concentrated
  mainly in the coastal regions and the south),
  1.3 times of H.K.
• population 65 years over 23.2
  (higher proportion of elderly)

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Demographic Data (contd)

• Annual population growth rate 0.2
• Currency 1.0 HKD 1.00772SEK
• Dependency ratio (per 100)
  54
• (0-15yr gt65yr / 15-65yr)
• Total fertility rate
  1.6

Source WHO, The world health report 2005
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Social Value

• A strong sense of solidarity and social
  cohesiveness
• Social gradient is small
• Collectivism in orientation
• Confidence in the civil service and respect for
  Government policies

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Household structure family

• Private household
• About 2.1 persons per private household
• Lowest size in the EU.
• 30 couples without children
• 40 one-person household (Highest percentage in
  the EU)

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Consequences

• Longer life expectancy of female
• As a result, households often consist of single
  elderly women.
• Health and wellbeing of them living alone, they
  can be significantly affected by available
  financial resources.
• Social exclusion may also result in isolation
  which can threaten mental health.
• Affect the costs in the health care organization.

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National health accounts indicators (2002)

• Total expenditure on health as of GDP
  9.2
• Total expenditure on health per capita
  US2,489
• GDP per capita
  27,271
• General government expenditure on
• health as of total general government
• expenditure
  13.5
• General government expenditure
• on health as of total expenditure on health
  85.3
• Private expenditure on health as of
• total expenditure on health
  14.7

Source WHO, The world health report 2005
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• Health Status

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Life expectancy at birth M/F 78/83
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Health resource utilization (1)
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Health resource utilization (2)
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Main Causes of Death

• Main causes of death
• Cancers are the most frequent cause of death
  under the age of 65 years, followed by
  Cardiovascular diseases.
• At 1-14 years, both sexes have the lowest
  age-specific death rate among the EU countries.
• At 15-34 years, women and men still have the
  lowest overall mortality observed at that age in
  the EU.

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The Cause of the Death (contd)

• At 35-64 years, men have the lowest age-specific
  total death rate. Women have some potential for
  improvement lies in reducing mortality from
  cancer.
• At 65 years and over, the total age-specific
  death rate is the second lowest among the EU for
  women and the third lowest for men.

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Health Care System
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3 levels of Governance in the Swedish Healthcare
system

• National
• County Council regional unit
• Municipality local unit

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(1) National

• Responsible for health principles, policies and
  legislation
• Administration of national health insurance
• Transfer state grant to County Councils and
  municipalities

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(2) County Councils

• 21 County Councils cover geographical areas
• County Councils play a dominant role in Swedish
  healthcare
• Responsible for financing, management and
  delivery of healthcare services
• Scope including primary care, hospital care,
  dental service, public health, health promotion
  and preventive care

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County Councils (contd)

• Majority of hospitals are owned by County
  Councils
• Healthcare totally dominates the tasks of County
  Councils, accounting for more than 80 of their
  total expenditure

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(3) Municipalities

• There are 290 Municipalities
• Provide social services, home care service and
  nursing homes
• Care for the disabled and long term patients
• Care for elderly

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(3) Municipalities (contd)

• Provision of education, housing, street, road
  network, communication and transportation, water
  and energy supply, cultural affairs and leisure
  activities.
• May levy taxes on their population to finance.

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Health care delivery model
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Primary Health Care

• Aim of improving general heath and treats
  diseases and injuries which do not require
  hospitalization.
• Clinics for child which offer free of charge
  vaccinations, health checks and consultation to
  children under school age and
• Maternity clinic which offer regular check-ups to
  expectant mother

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General practitioners

• Sweden has one of the lowest ratios of GPs per
  1000 population (0.5) in the EU. (OECD 1995a).
• Most GPs work in the primary health centers, some
  are in private practice and under contract with
  the county councils.
• Patients has the freedom to choose their GP and
  to change their GP at any time.

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Primary Dental care

• Free dental care to children and young people up
  to the age of 19 by county councils
• For adults, dental care exceeding a cost of SEK
  700 in any one year is subsidized by public
  dental insurance

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Primary health care nurses

• District nurses tasks comprise nursing care,
  health promotion and disease prevention as well
  as health education.
• They have professional responsibility for their
  independent work, and they also follow
  physicians advice.
• Offer on site medical treatment and home visit.

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Community pharmacists

• All pharmacies are owned by Apoteksbolaget (AB),
  a state owned company, so that all pharmacists
  working in community pharmacies are state
  employees.
• The prescription charge for the first item on any
  one prescription is 170 SKr.
• 70SKr for each additional item.

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Hospital Care

• Inpatient care beds per 1,000 population 2.4
• Access to hospital services is normally assured
  by referral from a GP, but this is not obligatory
  and many patients go to a hospital directly.
• General hospitals are divided into three
  categories.
• i) 9 regional and teaching hospitals are
  administered by their local county councils but
  their activities are regulated by agreement
  between all the county councils making up the
  region.

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Hospital Care (contd)

• ii) 28 central county hospitals are large
  institutions comprising 15-20 specialties and
  also serve as district hospitals to their
  immediate neighborhood.
• iii) 56 district hospitals are smaller but have a
  minimum of four specialties internal medicine,
  surgery, radiology and anesthesiology.

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Private Sector

• Few private hospitals (only wealthy people able
  to afford)
• Less than 10 of physicians work full-time in
  private practice.

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Funding for the Swedish Health Care System

• Healthcare is mainly funded through taxes
• 87 from income tax (average 10.71 of income)
• 9 grants from central government
• 4 from patients fees
• Scanty amount from private insurance

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Scanty from private sector
Central government
Patients fee
Income tax
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Funding in hospital

• 1. Global budget
• 2. Case-costing system
• 3. Diagnosis-related group (DRG)

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Local Income Tax

• In 2004, local income tax averaged 31.5 of
  taxable income
  (i.e. County Councils 10.71 municipality
  20.79 )
• The highest was 34.04 and the lowest 28.9

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Patient fees

• GP visit 100 150 SEK
• Specialist visit 180 300 SEK
• Inpatient care 80 SEK per day
• High Cost Protection Program annual capping of
  patient fees (annual ceiling for outpatient care
  900 SEK)
• Drug Benefit Scheme subsidies with a per annum
  cap (annual ceiling for pharmaceuticals 1800
  SEK)
• No fee for children under 20

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Major problems and challenges

• Increasing medical expenditure
• Aging population and longer life expectancy
• Heavily rely on public healthcare sector
• Lack of competitive provider market
• No gate way ?does not usually need a referral to
  obtain specialist care
• Insufficient institutional care, slow expansion
  of home help services
• Resources allocation

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Major problems and challenges (contd)

• Protecting the patient choice and care guarantees
  such as the introduction of the Guarantee of
  Treatment in January 1992, which stipulated that
  every patient should be treated within three
  months of being diagnosed.

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End