Sweden: #15 in the 2020 World Index of Healthcare Innovation
Sweden, a world leader in digital health care, is experiencing a rapid rise in public health spending.
By Gregg Girvan, Mark Dornauer, and Avik Roy
Introduction
Sweden ranked 15th overall in the 2020 World Index of Healthcare Innovation, with a score of 47.40. It performed strongest in Science & Technology (49.72, #4), as befits the country best known for awarding the Nobel Prizes, and is notable for its high utilization of digital health care technology.
While Sweden’s debt-to-GDP ratio is a manageable 39.6%, growth in health care spending is rising rapidly, leading to a poor score for Fiscal Sustainability (39.98, #27). During the COVID-19 pandemic of 2020, Sweden has taken the controversial path of minimizing economic restrictions, leading to a higher mortality rate than peer countries but possibly a faster exit from the lockdown phase.
Background
Sweden has long had a centralized, socialized health care system. In 1982, however, the landmark Health and Medical Services Act devolved management of health care to 12 county councils; locally, 290 municipalities provide care for the elderly and disabled. The Swedish Association of Local Authorities and Regions (SALAR) provides guidance to both of these areas.
In essence, while the national health care system provides regulation, supervision, and some funding, most of the responsibility for financing and providing health care falls to SALAR. Most hospitals in Sweden are public as well. Sweden imposes caps on cost-sharing at SEK 1,100 ($120 U.S.) for health services and SEK 2,200 ($246 U.S.) for drugs per individual.
Private health insurance is gaining market share in Sweden, because it offers faster access to a broader range of health care services. Sweden has long been a home of innovative pharmaceutical companies, including Astra AB (now part of AstraZeneca) and Pharmacia (now part of Pfizer), along with mid-sized companies like Swedish Orphan Biovitrum.
Quality
Sweden’s overall quality metric ranked 10th. Sweden does an excellent job of measuring preventable disease (4 of 31), and patient satisfaction is generally high. However, Sweden’s single-payer system makes patient-centered customer service difficult to access, rendering a subcategory ranking of 21st.
Choice
The Swedish health system scores well on offering access to the latest technological advances (8 of 31) but overall ranked in the bottom half of choice (20th). In particular, the affordability of health insurance remains an issue, as Sweden ranked 22nd within the subcategory.
Science & Technology
Sweden performed exceptionally at overall innovation, ranking 4th. Not only were its medical and scientific innovation metrics high, due to multiple Nobel winners and patents in these respective fields, but Sweden’s nationwide EHR adoption was extraordinary and 1st overall.
Fiscal
While Sweden excelled in overall innovation, it struggled in long-term fiscal sustainability (27th). In particular, its public health spending per capita and growth of health care as a share of GDP each ranked 27th as well. While its debt-to-GDP ratio ranked 12th, it was not enough to offset the overall subcategory ranking.
