THE HONG KONG POLYTECHNIC UNIVERSITY MSc. In Management (Health Services)

1. THE HONG KONG POLYTECHNIC UNIVERSITY MSc. In Management (Health Services) Healthcare Systems Reform in Tax based Systems in Sweden Problem 1: What are the existing major problems and challenges confronting the country? Current Issues in Health Services Management MGT 557

2. 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

3. Location of Sweden Source: www.sweden.se

4. Sweden Export

5. Capital of Sweden-Stockholm

6. 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

7. 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)

8. Demographic Data (cont’d) • Annual population growth rate: 0.2% • Currency: 1.0 HKD = 1.00772SEK • Dependency ratio (per 100): 54 (0-15yr + >65yr / 15-65yr) • Total fertility rate: 1.6% Source: WHO, The world health report 2005

10. 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

11. 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)

12. 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.

13. National health accounts indicators (2002) • Total expenditure on health as % of GDP: 9.2 • Total expenditure on health per capita : US$2,489 • 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

19. Health Status

20. Life expectancy at birth M/F : 78/83

21. Health resource utilization (1)

22. Health resource utilization (2)

23. 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.

24. The Cause of the Death (cont’d) • 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.

30. Health Care System

31. 3 levels of Governance in the Swedish Healthcare system • National • County Council – regional unit • Municipality – local unit

32. (1) National • Responsible for health principles, policies and legislation • Administration of national health insurance • Transfer state grant to County Councils and municipalities

33. (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

34. County Councils (cont’d) • 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

35. (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

36. (3) Municipalities (cont’d) • 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.

37. Health care delivery model

38. 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

39. 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.

40. 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

41. 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.

42. 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.

43. 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.

44. Hospital Care (cont’d) 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.

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

46. 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

47. Scanty from private sector Central government Patient’s fee Income tax

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

50. 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%