”The Swedish health care system is often considered a model for other countries to emulate, both because of its excellent outcomes compared to OECD countries and several well-developed strategies to assure and improve the quality of its health care…Sweden’s generous health care system performs well on most quality indicators.” These are some of the key takeaways from the OECD Reviews of Health Care Quality: Sweden 2013 report.
Sweden’s health and elderly care systems deserve their reputation as being among the best in the world. Yet an ageing population with growing chronic conditions and requiring more complex health services are testing Sweden’s ability to continue delivering high-quality care, according to a new OECD report.
The OECD Health Care Quality Review of Sweden says that Sweden has a larger share of elderly people than most OECD countries: 5.2% are over 80, compared to the average of 4.2%. Spending on elderly care is 3.6% of GDP, compared to an OECD average of 1.7%. The country also has the highest number of care workers per capita, and they deliver care where it is generally most wanted – at home. Seven out of ten dependent elderly people receive care in their homes.
The quality of health care in Sweden is generally good. Rates of avoidable hospitalisation for chronic conditions such as asthma (22.2 per 100 000 population) are among the lowest in the OECD (average 45.8) and 90% of people using primary care in Sweden said they were treated with respect and consideration by staff. Sweden’s quality registers, which track the quality of care that patients receive and outcomes for several conditions, are among the most developed across the OECD.
But the co-ordination of care for patients with complex needs is less good. Fewer than half of patients with type I diabetes, for example, have their blood pressure adequately controlled, with an almost three-fold variation (from 26% to 68%) across counties. Only one in six patients has had contact with a physician or specialist nurse after the discharge from hospital for stroke, again with substantial variation across counties.
Hospitalisation for uncontrolled diabetes of elderly people aged over 80 years is among the highest in the OECD, and around 1.5 times higher than in Denmark. Average length of stay in hospital after a heart attack in Sweden is less than 5 days – among the lowest in the OECD, and a sign of efficiency. However, municipalities are often not adequately equipped to manage patients coming out of hospital so soon – only around 20% of primary care doctors in Sweden report that they receive the information necessary to manage a patient within 48 hours after hospital discharge, compared to almost 70% in Germany.
Co-ordination of care between hospitals, primary carers and local authorities is becoming the biggest challenge to the continued excellence of Sweden’s health and social care system, according to the report. Central government will have to set out responsibilities very clearly, by developing standards, building the evidence base and sharing knowledge. For example, central authorities should be given a more defined role in assuring the quality of services by setting out national quality standards. Clear standards are particularly needed to underpin the new intermediate care facilities being developed by municipalities. The information infrastructure must improve by developing new indicators of quality of care provided by GPs and elderly care services. Finding ways to link across different data sources is also necessary, to allow a complete picture of an individual’s care to be built up.
The OECD Health Care Quality Review of Sweden also recommends:
- Ensuring that recent choice and competition reforms in the primary care and elderly care sectors do not fragment services for patients with complex needs
- Encouraging quality measurement and improvement in the elderly care sector by developing a vision for quality assurance of care services, with minimum quality standards, an accountability framework and a shared framework for monitoring outcomes in long-term care
- Addressing deficiencies in care after sudden disabling events such as hip fracture or stroke by better meeting patients’ expectations of care and rehabilitation after hospital discharge and strengthening secondary prevention efforts
You can find the report’s main findings and recommendations as well as the full report at www.oecd.org/health/qualityreviews.
OECD Reviews of Health Care Quality examine what works and what doesn’t in countries, benchmarking their efforts and providing advice on reforms to improve quality of health care. The country reviews will be followed by a final summary report on the lessons and good practices relevant to all governments.