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demosEUROPA
Forum ”Dialogue-Innovation-Future”.
The role of innovation in the health sector.
5 December 2007, Warsaw, Poland
The case of Sweden
Paper presented by
Stefan Håkansson, Ph.D.
Associate professor
The National Board of Health and Welfare
Stockholm Sweden
stefan.hakansson@socialstyrelsen.se
Organisation of health and medical services
Responsibility for health services is divided between the
state, 21 county councils and 290 municipalities.
The Health and Medical Services Act from 1982 give
county councils and municipalities considerable freedom to
organise their services. The state is responsible for overall
health and medical care policy.
The Swedish Association of Local Authorities and
Regions (SKL) is the body that represents the interests of
the county councils and munipalities. The Association is the
party the state negotiates with on issues concerning the
county councils and munipalities
Government agencies
• National Board of Health and Welfare (SoS)
• Medical Responsibility Board (HSAN)
• Swedish Council on Technology Assessment in
Health Care (SBU)
• Medical Products Agency (MPA)
• Pharmaceutical Benefits Board (LFN)
Aspects of ”good care”
guiding evaluation
• Safety
• Patient centeredness
• Quality
• Equity
• Effectiveness
• Care within reasonable time
Per cent
Sw
0
1
2
3
4
5
6
ed
en
I
No tal y
rw
ay
Ja
pa
Sw a Fr n
i tz nce
er
la
nd
G UK
er
m
an
y
Sp
a
Au in
st
Be ria
lg
De iu m
nm
a
Fi rk
nl
a
Po nd
rtu
ga
Ne l
th USA
er
la
Au nds
st
ra
Ca li a
n
Hu ada
ng
a
G ry
re
ec
e
Lu Ic el
Source: OECD Health Data, October 2006
x e an
Ne mb d
w o
Cz Z urg
ec ea
h la
Re nd
pu
b
Ire li c
Sl lan
ov Po d
ak la
Re nd
Population 80 years old and over in OECD 2003
pu
bl
Ko ic
re
M a
ex
ic o
Health Care Costs and GDP per Capita in OECD 1960, US Dollar (PPP)
160
USA
140
120 Schveiz
Health Care Costs
Kanada
100
Sverige Australien
80
Frankrike UK
60 Österrike
Finland Belgien
40 Italien Island Norge
Irland
Japan
20 Grekland
Spanien R2=0,94
0
0 500 1000 1500 2000 2500 3000
GDP
Correlation between GDP and health spending per capita in OECD
2002, USD/PPP
6000
5000 USA
Health spending
4000
Sw i Nor Lux
3000 Ice Can
GerFra
Sw e Ire
2000 Gre
Fin
Por
Spa R2=0,83
1000
Hun Kor
Pol
Slo
0 Tur Mex
0 10000 20000 30000 40000 50000 60000
Gross Domestic Product
Healthcare expenditure as percentage of GDP in Sweden and U.S.A.
1970-2005.
Source: OECD Health Data, October 2006.
18
USA 16,0
16
Sweden Bush
14 Clinton years
12
Percent of GDP
9,0
10
Persson
8
6
4
2
0
1970 1975 1980 1985 1990 1995 2000 2005
”Sweden’s single biggest economic problem is
the high number of people absent from work
due to sickness or disability”
Country Reviews:
OECD Economic Surveys:Sweden
June 2005, chapter 3.
The Society´s costs for all Ilnesses in 2002.
SEK billion in 2002´s prices.
Costs Women Men Total
Mortality 16 24 40
Early retirement 71 63 134
Sickness benefit 109 79 188
In-/outpatient care 87 72 159
Pharmaceuticals 16 13 29
Total 299 251 550
Source: National Board of Health and Welfare (2004) Jämställd vård?
Könsperspektiv på hälso- och sjukvården.
In comparison with OECD countries Sweden has:
Resources
• Average GDP per capita
• Average number of physicians and nurses per capita
• Few acute hospitals beds
• Average health care expenditure per capita
• Average pharmaceutical drug expenditure per capita
• Low percentage of drug expenditure of total,13% (2005)
• High public spending: 85%
Demography, Employment, Research & Development
• Highest elderly population 80 years + (Sweden 5.3%)
• High employment ratio, especially by women
• Highest spending on R&D: 4%
• Very high number of people absent from work due to
sickness or disability
Resource Utilization
• Short average length of stay
• Very few doctors’ consultation per capita
• High ratio of ambulatory surgery
• Average use of medical technologies
Number
0
2
4
6
8
10
12
14
16
Sl J apa
ov
ak n
Cz R
e c ep
hR
Hu ep
ng
ar
y
Ko
re
a
US
A
Sp
a
Be in
lg
G e iu m
rm
a
De ny
nm
a
Fr rk
an
c
Au e
s
Au tria
s tr
a
Ca li a
Lu n
x e ada
mb
ou
rg
Ita
Ic e l y
ne
the land
rl a
nd
Source: OECD Health Data, 3rd revision
Po s
l an
Ne d
w
Z e UK
al a
n
Fin d
l an
Tu d
Doctors' Consultations per capita in OECD 2002
rk
Po ey
Sw rtu
i tz ga l
er
la
Sw nd
ed
e
Me n
x ic
o
Life style factors
• Low percent daily smokers (men lowest within OECD)
• Rather low Body Mass Index (BMI)
• Relative little alcohol use
• Low calorie intake
• High level of physical excercise
• Average consumption of butter
• Low consumption of fruits and vegetables
Outcomes
• High level of life expectancy
• Low level of infant mortality
• High level of perceived good health
• Average ranking on public satisfaction (Eurostat)
• High ranking in EURO HEALTH Consumer Index 2006
• Rather good ranking regarding Aging Vulnerability
In the EURO HEALTH Consumer Index (EHCI 2006), the
scores for the five disciplines have been given the following
weights (Number of indicators within brackets):
Sub discipline: Relative weight:
Patient rights and information (10) 1,5
Waiting time for treatment (5) 2,0
Medical outcomes (6) 2,0
Provision levels (3) 1,0
Access to pharmaceuticals (4) 1,0
Total sum of weights 7,5
Index
0
100
200
300
400
500
600
700
Ne Fra
t h nc
er e
lan
Ge ds
rm
a
Sw ny
Sw ed
it z en
Lu erla
xe nd
m
b
Be urg
lgi
um
Au
st
Fi ria
n
De land
nm
ar
k
Sl It aly
ov
en
ia
M
Un al
ite Hun t a
d
Ki gary
ng
d
Po om
rtu
ga
(Maximum index value: 750)
Sp l
a
Gr in
ee
c
Cy e
pr
Es us
to
Cz ni
ec Po a
h l
Re and
EURO HEALTH Consumer Index 2006
pu
b
Sl lic
ov
ak
ia
La
Source: Health Consumer Powerhouse, Presentation in Brussels June 26, 2006
tv
Ire ia
Lit land
hu
an
ia
Strengths and weaknesses of the top 5 countries
Per cent of the maximum value. (EHCI 2006)
Sub France Nether- Germany Sweden Switzer-
discipline Lands land
Patient 79 100 71 63 75
rights
Waiting 100 73 100 47 93
Time
Medical 67 78 67 100 78
Outcomes
Provision 100 75 100 100 63
levels
Pharma- 70 100 90 100 90
ceuticals
Index
Ö
N
0
100
200
300
400
500
600
700
800
900
ed ster
er r
lä ike
nd
e
Fr rna
an
kr
i
Sc ke
hw
Ty eiz
sk
la
n
Sv d
er
ig
e
N
or
g
Fi e
nl
an
D
an d
m
ar
Be k
Lu lgi
xe en
m
bu
r
Es g
tla
n
C d
yp
e
Sp rn
an
i
Tj e n
ec
ki
en
St Irl
or
br and
ita
nn
ie
n
Ita
lie
Po n
rtu
ga
l
Source: Health Consumer Powerhouse
M
Sl al
ov ta
en
G ien
re
kl
Sl and
ov
ak
Euro Health Consumer Index 2007
ie
U n
ng
R e
um rn
än
ie
Li n
ta
ue
n
Po
Bu len
lg
ar
ie
Le n
ttl
an
d
Aging Vulnerability Index
•Fiscal Room
•Benefit Dependence
•Elder Affluence
•Public burden
Source: The Center for Strategic and
International Studies, Washington D.C., U.S.A
Aging Vulnerability Index: 2003
Source: The Center for Strategic and International Studies, Washington D.C. November 15, 2002
100
90
80
70
60
50
40
30
20
10
0
UK
A
ly
n
da
-10
ain
m
ce
lia
y
en
s
US
pa
an
Ita
d
iu
na
ra
an
ed
lan
Sp
Ja
lg
rm
st
Ca
Fr
Sw
Be
er
Au
Ge
th
Ne
The most innovative industrial
countries 2007
1. Sweden 10. Canada
2. USA 11. France
3. Switzerland 12. Irerland
4. Finland 13. Belgium
5. Denmark 14. Austria
6. Japan 15. South Korea
7. United Kingdom 16. Spain
8. Germany 17. Italy
9. The Netherlands
Source: DIW (2007)
Private enterprises operating in the Swedish health
care sector
Source. NUTEK 2007
Number 1993 2004
Private enter- 5 000 12 600
Prises
Employment 41 000 104 000
Turnover Ca 20 50
(bilion SEK)
Life science in Sweden
• Has had a strong tradition in Sweden
• Astra´s blockbuster ”Losec” and Gambro´s artificial kidneys
and Elekta´s gammaknife has treated 350,000 people in 200
units or the pacemaker that was invented in Seden
• 50 billion in export 2005
• Sweden´s competitive advantage decreasing
• Clinical trials decreased from 550 to 400 last 10 years
• Losec and Nexium sold for 6,500 million USD
• Sweden has had a top position regarding introduction of new
and effective drugs, but this position is gradually
• decreasing (SNS, 2007)
• IT or e-health in not used in a cost-effective way,
• cf NHS gigantic effort (biggest public in the world
Öresund Science Region
• Europe´s most attractive biotechnology region next to
London and Paris
• Employs 40,000 people
• World class in research in
• Diabetes
• CNS (Central nervous system)
• Stamcells
• Inflammation
• Cancer
• Bioinformatics
Value of new effective drugs
• In a study in USA 1992-2002 new drugs
explained 44% of increased survival
• In a study in 20 countries 1995-2002
30% of decreased death could be explained by
introduction of new drugs
• But in many countries government are worried
over the increased costs of new drugs
Governmental funded medical research
• During the 1990s big increase in:
USA, Canada, Norway, Finland, UK, India,
Japan and Australia.
But in Sweden has the funding decreased
by 20 %
