What do you know about What do you know about Sweden? Sweden?

To measure Quality and To measure Quality and Efficiency in Health Care – a Efficiency in Health Care – a national perspectivenational perspective

12 th of April 2012Mona Heurgren

Head of UnitUnit for Development of Efficiency and Quality

StudiesThe National Board of Health and Welfare

AgendaAgenda• The Health Care System in Sweden • Developing and publishing public reporting on

quality and efficiency- aims and strategies- results - ongoing work• Effects and influences of public reporting

Swedish Health CareSwedish Health Care• The Swedish health care system is mainly

public owned and financed by taxes• Sweden has a decentralized health care system

with 20 county councils with a high degree of autonomy

• The counties both finance and manage health care • The government stipulates the laws•Sweden spends about 10% of the GDP (average in

the OECD countries)•Patients co-payments are low, about 4%

The Governments Focus on The Governments Focus on Quality and EfficiencyQuality and Efficiency

Ongoing projects:Ongoing projects:

• National Strategy on Public Reporting• Regional Comparisons of Efficiency and Quality and

performance assessments in all sectors• Improving and implementing the National information

infrastructure• National Guidelines in Health Care and other

evidence based medicine• Focus on access, care of elderly and mental health

Systematic reviews of evidence-based

knowledge

Regulations, National Guidelines & priorities

Nationwide follow-up, public reporting,evaluation & supervision

Local and regional management & systematic work on improvement

Follow-up & analysis at local & regional levels

Good Care

A National Strategy for Knowledge A National Strategy for Knowledge management of Good Caremanagement of Good Care

• Evidencebased• Safe• Patient centered• Timely• Equal• Efficient

Terminology, Definitions

SnomedPrimary Classifications

Medical journalsCost data

Quality indicators

Aim: Improve Quality and EfficiencyThe ice berg

Laws & Regulations

National Patient Registers

National Quality Registers

Presentations, web

Public Reporting

Information on Costs, waiting times

DRGs

Reimbursement models

Personal identification numberPersonal identification number• All Swedish citizens have a unique personal

identification number, given to the person at birth• The personal identification number has a general

use, and is also used in every contact with Health care

National data sources in SwedenNational data sources in Sweden

• Individual case data – all inpatients and physician visits in the National Patient Register

• National registers on Cause of deaths, Cancer cases, Births and all Prescribed drugs

• Case-costing data– national database• National Quality Registers (around 70)• Waiting list database, patient satisfaction surveys• National DRG-system - NordDRG

Public reporting in SwedenPublic reporting in Sweden

Social sector: Children and Youth, Economical support, Care for elderly, Care for disabled and dysfunctional, Abuse and dependence

Health Care sector annual,special edition on Cancer 2011

Performance Assessments to national Guidelines(Heart care, stroke, psychiatry and Cancer)

Aims• To encourage the providers and management of

health care to improve performance• Report on the achievement of the counties in

terms of quality and efficiency for better transparence

• To improve the possibility to audit and evaluate ... in both Health care and the Social sector

Regional comparisons of Regional comparisons of Efficiency and QualityEfficiency and Quality

• The work started in 2005. Six reports have been published (two in English)

• A joint project between the National Board of Health and Welfare, The Swedish Association of Local Authorities and Regions and the County Councils

• The indicators reflect many perspectives of health care and will in the future cover all sectors of health care

• 173 indicators where published for year 2011

Perspectives of QualityPerspectives of Quality1. Medical quality2. Access3. Patients experience4. Costs and efficiency

Socio- Economic dataSocio- Economic data

Development Development over timeover time

Comparisons on county levelComparisons on county level

Has the work had any impact?Has the work had any impact?• Yes, most of the measured indicators have

improved over time• Status to be published in the report, a change of

thinking – has improved transparency • Focus of quality - Quality issues are much more

discussed and debated on all political levels• Favorable press – high impact on national and

local press over 80 articles in 2011 • All counties have an organization for working with

regional comparisons and how to use the results

SummarySummary• Since most of the health care in Sweden is decentralized

and public financed we need to find ways to continuously evaluate the quality in the health care system

• One way to evaluate if the system is to compare performance from many different perspectives on international, national and local levels

• The other way is to evaluate health care from existing national guidelines and other evidence based knowledge

• The focus must bee on access to data and a discussion about the idea of quality

• Publishing data has a great impact on behavior

On the webbOn the webb• All results from published public reporting in

health Care and Social Care per county and in some of the cases per hospital

• All published performance assessments• A library for the published indicators• Some of the reports are translated in English• News and articles

www.socialstyrelsen.se/english

ThankThank You! You!