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The renewal of the Swedish healthcare system

Göran StiernstedtHelsinki 3rd of October 2013

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Why renewal?

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Local self-government

• Municipalities and county councils/regions are responsible for much of the public services

• Strong local self-government

• Right to levy taxes on incomes and charge users for their services

• Municipal/county/regional councils elected every four years

Regional and local authorities

• 20 county councils/regions – population between 126 000 and 2 091 000 inhabitants

• 290 municipalities – population between 2 400 and 864 000 inhabitants

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Problems

Efficiency Access Equality Integration Structure

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Problems

Efficiency

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Open comparisons

Started 2006 Annual Open – media and public 169 indicators 2012

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Overall indicators

Mortality, avoidable hospitalisation Drug therapy Confidence and Patient experience Availibility Costs

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Indicators

Pregnancy, Childbirth

and Neonatal Gynaecological Musculoskeletal Diabetes Cardiac Stroke

Kidney Cancer Psychiatry Surgical

interventions Intensive care Other

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Open comparisons – the paradigm shift

”This is the first time my boss has asked me about anything else but money”

Analysis of success factors

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HbA1c>73 mmol/molPercent

Not För Jämtland, Värmland och Västerbotten föreligger sannolikt metodproblem för HbA1c . * Andel patienter med har ett blodtryck över 150/80 mm Hg Källa: Nationella Diabetesregistret Årsrapport 2013, Health Navigator-analys

Blood pressure >150 mm Hg*Percent

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18161514130

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Halland

Jämtland

Jönköping

KalmarKronoberg

NorrbottenSLL

Sörmland

Uppsala

Värmland

Västerbotten

Västernorrland Västmanland

VGR

Örebro

Skåne

Blekinge

Dalarna

Gotland

Gävleborg

Östergötland

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Success factors

Focus on target values Differentiate follow-up. Focus on patients

with problems Diabetes always on the agenda Careful follow-up and feedback Work with improvement within the

organisation

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Access – wait, queues

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Legislation – max. waiting time

< 1 day primary care telephone

< 7 days primary care visit < 90 days specialist care <90 days for operation

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Access

Agreement between government and county councils since 2008

110 mill euro/year County councils reimburshed

according to performance

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Agreement

>70% <60 days for vistit to specialist care

>70% <60 days for operation

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Waiting time guarantee - receiving treatment < 90 days

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Queue Billion - receiving treatment

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Waiting time guarantee - consulting a specialist< 90 days

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Queue Billion - consulting a specialist

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Integration

Integrated care for elderly Health care from 21 county councils Supportive care from 290

municipalities 3-4% of population Approx 50% of resources

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Integrated care

Agreement between government and county councils since 2010

130 mill euro/year County councils and municipalities

reimburshed according to performance

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Agreement - reimbursement

Use of quality registers Indicator for avoidable hospitalisation

(>65 y) Indicator rehospitalisation <30 days

(>65y) Indicator for use of drugs – improper dugs

(>75y), antpsychotic drugs (>65y), antiinfammatory drugs, NSAID (>75y)

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2010 2012 07 01 – 2013 06 30

Täckningsgradsutveckling Palliativregistret >=65 år

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No. Of registrations in BPSD

Den 19/8-13: 8 810 personer registrerade

17 732 registreringar

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2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

2010 dec

2011 dec

2012 dec

2013 jan

2013 feb

2013 mars

2013 april

2013 maj

2013 juni

2013 juli

Antal patienter

Antal registreringar

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Unsuitable drugs for elderly

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Antipsychotic drugs

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Antiinflammatory drugs

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Structure

Centralisation Decentralisation – integrated

care

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Structure Peniscancer - 80 cases/yr 30 hospitals 5 hospitals >4 patients/yr

Oesophagus cancer – 650 cases/yr 250 – operated for cure 19 hospitals 8 hospitals <4patients/yr 2 hospitals >10 patients/yr

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Structure

Colonca Today - 40-50 hospitals Tomorrow – 10-20 hospitals

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Structure

Increasing demand on national co-ordination

Coordination of information technology

Coordination of treatment strategies Insufficent equality of outcome Insuffficent cost-effectiveness Overload of political input?

Regional and local authorities

• 20 county councils/regions – population between 126 000 and 2 091 000 inhabitants

• 290 municipalities – population between 2 400 and 864 000 inhabitants

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Structure

Regional reform like in Denmark or Norway?

Do we need county councils? Committee on the subjects above?

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Thank you!