Sometimes described as the best in the world, Sweden’s healthcare system is facing serious governance issues that must be addressed. The primary challenge to sustained excellence in Sweden's health and social care system is coordinating care between hospitals, primary care, and local authorities. Additionally, the funding, quality and efficiency of the country’s healthcare services and the ability to accurately monitor these measures remain important challenges in Swedish primary care and an area of concern for policymakers.
Sweden’s decentralized approach can be held responsible for the country’s obstacles to achieving a more equitable and less fragmented healthcare system. This context is also problematic for pharma companies looking to gain market access as a national approval is insufficient to ensure usage and companies must pursue drug reimbursement separately for each county. To add to the plight of biomarkers in Sweden, tripartite consultation has led to price reduction of drugs being re-evaluated that were already subject to competition due to the growth of biosimilar and parallel imports.
Sweden’s ranking has also been continuously dropping in terms of hospital wait times. These long waiting times to access treatments take a serious toll on patients' quality of life. The continuing downward trend in Sweden demonstrates the inability of the Swedish government to do anything concrete about the long wait times that affect quality of care in numerous ways. In recent years, gaps in specialized care have also been noted, primarily in Stockholm County. The county councils and the Swedish Association of Local Authorities and Regions' (SALAR) have pointed to a shortage of doctors, large migration to urban areas, and an outflow of nurses from the profession as the reasons for the longer wait times. However, infrastructure shortages should not force patients into unending queues as some of Europe’s poorest countries have much shorter waiting times.
As a result of an evaluation by the Organisation for Economic Co-operation and Development (OECD) in 2013, recommendations were made to deal with the challenges faced by the Swedish Healthcare system. The government has since been carrying out measures to ensure more equitable and accessible care, especially in life threatening chronic conditions like cancer. The focus of these measures remains shortening waiting times and reducing regional disparities. With these reforms, the government pledged a budget of over US$ 55 million annually between 2015 and 2018. Further, in 2015, new legislation went into effect with the purpose of strengthening patients’ rights and enhancing patient influence in shared decision-making. The government commissioned the Swedish Agency for Health and Care Services Analysis to monitor and follow up on implementation of the new law.
The government has also introduced standardized care pathways that will result in a more coherent care process ensuring shorter waiting times as well as better informed and generally more satisfied patients. In 2016, the Swedish government and the Swedish Association of Local Authorities and Regions set aside roughly US$ 50 million as incentive funds for the county councils to introduce this system of standardized care pathways. The National Board of Health and Welfare is tasked with monitoring and evaluating these measures and submitting a final report by April 1, 2019.
Besides encouraging quality measurement, improvement in the elderly care sector, addressing deficiencies in rehabilitation after hospital discharge, and strengthening secondary prevention efforts are further areas of need by which healthcare in Sweden can be improved. Broadly, ensuring coordination of services along with setting clear minimum standards should improve the system’s standing.
The measures introduced to cope with the challenges in the Swedish healthcare system will require the continued strengthening of infrastructure and resources, both monetary and human. This should fuel increased demand for medical interventions. Moreover, a more equitable system will ease market access, which will be welcome news for players in the pharmaceutical industry.
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This blog is part of a series of posts from DRG’s global market access team examining challenges facing pharmaceutical firms in different countries in 2017. See our other blogs as they are added here (https://decisionresourcesgroup.com/tag/2017challenges/).