Swedish healthcare is the ideal in the world, but there are still lessons to discover

In December 2013, when the OECD released its overview of healthcare in Sweden, as component of its annual overview of global wellness statistics the Swedish government was rapid to get in touch with a press conference to celebrate the truth that the report rated the outcomes of remedy in Sweden among the greatest in the planet.

Far more excellent news was added the following week, when an update of the OECD’s 2010 rankings of healthcare techniques in 19 industrialised nations noticed Sweden move up from fourth area to first.

So far, so very good. But all good items need to come to an finish. Sweden’s healthcare still has serious governance issues that want to be addressed. The OECD mentioned that the greatest challenge to continued excellence in Sweden’s wellness and social care system is the issue of co-ordinating care among hospitals, major care and local authorities – a note that will be acquainted to policymakers in the Uk and many other nations.

This criticism was, at least in component, welcome for Göran Hägglund, the minister of wellness and social affairs and leader of the Christian Democrat celebration, who has been arguing for many months that Swedish healthcare ought to be renationalised.

This is understandable from a political, if not ideological, point of view. .

Being minister for overall health and social care in Sweden is a bit like getting the puppetmaster more than 21 dolls without having strings. Healthcare is managed, and to a huge extent funded, locally, albeit inside of a statutory framework made a decision nationally.

For instance, considering that 2010, each patient has a proper to decide on in between a personal and public provider in major care. But attempts by the government to enhance choice for individuals by enabling organizations to set up clinics in main, and, more and more, in expert care all in excess of the country have often been thwarted by the autonomy of county councils, whose distinct political majorities have picked to employ government directives independently. 

In some areas, such as Stockholm, the reform to offer far more selection has been profitable, with wonderful productivity gains, shortened waiting occasions (the actual Achilles heel of the Swedish health technique) and a much more socially just distribution of assets.

In other places, perverse results have been shown, with older or chronically unwell sufferers becoming crowded out by more healthy patients in a program that strongly incentivises quick access to care.

The upside of the model is this experimental approach: it is hard to get healthcare reform proper from the start, and this way it is feasible carry out controlled experiments before rolling out a new, uniform scheme on a nationwide level. The downside is that the program will be significantly less equitable and far more fragmented.

I recognise that this must look really alien to a United kingdom audience, utilized to the prime-down NHS strategy. But the basis for the existing Swedish model harks back to a query that ought to be familiar, which is how to make a publicly-funded monopoly far more support-minded and manageable?

The philosophical starting up stage for the push to decentralise health care was to boost productivity and cost efficiency by transposing industry economic climate logic into the public sector, however not always by privatising it. This called for smaller organisational units. By shifting the concentrate from management by rule – the previous Weberian way – to management by goals, the support provider gained higher freedom to act independently, as extended as the goals have been met.

These are not poor guiding concepts. To go back to the old socialist system would, very frankly, be idiocy. If there is an worldwide trend in healthcare reform, it is to enhance autonomy, not the other way round.

But it is important to recognise that the which means of “market logic” will have to be interpreted by politicians, and implemented by public administrators, who appear to have had quite tiny contact with modern services companies. It would be crazy to assume spontaneous order to arise in the public sector.

So it is critical that Sweden acts on the OECD tips and seriously considers what function the state must play in healthcare. That could consist of making sure coordination of solutions and setting clear minimal common. Separating financing from production of healthcare would certainly enhance the situation.

Renationalising healthcare, nevertheless, would not.

Karin Svanborg-Sjövall is a journalist and author and is venture manager for welfare at Swedish thinktank Timbro. She was the keynote speaker at the Guardian Public Leaders Summit in 2013.

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Swedish healthcare is the ideal in the world, but there are still lessons to discover