Analysis Looking to Europe

Will Swedish healthcare reforms affect equity?

BMJ 2009; 339 doi: (Published 22 December 2009) Cite this as: BMJ 2009;339:b4566
  1. Bo Burstrom, professor
  1. 1Public Health Sciences, Karolinska Institute, Stockholm SE 171 76, Sweden
  1. bo.burstrom{at}
  • Accepted 21 October 2009

Sweden is introducing large scale market reforms, patient choice, and privatisation into its healthcare system. It is unclear whether it can also maintain its good record on social equity, says Bo Burstrom

Sweden’s healthcare system is a central part of the country’s comprehensive welfare state. Although the Ministry of Health and Social Affairs provides policy guidelines, implementation is decentralised to the 21 regions or county councils. Resources come largely from local taxes, although there are some central government grants and about 15% is raised from patient fees. Current legislation emphasises equity,1 but health and welfare reforms over the past few years have substantially changed the system, and there is concern that health inequalities will rise.

Health system performs well

Sweden spends around 9.1% of its gross domestic product on health care,2 and the system compares well with that of many other countries, in terms of costs, distribution of services across the country, and health outcomes.3 4 In one study comparing countries in the Organisation for Economic Cooperation and Development (OECD),5 Sweden had the lowest rate of avoidable mortality, a measure sometimes used to evaluate the performance of healthcare systems. Public satisfaction in Sweden is similar to that in the United Kingdom.6

Life expectancy at birth was 82.9 years for women and 78.7 years for men in 2006, and infant mortality was 2.5 per 1000 live births in 2007.7 The risk of dying from myocardial infarction has been almost halved (down by 44% among women and by 48% among men) over the past 20 years, and the risk of dying from stroke has fallen by one third. Smoking rates have dropped from 27% in 1988-9 to 15% in 2004-5 among men.7 Although obesity has been rising, increases in type 2 diabetes and cardiovascular mortality are not yet evident. …

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