Anell Anders, Glenngård Anna H, Merkur Sherry
Lund University School of Economics and Management.
Health Syst Transit. 2012;14(5):1-159.
Life expectancy in Sweden is high and the country performs well in comparisons related to disease-oriented indicators of health service outcomes and quality of care. The Swedish health system is committed to ensuring the health of all citizens and abides by the principles of human dignity, need and solidarity, and cost-effectiveness. The state is responsible for overall health policy, while the funding and provision of services lies largely with the county councils and regions. The municipalities are responsible for the care of older and disabled people. The majority of primary care centres and almost all hospitals are owned by the county councils. Health care expenditure is mainly tax funded (80%) and is equivalent to 9.9% of gross domestic product (GDP) (2009). Only about 4% of the population has voluntary health insurance (VHI). User charges fund about 17% of health expenditure and are levied on visits to professionals, hospitalization and medicines. The number of acute care hospital beds is below the European Union (EU) average and Sweden allocates more human resources to the health sector than most OECD countries. In the past, the Achilles heel of Swedish health care included long waiting times for diagnosis and treatment and, more recently, divergence in quality of care between regions and socioeconomic groups. Addressing long waiting times remains a key policy objective along with improving access to providers. Recent principal health reforms over the past decade relate to: concentrating hospital services; regionalizing health care services, including mergers; improving coordinated care; increasing choice, competition and privatization in primary care; privatization and competition in the pharmacy sector; changing co-payments; and increasing attention to public comparison of quality and efficiency indicators, the value of investments in health care and responsiveness to patients needs. Reforms are often introduced on the local level, thus the pattern of reform varies across local government, although mimicking behaviour usually occurs.
瑞典的预期寿命很高，在与以疾病为导向的卫生服务成果和护理质量相关的比较中表现出色。瑞典卫生系统致力于确保所有公民的健康，遵循人类尊严、需求与团结以及成本效益原则。国家负责总体卫生政策，而服务的资金筹集和提供主要由郡议会和地区承担。市政当局负责照顾老年人和残疾人。大多数初级保健中心和几乎所有医院都归郡议会所有。医疗保健支出主要由税收资助（80%），相当于国内生产总值（GDP）的9.9%（2009年）。只有约4%的人口拥有自愿医疗保险（VHI）。使用者付费占医疗保健支出的约17%，对就诊、住院和药品收费。急性护理医院病床数量低于欧盟平均水平，瑞典在卫生部门分配的人力资源比大多数经合组织国家都多。过去，瑞典医疗保健的致命弱点包括诊断和治疗的长时间等待，以及最近不同地区和社会经济群体之间护理质量的差异。解决长时间等待问题仍然是一项关键政策目标，同时还要改善就医渠道。过去十年最近的主要卫生改革涉及：集中医院服务；将医疗保健服务区域化，包括合并；改善协调护理；在初级保健中增加选择、竞争和私有化；药房部门的私有化和竞争；改变共付费用；以及更加关注质量和效率指标的公开比较、医疗保健投资的价值和对患者需求的响应。改革通常在地方层面推行，因此改革模式因地方政府而异，不过模仿行为通常会出现。
